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Discussion on Pupura Hemmoragica | ||
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New Member: Jimc |
Posted on Sunday, Jul 4, 2004 - 10:46 am: My 17 year old quarter horse has been sick since Labor day. He started with a decreased appetite, moving slow, and a fever of 105. The emergency vet gave him Bute and pumped some mineral oil down him. My own vet saw him the next day and started him on Tucoprim (Sulfa drug) and Bute for 5 days. He seemed to get better, then 2 days later, his legs and sheath swelled and his fever returned. The vet started him on PCN, more Bute, and Dexamehtasone (steroid) for 5 more days. His labs came back showing severe anemia with a HCT of 17 and HGB of 6.3. The vet said he had pupura hemmorhagia. Yes - he got better with the PCN and Dex and 3 days after finishing the meds, he started with a fever again. This time he got one shot of Dexamethasone and 5 days of Bute - and he got better. Two days after finishing the Bute, he swelled again, and this time his sheath swelled to emormous size and he had swelling in his neck and back. His temp spiked to 104, he could barely move, and he started coughing. His respirations and heart rate are rapid. We started him on Dexamethasone and Tucoprim again. Has anyone seen this? Also, has anyone given Naprosyn instead of Bute for fever management? How much Dex is too much, and how much Tucoprim is too much? The coggins test and west nile tests were both negative. |
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Member: Mrose |
Posted on Sunday, Jul 4, 2004 - 12:47 pm: Is your horse on pasture? What are his living conditions and what does he eat? Does he have diarrea or any other symptoms also? What part of country are you in? I'm curious, as we had similar episode, but with several horses, which started last year at almost the same time as the start of your horse's problems.Ours started with one horse, which I initially thought had a reaction to something in the field. Then, almost every horse (10 at home at that time) we had came down with similar synptoms. A couple of the younger ones had fevers only. Three of them got founder, two of them quite badly. The older horses all got swollen limbs, bags/testicles. It was very difficult to get rid of and lasted for some time-it seems like months before everyone was well. Our vet thought at first it was pupura hemmorhagia. He still thinks that could be the case, but isn't positive. We treated with Bute and Dex, then switched to Bute and Tucoprim. In people, Naprosyn isn't usually as effective for fever reduction; but Dr. O. will have to respond as to horses. Mine were on antibiotics for 10 days, btw. |
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Member: Jimc |
Posted on Monday, Jul 5, 2004 - 1:57 am: We live on a 4 acre ranch in northeastern AZ in the mountains. Our horse is in pasture, although he is now limited to the stall area in the barn. He usually eats hay and oats, and feeds in the pasture. We are now supplementing him with Senior feed. Our other horse is not ill.No diarrhea. Attached you can see the amount of swelling in his sheath. How much Dex did you use and for how long? By the way, a friend gave me some Dex. 4mg/cc and the label says for intraveneous use - can this be used in the muscle? His symptoms are fever (up to 105), swelling in legs, sheath, back, and his neck was swollen for one day (looked like he swallowed 2 baseballs. He has increased Heart Rate and Respirations}, and he can barely walk. Amazingly, he is eating, drinking, urinating and moving his bowels just fine. He has lost some weight. There were times when he was lethargic, but he is quite alert and responsive when his fever is down. He does not have any bacteria or white blood cells in his urine, however he has 2+ blood in his urine. He bleeds from injections easily. His gums are pale. He is a bit dehydrated and he started coughing about 3 days ago. |
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Member: Jimc |
Posted on Monday, Jul 5, 2004 - 2:19 am: Sara,Did all your horses survive the event? Did you ever have blood testing completed? I actually meant "Memorial Day" not Labor Day. Where do you live? Thankfully, none of the horses in my neighborhood are sick. My horse has been sick for about 5 weeks now. Each time we stop the meds, he gets sick again 3 days later. I don't believe we were giving him high enough doses and I don't believe we were giving him the meds for long enough. We are now giving him high doses of Tucoprim and Dex. We started with Tucoprim, switched to PCN, and back to Tucoprim. Frankly, it is amazing that he is alive. How high did heart rates and respirations get for your horses? My horses respirations have been as high as 60 and Heart Rate as high as 104 when the fever is up. We thought the horse had EVA, Strangles, Respiratory infection, or an autoimmune disease. Pupura hemmorhagica and severe anemia were confirmed with the blood test -- Hematacrit of 17 and Hemaglobin of 6.3. I don't know where the orignal infection started. |
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Member: Mrose |
Posted on Monday, Jul 5, 2004 - 9:15 am: All my horses survived, however two of them are now very susceptable to founder (ages 10 & 12) and they are the two that had the worse cases. hem is also an extremely easy keeper, so I have him on a diet of beetpulp, with a little rice bran, vitamins, minerals, Equine Senior and msm.They rec'd. DEX IV from the vet. One (a stallion) had a total of three injections spaced several days apart (maybe even a week apart-I should have written everything down to remember better.) He would appear to be better, then have another bout of it. This happened several times, with him going as much as a month seemingly fine. He also got hives, had a low grade fever, very swollen sheath & testicles and rear legs, some swelling under belly, but no where else. We had him on corticazone (sp?) steroids for what seemed like ages, as every time he'd go off them he'd start swelling and getting hives. He never developed any foot problems, thankfully. The gelding who had the worse case had swollen knees, rear legs, sheath & testicles and that is all. However, he was very depressed, had a low grade fever (I never caught any one with fevers as high as your guy's) and had very hot sore feet all the way around, with bad founder in the fronts with slight rotation in one foot even with prompt treatment (bute, pads, x-rays, then shoes with pads, etc.) The two youngsters, ages 2 & 3, that got this had the lightest symptoms - and I'm not sure if they had the Pupura, or something related - or maybe totally different but at the same time. They did run higher fevers-more like 103 to 104, got sweaty when their fevers were up, were depressed, and did have shallow, high rate respirations and faster than normal pulse, though I don't recall just what it was now. They both started treatment within an hour of my first noticing symptoms (I live a block from our vet!) and never developed any swelling. Two of the horses developed sores on their rear legs that got scaby and oozing which we had to treat every day. Blood work was done on the horses (vet only pulled blood on the stallion and two others) but I don't remember what the numbers were. I do remember the vet saying it looked pretty normal. I could get copies if it's important to you. Several, but not all, of the horses also had diarrea,one I had to put on pro-biotics for quite some time before it quit. This could have been, perhaps, a reaction to the medications instead of the desease itself. My vet commented that he had seen a lot more strange things the last summer or two with his feeling the draught might have something to do with it. We had an extremely hot, dry summer last year with a lot of wind. Dust and smoke blew in and around from everywhere. The horses all rec'd. Tucoprim for 10 days. The gelding had two courses of it with a few days in between, as did the one stallion. The stallion was also on an antihistamine for awhile as initially we weren't sure what his problem was and thought it might be an allergic re-action to something. We live in SW Utah. I have no idea how this all started. We could find no injuries,even small cuts, on any of the horses. The stallion first go hives and a little swelling when he returned from a horse show. However, he didn't return home,but to the trainer's barn about 30 mi. away. He had already been on one course of meds before he came home (my home) to recover from a knee injury. I'm still not sure that what he had was the same thing the others had. He had not been in the same fields and had no contact with the other horses. Have your read the info and conversations on the boards here? Also, www.thehorse.com has some good information I'm sure when Dr. O. reads all this he'll have some comments for you also. Good luck with your guy. |
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Member: Mrose |
Posted on Monday, Jul 5, 2004 - 9:24 am: I just looked, and my posts to Dr. O are under Swollen and Painful legs. There are some other conversations re: Purpura H. also. |
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Member: Jimc |
Posted on Monday, Jul 5, 2004 - 5:08 pm: Dr. O,What do you think about the symptoms of my horse? |
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Moderator: DrO |
Posted on Tuesday, Jul 6, 2004 - 7:30 am: Hello James,Fever and bilaterally symmetrical peripheral swelling in the horse are pretty nonspecific so there are many etiologic possibilities:
Within each of these groups of diseases are many individual diagnostic possibilities. Of the information provided is the very low HCt as many of the primary diseases in the above list would not cause this. It strongly suggests either a chronic problem that suppresses blood cell production or a hemolytic process that increases the destruction of RBC's which would account for the positive blood in the urine. For more on possible causes see:
Concerning your specific questions on medications you will them addressed at Equine Medications and Nutriceuticals. For NSAID's and steroids look under Antiinflammatories. DrO |
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Member: Jimc |
Posted on Tuesday, Jul 6, 2004 - 10:22 am: Dr. O, Can the 4mg/cc Dex be given IM even though the bottle says for IV use only? |
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Moderator: DrO |
Posted on Wednesday, Jul 7, 2004 - 7:10 am: Not having experience with the product you are using I cannot be certain however with the brands I use I have often given the 4 mg/ml IV preparation IM without ill effects.DrO |
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Member: Jimc |
Posted on Wednesday, Jul 7, 2004 - 10:17 am: Dr. O - I am giving Amigo (1100 pounds) Tucoprim 800/160 tabs. Twelve tablets twice a day (total of 24 tabs). How long should he be on this high dose medication considering his symptoms?? |
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Member: Jimc |
Posted on Wednesday, Jul 7, 2004 - 8:33 pm: The Tucoprim Dr. O is manufactured by Phoenix Scientific for the Butler Company. Have you used this brand IM? |
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Moderator: DrO |
Posted on Thursday, Jul 8, 2004 - 7:19 am: There seems to be some confusion in your last post: didn't you mean the dex used IM and not the oral antibiotic tablets? I have not used Phoenix's dex.Basically you use the antibiotic until the horse is no longer suffering from infection or increased risk of infection. Figuring into this calculation are: response to therapy, tissue damage, likely organisms being treated, and reactions to the medication. One concern is that with the severe anemia that your horse has that the Tucoprim suppresses RBC production and has been associated with increased incidence of hemolytic anemia: does your vet have other wide specrum antibiotic choices? DrO |
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Member: Jimc |
Posted on Thursday, Jul 8, 2004 - 4:03 pm: Yes - thank you - I meant "Dex", not Tucoprim IM. My vet has not suggested another broad spectrum antibiotic other than Tucoprim - do you have a suggestion for me to discuss with him? |
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Moderator: DrO |
Posted on Friday, Jul 9, 2004 - 10:47 am: This is a decision that should be based on his knowledge of the case and his experience. For a list of possibilities and their properties see Equine Medications and Nutriceuticals » Antibiotics and Antimicrobials.DrO |
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Member: Jimc |
Posted on Friday, Jul 9, 2004 - 6:23 pm: Thank you Dr. O. Unfortunately, Amigo died this afternoon. He was looking good this morning, had a spring in his step, was eating well, then at about 11:15 this morning we found him down and suffering. We put him to sleep peacefully. I just don't know what killed this horse, and it is driving me insane. He started with lethargy and a fever, seemed to get well with Sulfa and Bute, then swelled up in his legs, abdomen and sheath. That is when the labs came back with severe anemia. Again, he responded well to Dex, bute, red cell, and PCN, then regressed after the treatment course, and he developed a cough and had neck swelling. Finally, we started more Dex and higher dose Sulfa (Tucoprim) and he was doing great this morning. I just don't know. |
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Member: Deggert |
Posted on Friday, Jul 9, 2004 - 6:54 pm: JamesSo sorry for you and Amigo, I hope you find out what was the problem. I feel for your loss and at least you know you did the best for him. Take care. |
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Member: Shirl |
Posted on Friday, Jul 9, 2004 - 7:00 pm: James and Robin,My sympathy goes to you. He's over THE Rainbow Bridge now, free of pain, galloping with others that have passed over, waiting for you. Shirl |
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Member: Jimc |
Posted on Friday, Jul 9, 2004 - 9:58 pm: Hello horse friends. Thank you all for your sympathy. I believe Amigo is happy now, running like the wind. It has been a very rough day. We just burried Amigo under the Oak tree in the pasture. I am quite frustrated because when Amigo was down and suffering, I could not find one vet who could come out to put him down. Luckily, we had a way to put him down humanely ourselves without having to shoot him. He did suffer, but not for a very long period of time. I am not sure if we will ever find out what was wrong with Amigo. The tests were negative for EIA and West Nile. We know he was severely anemic, and we know he had an unidentified source of infection. The vets suggested an autoimmune disease, toxins, and pupura hemmorhagica. Friends suggested Strangles. I am not sure what it was. We have been anxious about giving Amigo Tucoprim due to his anemia, however, we had no alternative advice from our vet and Amigo obviously had an infection that needed treatment. I am curious, what other antibiotics other than Tucoprim are good broad spectrum antibiotics?? I also reflect back on the period when Amigo was getting PCN-G. Our regular vet ordered 20cc IM daily (300,000 units per cc) and the emergency vet who came out ordered 20cc twice a day. Amigo was about 1150 to 1200 pounds. Which dose is the most appropriate? Thank you all again for your sympathy and concern. We gave it our all to help Amigo and we are thankful that he is free from pain now. |
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Member: Mrose |
Posted on Saturday, Jul 10, 2004 - 12:58 pm: I'm so sorry that after all your effort and care Amigo didn't make it. At least you did all you could possible do for him. He's in some very good company right now and probably having a good romp.I sympathize with your frustration at not knowing what caused his death. It could, of course, be a combination aof things. If you ever find out please let us all know. |
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Member: Jimc |
Posted on Saturday, Jul 10, 2004 - 3:54 pm: Thank you Sara. I just can't help but wonder if I did more harm than good with the Tucoprim, as the Tucoprim can destroy RBC's and Amigo was already very anemic. I was giving Amigo Red-Cell, B-12 crumbles, B-12 injections, stress paste, electrolytes in his water, and 2 injections of a Gamma Globulin like immune booster, to counteract the side effects of the Tucoprim. I also infused him with some Normal Saline IV to treat his dehydration. He was eating like a champ and drinking a lot of water. WHAT OTHER CHOICES ARE THERE FOR BROAD SPECTURM ANTIBIOTICS WITHOUT THE SIDE EFFECTS OF TUCOPRIM}? The PCN-G did not seem to work, and the Tucoprim was suggested by 2 vets. I just want to learn for the future, so any advice that anyone can provide is much appreciated. |
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Moderator: DrO |
Posted on Sunday, Jul 11, 2004 - 7:13 am: Hello James and Robin,My deepest condolences on your horse. Looking at the history the last day, it seems the horse was responding when something else "broke". I am so sorry. Concerning your question about antibiotics, there is no one antibiotic I can list for you that you can then take as gospel will be useful the next time you have a horse with a infection. Your recent experience with TMP/SMZ is a good example of why. On the page I outlined above there is a list of antibiotics each with a article. The article tells you their spectrum of activity (most of those listed are wide spectrum) but just as importantly are the suggested use and hazards of each: all of this must be factored into what is used. Antibiotics are one of the most dangerous drugs we use regularly and their use carefully considered. Concerning the penicillin the dosage is in the article on penicillin but whatever the dosage it should be given twice daily. DrO |
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Member: Jimc |
Posted on Sunday, Jul 11, 2004 - 12:37 pm: Thank you Dr. O - this is a tough question;but do you think Amigo's problem was an autoimmune reaction to the Tucoprim? Please see the attached medical history. I know that nothing will bring Amigo back to me, but I want to learn from this experience. The pattern I noticed was Amigo improved with treatment and relapsed 2 -3 days after the medication treatments finished. I was told the "welts" were bug bites - they did dry up, crust over, and fall off - which does sound like bug bites, but at first I thought they were an allergic reaction to the Sulfa. I know I sound like a broken record, but what alternative antibiotic could have been tried on Amigo? The PCN did not seem to work the third time around (evidenced by the fever). \The attachements are in 2 parts - due to the size limits of attachments.
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Member: Jimc |
Posted on Sunday, Jul 11, 2004 - 12:39 pm: PART II MEDICAL HISTORY ATTACHED
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Moderator: DrO |
Posted on Monday, Jul 12, 2004 - 9:35 am: Hello Jim, we are traveling right now, when I return to my office next week I will review the documents.DrO |
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Moderator: DrO |
Posted on Wednesday, Jul 21, 2004 - 9:33 am: Hello Robin and Jim,I have reviewed the documents above and essentially you have a disease that is characterized by fever, depression, and peripheral swelling. He has tachycardia (elevated heart rate) in the later periods. The horse appears painful in many descriptions and develops a cough of unidentified cause. He has severe anemia that if do to hemolysis is happening fairly slowly. From this information you cannot rule in or out autoimmune hemolytic anemia and sequential CBC's might have helped a bit more with this, rather than just the one test listed. It is likely the horse's clinical signs were improving with the dexamethasone and worsening shortly after cessation. I think the most likely 4 etiologies that I place in order of suspicion from most likely to least: 1) cancer 2) autoimmune disease 3) systemic infection 4) many toxins Though the clinical signs are not specific for any of these 4 possiblilities the incidence and response to treatment suggest this order of likely hood. The acute collapse while the horse was apparently recovering, but the heart rate remaining high, does suggest to me a acute decompensating cardiovascular event including death from severe anemia, but this is just a possibility. DrO |
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Member: Jimc |
Posted on Friday, Jul 23, 2004 - 12:51 am: Thank you Dr. O. I don't think that I will ever know what killed our Amigo, but I do know that he was loved and that he is missed. I am happy to share that we purchased a 12 year old gelding quarter horse today. Buddy is a big guy - 16+ hands high. He was a racing horse in California (Do it again Don)in his younger days and has had many owners. He was recently kept in a smaller sized pen and it was obvious that he was bored and maybe a bit lonely. Buddy now has a 3 acre pasture with a pond, a pasture mate, and mares in the right and left properties. He is a rather happy boy today. The trailer experience was a bit rough however. Buddy resisted the trailer idea, he reared up and hit his head on the top of the trailer, then fell to the ground. He experienced a few cuts and bruises, but they have not stopped him from running around with full energy in his "new grounds" all afternoon and evening. Any trailering ideas out there for horses who rear up}? |
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Moderator: DrO |
Posted on Saturday, Jul 24, 2004 - 9:45 am: Delighted to hear about the new family member. Uusally horses will only bumpt their heads a few times before they stop rearing but it is not a guarantee. Let's hope he is a smart one and perhaps a more gradual introduction to the trailer will keep him calmer.DrO |
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Member: Mrose |
Posted on Tuesday, Jul 27, 2004 - 8:53 am: So glad you have another horse! Good luck with him. He certainly will have a good home. You might use a bumper on his head until he gets better at loading. |
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