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Discussion on Neuromuscular Autoimmune Disease - need advice | |
Author | Message |
New Member: dldawn |
Posted on Sunday, Oct 18, 2009 - 1:17 am: Hello, I am a new member and am excited to be a part of this "community". My 17yr. old QH mare that I have had for 15 years was diagnosed in February with a neuromuscular autoimmune disease. She suffered from muscle shaking and fatigue which got so bad that she spent a month in the clinic for tests. At her worst, she couldn't go longer than about 30 minutes on her feet, then she'd need to lay down. Once she got 10-20 minutes off her feet, she looked fine...until she'd need to lay down again. They tested her for ENMD, EPM but after putting her on prednisolone and seeing the very positive response, they diagnosed her with an autoimmune disease.After 8 weeks on steroids and slowly weaning her off, she was doing great, only to have it re-occur about 6 weeks later; coincidence or not, it was a week after receiving Rabies and flu/rhino vaccine. After another 8 week steroid treatment..which ended 3 weeks ago, she has been doing great. However, I believe I am seeing the shaking return, which initially shows as an occaisonal "jerking" in her front legs. Among the many questions I have is what can cause this? Is there any possibility of it being from something in her environment? My vet has no explanations. We have run blood work on her...which did show a high SeM protein level...which he says is the Strep Equi bacteria. A guttural pouch wash showed no sign of this. Will my horse have an autoimmune disease for the rest of her life? Is the only long term treatment for this to be on prednisolone for the rest of her life? Is that safe? I know that my vet will more than likely put her back on steroids if is happening again. What are the nutritional needs for a horse with this condition? Any advice you can give me would be greatly appreciated. I don't want to lose her but want to give her the best life I can without her being in any pain or discomfort. Thank You! |
Member: scooter |
Posted on Sunday, Oct 18, 2009 - 6:48 am: Hi Diana, welcome to HA. What body condition is your mare in? What does her diet consist of including pasture? Does she seem to be in pain when this happens?Funny something like that would start at the age of 17, has she been healthy up until then? I hope Dr.O. can give you some ideas, it does sound strange. |
New Member: dldawn |
Posted on Sunday, Oct 18, 2009 - 4:40 pm: Hello Diane,I am not exactly sure what her body condition is, but she is a bit overweight. You can't see her ribs and she sort of looks like she has a hay belly. She is currently not getting worked and really hasn't had any type of exercise since January. I have only been either hand walking her or riding her at a walk for about 15-20 minutes 3-4 times per week. She goes out in a small paddock for 1/2 day. She eats mostly hay (timothy or grass mixture) and gets only 1 1/2 lbs grain per day (sweet feed and Purina strategy mixed). I am actually now looking into putting her on a low-cal high vitamin type "grain". The vet tells me that she isn't really in pain, but is uncomfortable because her muscles feel fatigued and weak. I have owned her almost her entire life and she has always been healthy. It is very frustrating; I wish I just had an answer as to what is causing this so I could avoid it! But, the vet tells me that once they have an autoimmune disease, it is incurable. I am now just wondering if staying on steroids for life is a safe choice. I may not have any other options. Thanks for the response. Diana |
Member: scooter |
Posted on Sunday, Oct 18, 2009 - 5:34 pm: Was she checked for cushings disease? FME and some things I've read they can act this way. Has she any other symptoms of CD like slow shedding, drinking alot, loves the salt, urinating a lot, depressed, sore footed, (which could lead to laying down alot and shaky legs)? They all seem to have their own symptoms. Just something to consider. She is in the right age group and the times of year she got worse early spring/early fall is usually the worst. Not all horses test positive for it that have it, symptoms seem to be more diagnostic.My arab gelding has had CD since he was about 17 and this fall he could hardly walk, but didn't really present as founder, I really thought he was on his last leg. Laying around a lot, uncomfortable, and just plain weird! Altho hesitant about starting it, Pergolide has turned him into a new horse Tho I would think a vet would reconize the symptoms of CD, some horses just present strangely, like I said just a thought if interested Dr.O. has a good article in here about it. |
Moderator: DrO |
Posted on Sunday, Oct 18, 2009 - 5:57 pm: Welcome Diana,I am sorry to hear about your horse, I am afraid you have the proverbial and much dreaded "interesting case". Let's first deal with, "What is the cause?" From your description of the workup so far I have to say that autoimmune disease remains a tentative diagnosis. According to your post the diagnosis is based on glucocorticoid treatment being palliative but this might be the case for any disease that causes inflammation. For instance spinal cord compression often improves with steroids as it decreases the pressure from inflammatory swelling. Further diagnostics that might be helpful would be muscle enzymes (is this muscular or neurological), electromyography (what is the nature of the weakness), and biopsy of the tissues that the earlier diagnostics implicate. As to the nature of autoimmune disease itself we have an article on a more common form of AI, that of the skin. Though it deals with the skin, the introduction briefly explains about what AI is but then has an extensive treatment subtopic that would apply to any AI disease. It includes a discussion on how to deal with long term glucocorticoid treatment. For more see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Hair and Coat Problems / Itching / Irritated Skin » Autoimmune Skin Disorders: Bullous and Pemphigus. DrO |
Member: ekaufman |
Posted on Monday, Oct 19, 2009 - 12:16 am: Hello Diana,Welcome to HA. I'm sorry to hear of your troubles with your horse. I have only two semi-relevant observations. The first is that I maintained an old TB on prednisolone for several years with no effort to wean him off, and he suffered no evident side effects from the ongoing treatment. He suffered from compression of the spinal cord due to a history of trauma, hard use, and arthritis-- the pred. relieved his inflammation and gave him a comfortable retirement, though I never put him back to work. The second is that I have owned other animals (a dog, and a barn cat) with auto-immune disorders that were pred. responsive. In those cases, I was told that there is no good evidence for what causes the ailment. My dog recovered and went on to a long life. My cat is a recent illness and is recovering very well now, with an unknown prognosis. He's taking my old TB's leftover pred.. Some of these illnesses are just not as thoroughly studied as we'd like when we have to deal with them, or wish to rule them out. Good luck, and let us know how you and your horse get along! - elk |
New Member: dldawn |
Posted on Monday, Oct 19, 2009 - 11:13 pm: Thank you Dr. O and others for the response. Let me answer a few of the questions. When my horse spent a month at the clinic back in February of this year, they did 3 different muscle biopsies on her. Upon her arrival to the clinic, their immediate diagnosis was ENMD or a Lou Gherig's disease. But a muscle biopsy done on her rump at the top of the tail, as well as biopsies taken from either side of her neck...where her muscle trembling originated, all came back negative. I don't know all the names of the work-ups she had done, but I know they drew alot of blood checking various things. They even did a spinal to check for EPM. When they started her on steroids, they did stress tests on and off the medication and she always reacted well while on the meds.I think you are right Dr. O when you say she is that "interesting case". They wanted to keep her at the clinic for a conference they were having to present her case because it was so unusual. With what appears to be another onset of the condition coming on now, my vet says that we will most likely need to keep her on a long term low dose of prednisolone. I know he said there were other tests he could run, but practicality and finances prohibit that. I am encouraged to hear of other "success" stories of long term steroid usage. I guess I was just very worried about laminitis/founder as I have read that chances of this can increase with steroid usage. She is such a great mare and a great friend to me...that as long as I can keep her comfortable and do some light riding with her, I am happy. Thank you... |
Moderator: DrO |
Posted on Tuesday, Oct 20, 2009 - 6:39 am: Got it Diana, it looks like they have probably worked this up to be pretty sure of the cause. The article I reference above gives treatment recommendations and steroid alternatives. If you would like to learn more about glucocorticoids and horses check out Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Steroids, Overview of Antiinflammatory Use. Note that despite the long list of potential adverse effects that for autoimmune disorders the benefit outweighs the risk of treatment. I would note that in a small number of AI cases spontaneous recovery does occur.DrO |