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Discussion on Generalized swelling, cause unknown | |
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New Member: chippy1 |
Posted on Monday, Aug 15, 2011 - 5:02 pm: Hello all,I would appreciate thoughts and advice on the following case, my own horse. She is a 3 year old Rocky Mountain Horse, was just stating under saddle. On Wed Aug 10 I was taking her out for training when I noticed her halter fit more tightly. Looking more closely it seemed both parotids and submandibular salivary glands were swollen. Worried about her airway, we immediately took her to a clinic, where she was sedated and full oral exam performed for any evidence of puncture, bite, foreign body,etc. Nothing found. An aspirate of the submandibular region revealed clear serous fluid with lots of eosinophils. Airway seemed to be stable. We reversed the sedative, took her home and started Banamine and Tucoprim. Next day, more swelling about head, and extending along topline to withers. Had another vet out and she suggested an antihistamine. This was done started and continues still twice daily. Next day, no better, head more swollen still, seems to involve every salivary gland, very symmetrical, extends into neck so much so that visualization of the jugular vein is difficult. Airway ok, no petechia. Respiratory sounds, heart, ok, no fever - just slightly increased respiratory rate. (Its hot here in MO).Had vets #3 and 4 out. (Two different clinics) Just for their opinions. Got lab work and it shows a normal CBC. (No eosinophilia), Losing protein, globulins and albumin - all DrOpping. Decision made to begin Dexamethosone. Treated with 40 mg IV, then followed with 40 mg twice daily orally. MU vet school says she will absorb it thru gut. She is on pasture, with a run in shed and eating, drinking and pooping still. Today, Mon, Aug 15, I started decreasing the dexamethasone dose to 20 mg, twice daily orally. (She had had 5 doses of the 40 mg over prior to this reduction in dose). This is MU and my vet's recommendation. Still having a swollen head. She seems more lethargic. Digital pulses feel ok, she's still eating and drinking, haven't seen poop today, but I might have missed it. She seems a bit more lethargic and even seemed to stumble a little. Talked to the 2nd vet that saw her today. They are sending in allergy testing labs gathered at time of blood draw 3 days ago. No results for a few weeks. She has significant dependent edema present between the forelegs in the chest. She looks "bloated" through the barrel. The head looks a bit better this afternoon, but was worse this am. No petechiae. Recent past history: no travel, no exposure to other horses. All vaccines current and due in Sept. Rec'd Strangles (StrepVax II) on June 23. Current on worming. (done quarterly) pastured with minidonkey - he has no symptoms. As I said, she is still eating, drinking. Feet feel ok, no bounding pulses, feel cool. She is in shaded run in shed on pasture grass. Has access to grass hay which is given free choice daily and grain pellets fed 2 times daily (no recent feed change) I 'm worried this could go the wrong direction easily, and quickly, as to me, she looks a bit more lethargic. Any thoughts you all might have on what I'm dealing with will be so much appreciated. I waited 20 years to be able to have a horse and she is dearly loved. PS, you could say I'm vet #5 on the case besides the MU vet that I've discussed her case with. I did small animal only when I was in active practice and then I went to medical school. Love being a vet, but also love helping people. Any thoughts on what I am actually dealing with (autoimmune vasculitis??) and proper course will be appreciated. I'll follow up on all your questions. Thanks very much. |
Moderator: DrO |
Posted on Monday, Aug 15, 2011 - 7:20 pm: Welcome DrN,While immune mediated vasculitis is a possibility I think viral or bacterial induced vasculitis / lymphangitis more likely. Herpes and Strep. zoo. equi has a propensity for this area and is common. Both of these can certainly have a secondary immune component. And while a normal temp and CBD make the dx difficult this happens sometimes in the individual with a partial immune response: a strong local reaction but no systemic reaction. I think the enlarged structures are more likely lymph nodes which are also prominent in the submandibular and parotid region. Could we have the actual vital sign values and the lab values including the lab's normals? In the mean time often edema of the head is exacerbated remarkably by prolonged grazing and the concomitant increase in hyDrOstatic pressure created by a down head. Stalling and feeding up off the ground can help remarkably in some cases while either we figure this thing out or it resolves on its own (likely). DrO |
Member: mrose |
Posted on Monday, Aug 15, 2011 - 7:21 pm: While you are waiting for Dr.O's response, I would walk the pasture carefully and look for any weeds, clovers etc. that might cause a reaction or be poisonous. With the weird weather various parts of the country have been having, different types of things have been popping up that you might no normally see.I would also cold hose her a couple of times a day to help with swelling, and to make sure her coats is dust free as possible, no pollens, etc. on it. Are you using any fly sprays or anything else on her coat? Any fly repellent bands on her neck or legs? Anything, however minimal, different in her care or feed? No shots or worming since last June? If my legs, head and chest were swollen I'd be stumbling and lathargic also, poor thing. I hope you find some answers soon! Oh, you should also do a search on this site for swellings and anything else that might apply. There's a lot of good info here, not only from Dr.O but from other members many of whom have had problems with various swelling problems, allergic reactions etc. Good luck! I have found antihistamines to be pretty useless when treating horses, so am glad you started Dex. |