Site Menu:
This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below: |
HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Discussions on Antiinflammatories not covered by the above » |
Discussion on Monitoring for Long Term NSAID Use | |
Author | Message |
Member: Mwebster |
Posted on Sunday, Nov 30, 2003 - 3:57 pm: Dear DrO,I asked my vet to run a CBC and serum test to monitor my older arthritic gelding for GI/kidney problems, as you've advised another HA member using long-term NSAIDs, and also because my gelding seems to need more NSAIDs to be comfortable, so before increasing the dosage I wanted to make sure things are ok. I'd been hoping to increase his daily dose of 1g/day to 1g-1.5g as needed (he weighs about 1250lb, 16.3 warmblood). Well, the tests show his BUN is high (32, lab range 8-20). His creatinine is normal (1.8, 1.0-2.0), although tests done 2 years ago by a different lab (prior to starting the meclofenamate) showed normal BUN and low creatinine (1.2 and 1.4, on that lab's scale of 1.6-2.2). Also a tad high are his albumin (3.8, 2.6-3.7), MVC(56, 36-50), and MCH (19, 10-18). His RBC is right at the low end, but always has been, and another vet explained that's typical of warmbloods. He'd been quietly grazing prior to drawing the blood sample, but was galloping around his paddock playing hard with a friend just prior to drawing the serum sample (we had a miscommunication, the vet had to go back for another vial for the serum test, though I don't know whether the vials would be labeled in a particular order for the lab). His potassium was high as well, but there was a note from the lab that said the sample hadn't been centrifuged so the number might be artificially high. The samples were pulled on 11/26, and received by the lab and tested on 11/28. Of course, I'm worrying about the high BUN. The last thing I want to do is harm his kidneys. Is there anything besides a kidney problem that might explain the high BUN, especially in the face of a "normal" creatinine? (Or is his creatinine actually "elevated" if he's normally on the low side?) Is the change from a BUN/Cr ration of about 10 to about 20 also indicative of a problem? I'm thinking his stall feels wetter than usual, but haven't measured intake yet (will do that next). It could just be he's hanging out in it more at night. This is also bad news because he's been dealing with a string of sudden lamenesses, either the left front, or the right front, and now there's something going on in his back and/or hind end. A couple of times over the past few weeks, I've found myself doing tail-pull tests -- I've just felt something isn't normal in his back end, he doesn't feel quite coordinated. This week, he practically sat on me when I picked up his left hind foot. So, I gave him an extra gram (usually he gets 1g at night) on Wednesday morning, the day the vet came to pull blood, and the racing around was the result (the vet actually commented how great he looked...). Whatever hint of incoordination or hind-end lameness was gone as he celebrated, bucking, head-tossing, etc. Maybe he overdid it, but I've never seen a little running around cause what I saw the next day, when he looked very lame again on his normal dose, and now that I've withdrawn the NSAIDs because of the high BUN, he looks ancient, moving slowly and with a shuffle, like a person suffering from severe lower back pain. He flunks the "chin up and back up" test. It's as if he's arthritic everywhere, as if it's "systemic". The vet is coming back tomorrow. Should we rerun the serum test? We're waiting for the results of a Lyme test -- though I know that's controversial. He was vaccinated for WNV, etc. etc. this spring, and flu/rhino this fall. He's up to date on worming and teeth. No change in his tack, and all I've done is take him for bareback walks/grazes during the last few weeks. verything else seems normal -- appetite, temperature, pulse, respiration, attitude, etc. Is there anything else we should test him for? The only changes I've made in his management are that I did get his left elbow injected (HA + triamcinalone) in mid-July, which of course made that elbow arthritis "go away" for a while, so we were hacking out happily during August and September, and in mid-October I had his coffin joints injected. And even when I withdrew the NSAIDs prior to those vet visits, he was pretty good. We were hoping the injections might let me pull him off the NSAIDs for a few months to give his system a rest. But my horse is now achier by far than he was before the injections, and the pain in the back end, if that's what it is, is new or at least apparent now, though it responds to the NSAIDs just like all the other aches seem to. The only other thing I've changed in the last few months is I switched him from 2qts/day of 10% pellets to 14% pellets, thinking a little more protein would help keep the muscle on him. Could that cause a rise in BUN in an older horse? (Should I switch him to plain oats, i.e. lower protein diet per your article on CRF?) Sorry this is so long, and I know you can't diagnose my horse long distance. I'd be grateful for any insights at all and/or recommendations of other things to test for. Melissa |
Moderator: DrO |
Posted on Monday, Dec 1, 2003 - 7:09 am: A elevated BUN is not uncommon in horses on good diets as protein breakdown from the diet contributes to the BUN and is not considered as reliable a indicator as the creatinine. Assuming the kidneys are not really effected this really does not need to be treated: it is a marker not a disease at this level. Also these occasional tests of Cr and BUN are not very helpful as they go up and down during the day. If you are concerned about kidney function you should probably take a urine sample after a night with no water to see if the horse is concentrating. They lose the ability to concentrate before they lose the ability to rid themselves of BUN so a high BUN in the face of concentrated urine suggests a non-renal cause.You need to get the vet out at a time the horse is lame/weak to see what exactly is going on, the rule out list for symptoms like you describe is very long. Besides arthritis consider founder, navicular disease, and perhaps Tying up and EPSM. I presume you have read our article on arthritis and you are doing all the less toxic ancilliary therapy. DrO |