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Pneumonia, heaves or heart failure?

This is a discussion on Pneumonia, heaves or heart failure? within the Horse Health forums, part of the Keeping and Caring for Horses category
  • Horse pneumonia, naxcel for 5 days
  • Jugular pulse in horses with heaves

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    07-06-2012, 11:22 AM
  #31
Foal
Yes I do understand that and I appreciate your advice. We had him on a strong dose of furosemide twice daily, but with the 102 degree weather and his lungs are essentially clear except for faint crackled in the right lung, my vet said its ok to decrease by half and see how he does.

I'm SO hoping and Praying that his pneumonia was exacerbating his aortic insufficiency.... That would mean we would have more time together... More time than if his primary issue was CHF. His fever is down and the clear nasal discharge that turned rust colored have FINALLY gone away so I know he had an infection.

I know denial isn't a river in Egypt... And my hope of being with him another year may leave me crying...

Thanks for your post and I hope you continue to offer your wisdom. We aren't finished by a long shot. We have follow up labs, exams and imaging coming up in the near future.
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    07-06-2012, 12:46 PM
  #32
Foal
Quote:
Originally Posted by tealamutt    
I do not wish to be the bearer of bad news, but part of the reason that his lungs are clear is because of the lasix. I have trouble conveying this to the owners of my small animal patients who are in congestive heart failure. I am keeping my fingers crossed for you that this was just a very severe case of pneumonia but if you cut back on his diuretic please do so under the guidance of your vet so you can make sure he doesn't develop pulmonary edema again. If it is heart failure, the more times we allow the edema to develop, the harder it is to get things managed again.

I honestly am not trying to be a pill and I REALLY hope things go well with him, but with how rapid his response was to the meds I fear the worst. Pneumonia does not generally respond to antibiotics so quickly so I am worried it was the edema responding to the lasix. I will keep my fingers crossed that he does well as you back off on the diuretics.
Are you a vet? If so that's AWESOME! :)
The only thing that makes me wonder about how he improved so quickly on naxcel, enalapril and lasix... We gave a very high dose of naxcel (20ml) IM twice daily, and started the enalapril at the same time. I didn't have the lasix on hand and she had to call it in, so we didn't actually start the lasix until the following day, and he had already shown significant improvement by the time I got the lasix home. Yes I understand that's a very quick response for pneumonia... AND I've read that enalapril's gastric absorption in equines is dubious at best.... So.... I dunno. I'm not a vet. But by the time I got the lasix home his cough was 1/4 of what it had been - and believe me, it was BAD. He was pitiful and I thought he was going to die.

I can't help but wonder about how he has responded to bactrim and naxcel. He did seem to improve ~slowly~ the 3 times he was on bactrim, BUT the cough and malaise came back after a few weeks. Then he was given high doses of naxcel and he showed improvement, but when switched over to bactrim again he started to decline... So I guess there must be some bacteria that are susceptible to bactrim, but MORE susceptible to naxcel. That's about all I can think of that would explain it.

I'm not trying to discount his heart condition. I give him his medicine faithfully and we go for walks now instead of rides... I don't stress him in any way. But I do feel very encouraged to that he's galloping through the pasture now when it's time for his triple crown senior! Man that stuff is like crack for horses! :) And he seems to tolerate galloping now. Before he couldn't even walk with me without gasping for breath. :(

So, do you have any thoughts about the antibiotic issue? And what do you think about excede (extended release naxcel) maintaining a high enough serum concentration for the duration of treatment?
     
    07-06-2012, 10:27 PM
  #33
Yearling
Well the fact that he had improved before lasix was on board is very encouraging! Yes, I am a vet and it is sometimes awesome ;) I like Exede, it is still new and needs some more clinical studies but it is a very promising drug. I also missed the part where he had responded while on Bactrim initially, also an encouraging detail! However you slice it, he is feeling better and that is a good thing. I also have an older gentleman gelding so I know how it is to worry about a senior horse. As he gets up there in years things like this always scare me and make me wonder if I'm going to have to make a hard decision. Please keep us updated on how things go.
     
    07-09-2012, 02:32 AM
  #34
Foal
UPDATE advice please for TEMP

Well... Khaiyaann had been doing great on the naxcel and then the excede (which is nothing but naxcel extended release). Yesterday he free lunged around me of his own accord, and today he galloped through his pasture again without any shortness of breath or jugular vein pulse/distention.

BUT tonight his temp is 101.6 rectally, and that worries me. It has been hot here, up to 104 F today, but tonight it's 85 F and humid. It was just as hot yesterday and his rectal temp was only 100.6 F.

Otherwise he's acting fine - no cough, no shortness of breath, good appetite too.

I guess I'm worried because I read that excede may not maintain serum levels at therapeutic range?

So do you guys think this temp is something to worry about?
     
    07-09-2012, 07:08 PM
  #35
Green Broke
The normal is up to 101. As he's only slightly above that I'd keep an eye on it & hose him down to keep him cool. Listerine baths will help cool him too.
If he goes over 102 notify your vet. Bute & banamine are good anti-pyretics (fever reducers) but I wouldn't give any unless the vet says to.

You may want to keep a chart of his temps to see if he follows any pattern (lower in AM than PM for example).
     
    07-10-2012, 01:39 AM
  #36
Foal
Today my vet suggested that I keep a chart of his temps, just as you suggested! :)

She said that horses will often run a temperature at night but be ok in the morning - called biphasic. She thinks it's only mildly elevated too, but today we decided to cover him for another 5 days with antibiotics - this time penicillin and gentamycin. She said his age is a factor, and that every time this reoccurs it comes back worse than before, so we're going to hit him hard with medicine and hopefully this won't come back!
     
    07-15-2012, 03:02 AM
  #37
Foal
Exclamation UPDATE need opinions please

Well, Khaiyaann's recovery has been going very well with his lungs and heart. Tomorrow he gets to switch over to oral antibiotics (thank God) instead of injectable.

BUT... My vet taught me where to give him his antibiotic injections - pecs, neck and butt. I had been rotating sites so one area didn't get damaged from constant use. However, his pecs.... At first (yesterday) I noticed what looked like little flaps of skin hanging down from both pecs. They felt soft and like there was nothing in them. But today his right pec skin flap feels hard to the touch, warm to the touch and is more swollen than yesterday.

I called my vet and sent her pics via cell phone. She said apply heat, and that she didn't think it is abscessed yet... Yet...

Any ideas on how to help this poor fella before it really gets bad? He's been through SO much lately and I'd like to stem this off if possible.
     
    07-15-2012, 09:12 AM
  #38
Green Broke
I have no idea but I really hope he pulls through with no more illness. Such an exhausting time for you. Keep up the good work, it seems to be working.
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    07-15-2012, 12:40 PM
  #39
Green Broke
I'd never give an IM in the pecs. That muscle is just too small but still, lots of people do it. It seems to be the latest craze or something.
I would avoid that site & use the others.

Those little bags will take a while for the body to absorb because they are dependent. You could try applying an epsom salt poultice, that will help draw out fluid.
     
    07-16-2012, 04:04 AM
  #40
Foal
Thanks for that. I'm worried about it because now it has doubled in size - the two flaps have become one - and it feels warm to the touch. :( And he's already been through SO much lately@!
     

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