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Me and Smiling Horse 07-03-2012 09:51 AM

Pneumonia, heaves or heart failure?
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HI there. My name is Angela and my best friend, Khaiyaann (which is pronounced "Cayenne") is a 25 year old Arabian gelding. He is the sweetest, gentlest, most affectionate horse I've ever known, and I'm so lucky to have him!

He had been very healthy and robust. I was riding him almost daily and he responded to exercise very well... Until last December. I took him to Florida for the winter, where I would be working, because there was no one to care for him at home. I found a suitable stable 10 minutes away from my rental, so away we went AFTER he had a vet check and all of his vaccinations.

Upon arrival, my big boy seemed very ill. His eyes were heavy lidded, swollen and weepy. His temp was 100.9 rectally. I could tell that he just didn't feel well at all, so he stayed in the stable for 5 days until he started to feel better. And then it was time to explore his new surroundings!

We were in Florida for 3 months, and we're home now. He lost a LOT of weight while he was there and developed a clear nasal discharge which he never had before. Despite my best efforts at plumping him up while in Florida, he didn't gain any weight at all. I tried soaked beet pulp, great pasture, triple crown senior feed and corn syrup on his feed.

Now that we're home I'm around him all the time, much more so than back in Florida because he's here at home with me. He went into respiratory crisis about a month after being home. I called my vet and she came out. He had "crackles and wheezes" throughout his lungs, a dry cough, an elevated respiratory rate, and clear nasal discharge, but not much of a fever. She diagnosed him as having COPD and gave him Bactrim (just in case of infection), prednisone, albuterol, and trihist. After 4 days on this regimen he seemed to improve.

He gained his weight back rather quickly! But after about a month he started developing his symptoms again, only this time with difficulty breathing on top of the other symptoms. I panicked and called my vet but she couldn't make it, so I called a different vet and he did make it. He thought my big boy had an infection, so we gave another round of Bacrtim, and after about 5 days my boy started to improve. And all was well.

We've been home for a little more than 3 months now and just recently he went into another a terrible crisis. My friend's vet was just down the street and she could come quickly, so another new vet checked him out. Same symptoms. Difficulty breathing, clear nasal discharge, crackles and wheezed throughout all lung fields, shortness of breath, and a terrible persistent cough but temp was 100.9. She did an echocardiogram right there in my barnyard because of his loud heart murmur. She said that he has a grade 5/6 diastolic murmur - aortic regurgitation. She said his lungs were very moist. She spoke to me about putting him doen, but I just couldn't do it at that time. I was devastated. She thinks its his heart - going into congestive heart failure. We started him on enalapril, lasix, and also an antibiotic (naxcel) due to my concern over a lingering infection that started after long transport (975 miles) into a totally different climate.

Over the next 48 hours he showed ~significant~ improvement. His cough was gone completely, he was not short of breath at all, but he was still tired. He received injectable Naxcel for the first 2 days and then he was switched over to bactrim by mouth. After about 72 hours on Bactrim, he started to show signs of shortness of breath again. I called her out and she started him on Naxcel again (upon my insistence) and he will keep getting it for the next 8 days.

So... I read on the internet that horses often do FINE with even severe heart murmurs. All of the literature that I can find says that murmurs usually are not fatal for horses. So I'm perplexed... I want to believe that his crises have been caused by a lingering pneumonia and NOT by heart failure.

Today he is doing very well. No cough at all, no shortness of breath. He is bright and prancing, nickering for his feed! He is not on steroids now, or an antihistamine for COPD and hasn't been for 2 months. But he is on enalapril, lasix and naxcel.

Has anyone out there experienced anything similar to this? I'm hoping for some advice or perhaps some ideas? I love him SO much. He's a part of my family, not just a "pet." Any and all advice would be greatly appreciated.
I have pictures of Khaiyaann (Cayenne) on my profile, so please check him out! He's 25 1/2 years old now.

poppy1356 07-03-2012 10:20 AM

Hmm I'm not much help but we recently had a pony at my barn that got pneumonia so much that it eventually made it extremely hard to breathe as it had hardened all of the broncheal tubes, I think that's what they are called, whatever they breathe from. Anyway, because it was left for so long eventually she had to be put down.

How long has he been on antibiotics at one time? Maybe he needs meds for twice as long to fully clear an infection.

Also my mare was recently diagnosed with a heart murmur of 1-2/6 so barely noticeable. My vet said that I would only need to worry if it was closer to a 4 or 5. To me he seemed to describe it as a potentially deadly problem. But again allergies and her bronchitis was possibly making her heart murmur more present.

I would at least call different vets that specialize in this and get their opinion then decide what to do.

Edit: I don't mean to scare you, I have just seen what happens when an infection isn't fully taken care of. If that is indeed his case. I would also probably get a full blood panel done to make sure there isn't anything else going on.

texasgal 07-03-2012 11:02 AM

Welcome to the forum. Your gelding is very pretty ..

I agree with poppy .. keep after your vet, or a new vet, to get the test that can tell you what's going on .. or at least rule out infection.

natisha 07-03-2012 11:10 AM

Did she hear the murmur with your horse at rest & did she check to see if it was still there after /during exercise? Many horses have a murmur that is not heard during work, those I believe, are nothing to worry about.
I see she did an echo. Did she do it at rest & after work?

Does your horse have any leg or belly edema/swelling? ( Note that belly edema is more common in hot weather, especially in oldsters). CHF would lead to generalized edema. Any frothy nasal discharge?

Has blood been drawn? If there is an infection, like pneumonia or chronic bronchitis it will show in blood work (WBC, differentials etc.). Arterial blood gases would show the amount oxygen & carbon dioxide (CO2) in the blood & can tell you how well the heart is working.

I can't believe a vet who only saw your horse one time would discuss euthanasia without being asked.

It seems to me that your horse has responded to some treatments that cover a wide variety of illnesses so I understand your frustration.
If he has CHF he would not have gotten better with antibiotics & if he has pneunomia he would not have improved with lasix alone.

Is there a vet hospital or large clinic near you? They would be able to give you a definite diagnosis.

I hope all works out for you & your lovely horse.

Hunter65 07-03-2012 11:16 AM

Youyr boy is beautiful, I hope he will be OK.

Me and Smiling Horse 07-03-2012 11:32 AM

Thank you both for the replies, and THANKS for the compliments on his good looks! Like I said, I got lucky! I bought a "fixer upper" house with a small amount of acreage which housed FIVE horses, and he was one of them. They were being kept in a tiny round pen, no grass, living in their own mire literally knee deep. Their legs sank in the manure up to their knees. He was being starved to death and every bone in his body was visible. SO when I purchased I did so on One condition - that they let me keep Khaiyaann. My property is just too small for more than one horse, otherwise I would have tried for the others as well.

I'm sorry that I failed to mention the blood panels that were done. He did have a full chemistry panel from the second vet, and the third vet (that I think I'll keep) did a troponin level (a cardiac enzyme). His organs are all doing well (kidney, liver etc) but his heart enzyme was elevated. We didn't to a white blood cell count because he was being put on antibiotics anyway. I have to pick and choose right now because this type pf veterinary care is VERY expensive and I can't afford much more - I'm poor but proud! I have a $10,500 Arab quite by accident. He's registered (freeze branded on his neck with his registry number) so I contacted his breeders and that's how I know what he sold for at 3 years old. He knows dressage and I don't!

I just keep praying that maybe this infection is making his heart worse right now, and that it'll get better? He is going to remain on antibiotics for 3 weeks solid now. His troponin wasn't very high, just mildly elevated. I worry every day that I'll get home and find him dead... Or that he'll go into another crisis. When I lost my husband a year ago, my horse saved my life. I grieved so badly, and I still grieve, and he knows it. He insisted on interacting, going riding, etc by pitching a fit if we didn't! He kept me active and outside. Then I lost my dog 6 months ago - she died at 14.5 years old. He isn't well enough to insist on riding now, but he loves to go for walks and he waits at the gate for me. :(

poppy1356 07-03-2012 11:43 AM

Wow you've had a rough year. I really hope he gets better. Have you tried just calling and getting consultations over the phone with different vets? Maybe you can get different opinions from the vet and decide which option you want next? But I'm hoping those antibiotics help him.

Me and Smiling Horse 07-03-2012 11:52 AM

Hi Natisha,
Your questions are good ones!
No she didn't check his murmur at rest and after work because he was short of breath and unable to work. His nasal discharge is clear, not frothy. He doesn't have any edema or jugular vein distention at this time. I wish i could afford an arterial blood gas, but I simply can't. To date his care has been about $1000 with meds not included. There is a good equine hospital here, associated with a university, and I've looked into checking him in, but I don't have enough money. The vet who did the echo consulted an equine cardiologist at the university, and that's how my big boy was put on enalapril - an ACE inhibitor. The cardiologist said he thought perhaps Khaiyaann could maintain for months??? I wanted to get a betanatriuretic peptide (BNP) drawn but we can't find a lab to process it for horses? Why that would be, I have no idea.

Yes I am very frustrated and very frightened. I know that if COPD is causing this, then I have to move him to a place where there's more grass so i can get him off hay before it gets so bad that he can't recover. However, my vet said since his heart enzyme is elevated I shouldn't stress him by moving him. ???

I've insisted on long term coverage with the antibiotic that he seems to respond to best. So I have that covered, and naxcel is very expensive. I'm a nurse (a LPN - otherwise known as "low paid nurse") so I give him the injections myself.

My big concern is that either pneumonia or COPD (or my worst nightmare BOTH) could potentially worsen his heart condition? And how do I distinguish between these issues? How do I prioritize these conditions and choose the best answers in the best sequence? My vet did check out the hay I give him and she said it was high quality - locally grown, fresh, green. I can't afford triple crown forage. I tried that but his vet bills are mounting and he may need more visits so...

Saddlebag 07-03-2012 12:02 PM

Not good news but the copd is what is causing the heart problems. When he's having difficulting breathing his heart is begging for more oxygen and working overtime. His lungs are inflamed and that is why he responds to prednisone and maybe the weight gain. With copd (chronic obstructive) means the swollen lungs have difficult getting rid of carbon dioxide. With co2 remaining in the lung tissue, there is less absorption of oxygen. Speak to an good equine vet about the use of an Aeromask. This puts the medication more directly to the lungs and is administered by puffer. Some respond fairly well to Ventolin altho the heart beats a little faster. Others respond to Atrovent which has a bit of a drying effect ie reducing the fluid. There are also steroids which can be administered with the mask. In cases like this it is better to not allow the horse to get tubby as he will work harder to breathe. Google Aeromask and see if this might be something you are willing to try. forgot to mention - copd invariably means lung infections / pneumonia. The animal can become extremely sensitive to mold spores, so this is something you need to be mindful of in wet conditions.

Me and Smiling Horse 07-03-2012 12:33 PM

Thank you for the suggestions about the aeromask. I've discussed the use of steroids with my vet too, but she said that steroids will suppress his immune system, and if he has pneumonia, we shouldn't suppress his body's natural response... Maybe if he inhales the steroids it will not suppress his immune system as much as oral steroids would?

We also discussed albuterol and ipratroprium as bronchodilators... I thought it would be a good idea but she said we shouldn't give him anything to elevate his heart rate due to the aortic regurgitation?

I do think this all started with some kind of respiratory infection.

I'm going to consult a few more vets and see how they would prioritize his treatment. I'm so emotionally involved I can't think clearly. If it's COPD I can move him to grass pasture (board him) but if it's his heart then the stress of moving him could kill him... OMG I'm so confused.

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