Blood test interpretation

Suby2

Suby2

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My pony has been suffering from lethargy and the vets have been unable to find the cause so far.

She has had a recent blood profile done and one thing that I am thinking is of a possible copper deficiency.

Can anyone tell me how copper is shown in a blood test result? And, if possible what the normal range would be.
 
Why would you assume a copper deficiency? Typically if you want information on minerals you have to specifically request that test. A normal blood panel is looking at white blood cells for infection, and various organ-specific enzyme levels.
 
Thank you for your reply. No, I didn't ask for the test for copper at the time and I didn't realise now that it may not show up in a normal blood profile.

Despite recurring lethargy and anemia, the vet (and I have had more than one vet from the same practice) has not found the cause. My pony has low grade PPID (not on Prascend as advised she doesn't need it yet) and EMS. She was diagnosed with EMS in September and this has led to changes in her management as advised by the vet including putting her on Meformin. I have had her diet analysed by an equine nutritionist and followed their advice to the letter yet despite my best efforts she still gets lethargic and the vet's final conclusion was that she may be depressed as she is separated from her field companion (by an electric fence) although she in a reasonably sized part of the field with its own field shelter.

I could agree with this conclusion if it wasn't for the fact that when she went on an iron supplement for her anemia (prescribed by the vet) she began to improve within a few days and her behaviour and energy levels changed dramatically, however when she came off the supplement she became lethargic again. I mentioned this to the vet and she said it was just a coincidence.

Last Wednesday when I rode her she just plodded round with her head down and so I decided to buy an iron supplement just to see whether it was coincidence. She started the supplement last Sunday evening and when I rode on Wednesday I thought she was a bit better. I then rode on Saturday and she had definitely improved, walking out with her head up and ears forward and trotting and cantering without much persuasion (we are only happy hackers).

So, I did yet more research on the internet and one thing that I hadn't picked up on before is that copper deficiency can cause the symptoms that my pony has. It is brought on by lack of copper in the diet/forage. As my pony is on is poor grazing (deliberate to help her weight loss and reduce sugar intake) and has soaked hay I thought this angle was worth looking into. She does have a balancer which contains copper but I guess this is at just maintenance level and may not work where there is a deficiency.
 
When you say a balancer containing copper. do you mean a standard bagged horse feed known as balancer?I assume so from your comments, soaking hay and keeping her on minimal forage may indeed let her be low in minerals, but you will be aware that the balance of minerals in the diet and also in the blood is a complex issue.

It is possible to get your forage and so on analysed, but it is expensive and not what I would do except for competition horses stabled and on a fixed regime.
The classic copper deficiency is a reddish tings to the mane of a bay, helpful if a bay.
If she was deficient in iron, why was it decided to take her off the supplement, why was it thought no longer necessary if her diet was the same?
Is the hair normal, feels soft like a labrador, not harsh like a wire haired terrier [breeding will affect it of course]. Is the skin in good condition and the hoof quality good?

If it were me, I would phone up Equimins and ask for advice, you may be wrong, your vet may be correct, but to me, the money spent on a kilo of minerals is worthwhile, I assume it can't do any harm as normally excess minerals are excreted and they would not sell products likely to overdose if fed at the recommended rate.

I would make sure she gets some salt every day.
Micronised linseed is good for skin and joints and hooves.
 
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I know it sounds silly but have you thought that she may have an ulcer. There is a simple test that can give you an indication if there is bleeding in the gut. If your pony has anaemia then there must be some bleeding somewhere.
 
As I said I did have her diet looked at by an equine nutritionist and I also had her hay analysed. She is on Top Spec Anti Lam which contains copper. As far as I am aware horses should not stay on an iron supplement as there must be an underlying cause. As she is healthy in every other way I wondered if copper deficiency could be a factor. I do realise that I could be completely wrong. Her coat is in good condition and her hooves have improved on her new diet. I will also consider ulcers. As she needs to be kept lean due to the EMS I have to weigh all of her daily intake and have to be careful making any changes to her diet.
 
Suby2 said:
My pony has low grade PPID (not on Prascend as advised she doesn't need it yet) and EMS. She was diagnosed with EMS in September and this has led to changes in her management as advised by the vet including putting her on Meformin. .
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I would be tempted to ask your vet about a Prascend trial.
There is a great Facebook group called Equone Metabolic Syndrome (EMS) Cushings and Laminitits group UK? They are very knowledgable and helpful.
 
She was on Prascend for a while some time ago - just a quarter of a tablet a day. Her ACTH levels came down to normal and as she was depressed (yet again) she came off it.
 
I was thinking this too.


paulineh said:
I know it sounds silly but have you thought that she may have an ulcer. There is a simple test that can give you an indication if there is bleeding in the gut. If your pony has anaemia then there must be some bleeding somewhere.
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Anaemia does not necessarily equal bleeding. There is a faecal test for hind gut ulcers. Does she have any symptoms? Ulcers seem to be the problem du jour and I wonder how much money is spent trying to diagnose them...nevertheless the vet should be able to scope at home.
 
Hi Nudibranch. No, to be honest she doesn't have any symptoms of ulcers. She is fine to be girthed up, doesn't try to bite etc. but she is quite stoical and when she is unwell just goes very quiet and down. She is not as bad as that at the moment, just this persistent lack of energy and I am running out of ideas unless it is depression which is tricky to deal with. I just can't understand why for a period of time she changed so much even hooning round the field which she hasn't done for a long time. The vets seem to have decided that depression is the problem and as she is no longer insured for PPID, EMS and RAO and I am retired, unfortunately I have to consider the costs of any in depth examinations which may or may not find the answer.
 
Could it be worth trying Prascend now? I know she was on it before, but as PPID progresses it can cause depression. My oldest one was really depressed before starting on it. Could be worth a new trial just to see....
 
PPID can't be cured, it is a long term, progressive disease which can only be managed. If she was on Prascend and her ACTH came down, it was because of the treatment. When you remove the Prascend, the ACTH will go back up.

I would retest her ACTH level and restart Prascend as necessary.
 
I did ask the vet more than once and she did not think she should go back on Prascend. However having exhausted most other possibilities and taken notice of what people think I will ask to put her back on it.
 
After my boy was scoped yesterday I did ask the vet (O'Gorman's top Internal specialist. internal Medicine) about using the Gastrogurd and she told me that it needed to be given in the morning, again mine live out so would not have an empty stomach.
 
Hi just out of interest I wondered if you ever got to the bottom of the lethargy. I have been fighting to try and work out what is wrong with my previously very enthusiastic horse. Previous lameness meant suspected spavin and was blamed for lack of energy, but over the last 2yrs he has been very lethargic and is again looking depressed. He eats well, droppings are fine, all checks for teeth/saddle etc done regularly. When he was very obviously poorly at the start of the year & we did blood tests that showed raised fibrynogen levels but 3-4wks later they were fine again. His feet/coat are excellent and major organs & cushings were tested and came back clear. At my wits end as rode him yesterday and he can barely get into trot. He doesn't look like a horse with ulcers, but I have given him milk thistle and dandelion for liver and kidneys just in case and he is on brewers yeast in case of gut problems but nothing is making a difference and vets say he looks well so nothing wrong. Some other ideas please as he looks so fed up with life - could it just be he is bored as the yard is very quiet??
 
I've had a cushingoid pony and an EMS pony and I've found that their state of mind did have a massive impact on how well they handled their illnesses. Both got depressed very easily. When we got the EMS pony, my cushingoid pony perked up no end - I'd been ready to call it a day and it really did give her a new lease of life - she had a minion who she could train in the ways of evil :D

After I lost her (aged over 30) the EMS pony went downhill and we struggled with his laminitis. But when I put Wolf in with him last year, he's perked up no end too and has been much sounder - touch wood he hasn't needed any medication for ages. Yesterday they spent all day playing reary bitey games and chasing each other round....sigh.....but it's good to see.

Good luck getting it sorted - it's such a tricky balance getting the feed, exercise, psychological aspects and medication all balanced.
 
BethH said:
Hi just out of interest I wondered if you ever got to the bottom of the lethargy. I have been fighting to try and work out what is wrong with my previously very enthusiastic horse. Previous lameness meant suspected spavin and was blamed for lack of energy, but over the last 2yrs he has been very lethargic and is again looking depressed. He eats well, droppings are fine, all checks for teeth/saddle etc done regularly. When he was very obviously poorly at the start of the year & we did blood tests that showed raised fibrynogen levels but 3-4wks later they were fine again. His feet/coat are excellent and major organs & cushings were tested and came back clear. At my wits end as rode him yesterday and he can barely get into trot. He doesn't look like a horse with ulcers, but I have given him milk thistle and dandelion for liver and kidneys just in case and he is on brewers yeast in case of gut problems but nothing is making a difference and vets say he looks well so nothing wrong. Some other ideas please as he looks so fed up with life - could it just be he is bored as the yard is very quiet??
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I found the cushings test inaccurate. My results were 17 (29) and I retested at 11 (29). The vet thought he didn't have cushings.
I went through every symptom of cushings and realised he had a lot of them. We put him on a prascend trial and he has never looked back.
I would go through every symptom and see what you have if you look very closely at them.

My main symptom was a horse at this time of the year who could barely put one foot in from of the other. For mine "lethargy" was the key.

My horse started with cushings when he was 6 although I didn't realise for years as I found every other excuse for his symptoms. What seemed to trigger it was that he was very ill prior to that. No idea why and vet did loads of tests and nothing came up. . He recovered from the illness on his own but it may have been the trigger for some reason.

.
 
OMG - this sounds like my horse paddy - he has had an awful time this last couple of years and he has always been such a gung ho personality but he looks so tired out. He had a very strange viral infection a while back we think caused by some feed that he was changed on to and he has never been the same since. I was tempted to scope for ulcers but he looks so well in himself that I didn't want to put him through it after everything else. I think I'll go do some research on cushings & ask the vet to re-run the cushings test. It's so odd that he seems just to have no energy or enthusiasm. They did mess the test up the 1st time and forgot to run the bloods in time so had to take another sample. They just said to me it was fine but never gave me any levels - would you mind explaining how the results work? I.e., what score would be something to consider as a problem - I will also lok at other symptoms. I am convinced something has triggered this, I just don't know what!
 
BethH said:
OMG - this sounds like my horse paddy - he has had an awful time this last couple of years and he has always been such a gung ho personality but he looks so tired out. He had a very strange viral infection a while back we think caused by some feed that he was changed on to and he has never been the same since. I was tempted to scope for ulcers but he looks so well in himself that I didn't want to put him through it after everything else. I think I'll go do some research on cushings & ask the vet to re-run the cushings test. It's so odd that he seems just to have no energy or enthusiasm. They did mess the test up the 1st time and forgot to run the bloods in time so had to take another sample. They just said to me it was fine but never gave me any levels - would you mind explaining how the results work? I.e., what score would be something to consider as a problem - I will also lok at other symptoms. I am convinced something has triggered this, I just don't know what!
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one sign is infection and their lack of ability to deal with it. Mine was very fond of antibiotics. What a normal horse would have shrugged off in a couple of days mine needed antibiotics and preferably a second dose as the first didn't always clear it. So a horse getting infections. For him it was throat infections.
Next problem was skin infections. Always started Oct and cleared itself by the foll April or so. Lumps all over him which came to a head and scabbed. The only trigger I could think of in Oct was tapeworming. Asked the vet what they were but no idea. Stopped tapeworming but the skin infection continued. Started prascend and bye bye skin infection. We now get perhaps half a dozen scabs in a whole winter. Before he was covered in them Sometimes had to ride bareback as they were in the way of the saddle.

With the blood test they need to handle it correctly. I questioned my vet to make sure they knew this. Normally in England (certainly the south) it goes to Liphook. They test and send results back to vet by e mail. I asked vet for a copy of Liphook's e mail which they sent me. My vet is very accomodating. It simply shows a number. The highest acceptable is usually 29 but bet Aug and Oct it is 37 to take into account the higher levels at that time of the year ie seasonally adjusted.
If you are going to test I would suggest now when the levels may be higher to get a better chance of a positive result (presuming it is cushings)

I think very low results are fine but then about about 20 I believe (for <29) it moves more into a grey area.

There is a lot of info on www.thelaminitissite.org Everything you need to know in fact.

The test results need to be taken in conjunction with the physical symptoms. For eg if you had a perfect horse and not a single symptom I expect the vet would be wondering what the results meant but if they had a positive result plus some symptoms then it would help their diagnosis.

I asked my vet if there was any danger in trying a prascend trial and the answer was no. So there was no reason for them to refuse it. I remember the last time I rode mine before prascend. I had to get off and lead him home, That was after only 30 mins walking. He simply couldn't manage any further.
After about 2 weeks on a full dose of prascend (I built up very gradually to avoid the pergolide veil) it kicked in. I wasn't riding him but we christened him the "duracell bunny on speed" He went crazy in the yard. Trashed the field, I was horrified how I would ever control him on his back but after 6 weeks or so he settled down and became normal.

When testing I could see all the symptoms but the vet didn't point any of these out so I think it is very much down to the owner. I didn't think he was right so I wouldn't let it rest until I had done something.
Sadly I knew quite a lot about cushings as 6 months previously I had lost a horse to laminitis. When tested he was positive but it was too late to save him. It came totally out of the blue. I was not going to make that mistake again.
good luck with him
 
Thank you so much for such a detailed response and so sorry & sad to hear you've had to deal with cushings twice especially with laminitis which is just revolting! I will get a re-test done. It's odd though as the lethargy is major but he isn't showing any other symptoms at all, has never been laminitic and has never been fed anything other than fibre as he is a fruit loop (or used to be) on sugar, I gave him a scoop of mix for a couple of days the first week that I had him about 12years ago, he was such an utter pain I threw the bag away and have never fed anything but chaff since! I couldn't even give him haylage! Quite a contrast to the dope on a rope I have now. Maybe I should be brave and try a prascend trial, I think I am trying to avoid admitting that whatever is wrong could be and is life changing for him! But I would never forgive myself if he got laminitis so it's a no brainer really! I just can't think of anything else that would cause such lethargy. Time for another chat with the vet I feel!

The infection he had with the raised fibrynogin did cause him to come out in lumps all over his body and face and they scabbed like your's, the only part of the body that didn't come out in them were his legs, it was like looking at a case of severe hives and we decided he was allergic to alfalfa so he is now on an agrobs feed which is just grasses, since the change of feed it disappeared and hasn't so far come back - it just hit a nerve when you said skin infection as I am convinced it was an allergic reaction to the feed but it is most odd that your horse had the same thing happen, maybe the condition makes them very sensitive to change and he was quite stressed as had been for a bone scan.

Again thank you so much for taking the time to reply - lots of food for thought,
 
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I have been reading this thread with interest. My 21 year old gelding who has always been a livewire - to the point of being dangerous, has recently become a plod. It has come as a major shock. A couple of months ago I called the vet to have a blood check as I was so concerned. This lethargy came on within a few weeks. Bloods were clear, including a Cushings test. Vet suggested it could be hock arthritis. X Rays confirmed a diagnosis and he had his hocks injected. However, this was not the miracle cure I was expecting as he is still reluctant to work. His sparkle has gone. Even in the paddock he is quiet - not like him at all! I am now wondering if there is Cushings present even though the blood check was negative. I have no idea what his ACTH levels were as I wasn't given this information. Is there any possibility they have got it wrong??? He has none of the classic signs of Cushings, thick coat etc., but he does have a crest. Should I ask for a re-test??
 
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