Liver disease - advice needed

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jillyg

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My 20+ shetland cross (cushings sufferer) had a tetanus booster earlier this week and bloods taken to see how advanced the cushings is - he isn't used to veterinarian procedures and jumped about alot with the needle stuck in him. But blood was eventually taken. The next morning he seemed unsettled - walking around the field constantly, interested in the haynet but headbutted it instead of eating. When checking him in the afternoon he seemed to become "drunk" when trying to make turns, head butted everyone and everything - including his companion - leaning when he could and just needed to keep walking. Very distressing! The vet was called back in and decided to take more blood and administer steroids and antibiotics. In examining the original site of blood taking it was found to have come up in a large hard lump!
The second bloods came back with the devastating news that he now has liver damage - and the vet feels that the neurological signs were a symptom of this but I am not sure. Would he all of a sudden show signs of neurological distress and then return to normal (albeit with the aid of drugs) the next day? He has never shown any of these signs before (I have only owned him for approx 6 months). I am more inclined to think that the lump on his neck caused pressure on a nerve and that caused the temporary discomfort - does this sound weird? When I took over his care his worm egg count was 500+ - could the damage to his liver been caused by this? The vet seemed to err on the side of doom and gloom - a matter of when not if regarding his demise ... no word of the ability of the liver to regenerate with proper support. Should I get a second opinion?
Sorry lots of questions? But if anyone could give me advice I would be grateful as at present I don't feel I can go back to the vet and ask as I feel I might be fobbed off!
 
jillyg said:
My 20+ shetland cross (cushings sufferer) had a tetanus booster earlier this week and bloods taken to see how advanced the cushings is - he isn't used to veterinarian procedures and jumped about alot with the needle stuck in him. But blood was eventually taken. The next morning he seemed unsettled - walking around the field constantly, interested in the haynet but headbutted it instead of eating. When checking him in the afternoon he seemed to become "drunk" when trying to make turns, head butted everyone and everything - including his companion - leaning when he could and just needed to keep walking. Very distressing! The vet was called back in and decided to take more blood and administer steroids and antibiotics. In examining the original site of blood taking it was found to have come up in a large hard lump!
The second bloods came back with the devastating news that he now has liver damage - and the vet feels that the neurological signs were a symptom of this but I am not sure. Would he all of a sudden show signs of neurological distress and then return to normal (albeit with the aid of drugs) the next day? He has never shown any of these signs before (I have only owned him for approx 6 months). I am more inclined to think that the lump on his neck caused pressure on a nerve and that caused the temporary discomfort - does this sound weird? When I took over his care his worm egg count was 500+ - could the damage to his liver been caused by this? The vet seemed to err on the side of doom and gloom - a matter of when not if regarding his demise ... no word of the ability of the liver to regenerate with proper support. Should I get a second opinion?
Sorry lots of questions? But if anyone could give me advice I would be grateful as at present I don't feel I can go back to the vet and ask as I feel I might be fobbed off!
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The odd behaviour does seem to be related to the vet visit but it could be the tetanus, stress or so many other reasons unrelated. Any signs of laminitis, the drunk/wobbly can be due to sore hooves.
Has liver fluke been considered?

I hope some of the knowledgeable posters reply.
 
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Thanks for the reply - no signs of laminitis yet (and his previous owner said he never had any incidence of laminitis!); I moved both ponies 6 months ago to their new home and it was the first time this old lad had moved since being bought as a foal by the previous owner; he coped with the stress of this very well and out of the two is the more laid back. He was always a family pet, never broken in, and although handled obviously hadn't had so much attention and health care as he is getting now. We did consider stress but somehow I don't think so. Liver fluke wasn't even considered - the vet said it might be ragwort poisoning but I really think that is very unlikely - I knew the previous owner and had my pony at her yard so I knew how careful she was in keeping the fields clean - and since having them with me I too have been very careful. Also these boys have been together for years so would have had the same hay - so if it was in the hay surely the other pony would be showing signs as well? Another friend said it might be the tetanus - but I can't find any information on the internet regarding adverse reaction to tetanus.
 
I believe in Cushings the immune response is often affected so that could partly explain the previous high worm burden,which may have lasting physical consequences to gut and blood vessels. Google encysted small redworm and migrating red worm (bloodworm). I do think ragwort gets the blame for liver damage without confirmation of this sometimes. Milk thistle can help with liver damage, restore from Global herbs has a good reputation but better run it past your vet. My understanding of liver damage is that if his bloods start to improve the signs are more hopeful. Sorry I can't be much help as to causes and next step. If you aren't satisfied or convinced a second opinion might put your mind at rest if nothing else.
Is he being treated with Prascend?
 
Bit of a coincidence that it was after a vaccination, are you sure it wasn't the site of that which swelled up into a lump? One of the main functions of the liver is to process toxins, it may have been that the vaccination was just too much for his liver to cope with if he is older and has cushings. Vaccinations should never (and the manufacturers themselves stare this) be given to a horse that is not 100% health, and a Cushings horse won't be.
There's more info on here or just google 'vaccinosis':
http://www.alternativevet.org/FAQ_vaccination.htm
Cushings horses are more likely to have higher worm counts as their immune system tends to be lower.
The best thing for liver support is milk thistle seed - you can get it online at any herbal type shop, Hilton Herbs do it too
http://www.hiltonherbs.com/products/milk-thistle-seed-bruised/238
There's info on its medicinal use here:
http://en.m.wikipedia.org/wiki/Silybum_marianum
Keep an eye on him for laminitis developing if he's had a steroid injection, it can cause it in some horses.
Hope he's feeling better soon.
 
Haven't read the replies fully because I'm in a bit of a rush, but....

depending on where the first blood test was processed, they may well still have the remains of the blood sample. The lab that our vets use keep bloods for one week, but no longer. This gives a bit of leeway for testing the remains a second time or for carrying out different tests without having to take a second blood.

Chances are your blood will have gone to Liphook for ACTH testing to monitor the Cushing's, and I don't know how long they keep blood samples, but if I were you I would act quickly first thing Monday morning and contact your vet and ask them to contact the lab without delay to arrange for a profile to at least include liver enzymes, but I'd probably ask for a comprehensive profile just so you have as full a picture as possible of what's going on.

If you act quick enough (and manage to make sure your vet does!), then you may well be able to have bloods analysed from the initial sample, and that will tell you whether the liver was abnormal on that first day, or whether something happened after that point.

I really would stress to the vet receptionist that it's this first blood you are hoping to have retested, because it may mean someone from the office ringing Liphook straight away to ask them to retain that sample. If there's any delay in someone contacting Liphook (eg waiting for a vet to get back to you later in the day), then you risk the sample having been thrown out, and you lose the option of testing it.

Beyond that, I'm afraid I don't know, but everything I've said above would be my priority. It would be very useful to know whether the liver problem was present already, or whether it may be a (hopefully shortlived) reaction to the vaccination.

Sarah
 
Thanks for the replies
No he's not been prescribed Prascend! His blood count was 200+ - I still haven't got the correct total from them yet!
He was injected into the chest with the Tetanus and the blood was taken from his neck - and it was the site on his neck that was swollen.
The vet did suggest milk thistle so I know that's ok to give him - and he's on Cush X from Hilton Herbs which contains Agnus Castus to help with the cushings.
I try to keep my two boys as natural as I can and poo pick twice daily (yeah I know a bit over the top) and send in poo samples regularly to try and keep on top of the worm problem. They are both having a small amount of Dengies Healthy Hoof feed so I can put the supplements in (I will contact the company for advice on how much to feed given that they are turned out), a couple of light haynets now that the grass is going and turned out full time but with a field shelter. And I try to keep them as stress free as humanly possible!
I can manage his conditions just as long as I have the correct information - I was advised that he may suffer further off days (as he had the day after the injection/blood taking) and this was due to the liver damage - but from all the research I have done I can't find anywhere that the symptoms he had correlate to liver damage! The vet hasn't advised any further research/support .... basically said it was bad news for him and to expect the worse! Maybe I should find another vet to run more tests - especially now that I have more info
He is now seemingly back to normal - and thoroughly enjoying his buckets of food each day! He looks brighter and interested in the world again - which is great!
Thank you all for your comments - I understand his problems a bit more now - and don't feel that his situation to be absolutely desperate!
 
flintfootfilly said:
Haven't read the replies fully because I'm in a bit of a rush, but....

depending on where the first blood test was processed, they may well still have the remains of the blood sample. The lab that our vets use keep bloods for one week, but no longer. This gives a bit of leeway for testing the remains a second time or for carrying out different tests without having to take a second blood.

Chances are your blood will have gone to Liphook for ACTH testing to monitor the Cushing's, and I don't know how long they keep blood samples, but if I were you I would act quickly first thing Monday morning and contact your vet and ask them to contact the lab without delay to arrange for a profile to at least include liver enzymes, but I'd probably ask for a comprehensive profile just so you have as full a picture as possible of what's going on.

If you act quick enough (and manage to make sure your vet does!), then you may well be able to have bloods analysed from the initial sample, and that will tell you whether the liver was abnormal on that first day, or whether something happened after that point.

I really would stress to the vet receptionist that it's this first blood you are hoping to have retested, because it may mean someone from the office ringing Liphook straight away to ask them to retain that sample. If there's any delay in someone contacting Liphook (eg waiting for a vet to get back to you later in the day), then you risk the sample having been thrown out, and you lose the option of testing it.

Beyond that, I'm afraid I don't know, but everything I've said above would be my priority. It would be very useful to know whether the liver problem was present already, or whether it may be a (hopefully shortlived) reaction to the vaccination.

Sarah
Click to expand...

Wow Sarah - why didn't I think of that! - yes very first thing Monday I will be on the phone to them - I was going to contact them to get further info regarding the extent of the damage to the liver but completely forgot about the samples taken earlier - thank you!
 
I expect the lump is a haematoma from bleeding into the tissues at the site. Maybe because he resisted

Glad he's back to normal.
 
Oh poor pony! And poor you for all that worry. I can't understand the vets attitude of doom as far as the liver results go - but it does depend which enzymes are showing abnormality as to the prognosis but the vet really ought to explain. My horse showed abnormal liver enzyme results out of the blue, when being tested for gastric ulcers. He had shown no abnormal signs so it came as a shock, as it has for you. My vet recommended Ron Fields Remount which is herbal and supports liver and gastric things. He showed great improvement after a couple of weeks and enzymes were back to normal within the month. He will be on this now for the rest of his life ( vet recommends).
As far as your pony's head butting - I doubt it would be the swelling pressing on a nerve as you suggest. If it showed outwardly then its unlikely to be pressing inwardly too - path of least resistance etc! It could merely be that it was very painful and this was the pony's response. I am always concerned about vaccines and chemical wormers - our horses get so much. In the NHS they have started to say that once a human has had the required course of tetanus vaccine , then boosters are not needed - not annually - think its something like every 10 years? Anyway, its powerful stuff and with a Cushinoid horse it could have just overloaded the liver. I haven't witnessed a horse in extreme liver failure so couldn't say if the symptoms show real damage to the liver. The only thing I have seen in a very damaged liver horse was swelling behind the 'armpit area', under the belly. If he's ok now, then I would just try to forget the headbutting and look to support the liver with milk thistle and if you fancy, the Remount.
As far as the Cushings is concerned, I am trialling some fenugreek for my fatty who I think might have sugar metabolism problems. I got some useful info from www.naturallyanimals.co.uk - look under laminitis I think though it also mentions cushings. This is all natural rather than pharma. Fingers crossed.
 
Oh, forgot to say... why not give Liphook a call tomorrow as they would probably have someone in the lab for emergencies anyway. Or send an email tonight... but also phone.
 
The symptoms you described do correspond to liver damage, or 'Hepatic encephalopathy' which is a state of confusion due to liver failure:
http://veterinarynews.dvm360.com/dv...nd-diag/ArticleStandard/Article/detail/430414
"depression, head-pressing, circling, mild ataxia, aimless walking, persistent yawning"
I'd guess it was due to the vaccination though, and now his body has processed and begun to remove the toxins he's feeling better. Be good to give him a course of milk thistle anyway, and if you do get him tested again to see if his liver enzymes are still raised.
 
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I just wanted to let all those lovely people who enquired about the little shetland that he is alive and doing well!!!
It has even baffled the vet who expected his demise within a week due to the massive raise in the liver enzymes ... it seems that yes he has liver damage and the injection caused his little liver to go OTT temporarily - but with a addition of milk thistle to his feed and lots of tlc the little lad is (thankfully) still with us and enjoying life - he's been caught having a canter around the field on a couple of occasions!
Thank you again for all your advice and support - it helped me greatly during what was a difficult week!
 
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