Why do steroids make some horses worse?

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Silverfire

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My filly has just had 2 weeks of Prednisolone (for thickened intestine/daily low grade colic) and she is worse now than she was before she had it. Ive googled Prednisolone and read lots of things about the benefits of it and also done a search on here, but nothing says why it makes some horses worse. Vet treating her is away at the moment so can't ask him. Anyone know why it makes some horses worse? Thanks for any replies.
 
don't know if its horses specific, my dog was on high dose steroids when she had meningitis, they bugger the kidneys up - long term, i expect they upset digestion too. Try a pre/pro biotic to keep the tummy calm when on drugs. Global Herbs are a great company, have a look at their website
 
Dab said:
steroids kill off the good bacteria in the hindgut, for a horse with intestinal problems this is a very bad thing. get a 2nd opinion now!
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Sorry to be blunt but this just isn't true.

OP: Your horse's condition may be getting worse and might be even worse still without the steroids. It could be that a higher dose is needed, or a different steroid. There are sometimes concerns that an inflamed gut will not absorb the drug properly, and giving steroid by injection for a few days could help. It is also possible (although unlikely) that he is experiencing side effects from the drugs that are appearing in a similar way, although a short course of prednisolone is unlikely to do that.

What were the original signs of disease, what investigation was done, and what signs are present now?
 
alsiola said:
Sorry to be blunt but this just isn't true.
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Ok thanks, i'll go back to talk to the vet who told me this at a lecture this weekend! Can you tell me why you bluntly think this is not the case?


OP have you asked or talked to your vet about hindgut ulcers, as these maybe linked to thickening of the intestine wall, in which case steriods as i understand is not the way to go. Find a vet who has some knowledge about hindgut ulcers.
 
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Dab said:
Ok thanks, i'll go back to talk to the vet who told me this at a lecture this weekend! Can you tell me why you bluntly think this is not the case?
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Please do go back to them and ask them to show you the published evidence to back up their claims. They will struggle, and that is the reason that it is not the case, because no-one has ever shown it to be the case. Steroids have 3 major effects on the hindgut:

1) Reduce macrophage migration from the bloodstream to the gut wall
2) Reduce expression of inflammatory mediators via DNA/RNA regulation
3) Reduce prostaglandin synthesis leading to fewer mucosal antibodies

Although these effects can alter the microbiome of the hindgut, this is not mediated by killing bacteria, and is rarely if ever clinically significant. Steroids are exceptionally useful drugs, and the one of the few effective treatment options for inflammatory conditions of the intestines, so to make bold statements implying the treating vet is making a blunder is misleading and may result in withholding or delay of treatment for the horse.
 
Agree with alsiola - steroids are not just used by vets for this purpose but are also used by doctors and consultants to treat/manage inflammatory intestinal diseases in humans such as Chrones disease.
 
I recently read a post on steroids on another forum, which suggested that there are some serious side effects of steroids that vets do not seem to discuss with clients when recommending them. The post in question was relating to use of corticosteroids in joints, so not sure whether it would be applicable to usage for intestinal conditions, but I found the post very interesting. Below is a quote, full thread can be found here: http://phoenixhorse.myfastforum.org/about1678.html

Corticosteroids inhibit the synthesis of proteins, collagen, and proteoglycans in articular cartilage, by inhibiting chondrocyte production, the cells that comprise and produce the articular cartilage. The net catabolic effect (weakening) of corticosteroids is inhibition of fibroblast production of collagen, ground substance, and angiogenesis (new blood vessel formation). The result is weakened synovial joints, supporting structures, articular cartilage, ligaments, and tendons. This weakness increases the pain and the increased pain leads to more steroid injections. Cortisone injections should play almost no role in sports injury care. Although anti-inflammatory medications and steroid injections reduce pain, they do so at the cost of destroying tissue.

In a study conducted by Siraya Chunekamrai, D.V.M., Ph.D., steroid shots, of a substance commonly used in humans, were given to horses. The injected tissue was looked at under the microscope. The steroid shots induced a tremendous amount of damage, including chondrocyte necrosis (cartilage cell damage), hypocellularity (decreased number of cells) in the joint, decreased proteoglycan content and synthesis, and decreased collagen synthesis in the joint. All of these effects were permanent." .
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alsiola said:
Steroids are exceptionally useful drugs, and the one of the few effective treatment options for inflammatory conditions of the intestines, so to make bold statements implying the treating vet is making a blunder is misleading and may result in withholding or delay of treatment for the horse.
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OK but the 'cause' of the thickened intestine needs to be identified, if for example this is caused by ulcers or some other cause then treating with steriods would possibily not be the right way forward.

What happened to diagnostics? and finding the primary cause and treating that rather than just treating the effect?
 
Dab - How many owners actually allow vets to do the further diagnostics that will allow a cytological/histological diagnosis and are willing to pay for them? Very few! Also, procedures for diagnosing intestinal disorders in equines are fraught with risk and in comparison to other species ( humans included) - exploratory laparotomies are rarely performed for many reasons, not least the danger of equine anaesthetics. Equine medicine is limited by many things but by far the biggest limiting factor is the high cost of diagnostics/ treating animals that are essentially a "luxury".
 
alsiola said:
Sorry to be blunt but this just isn't true.

OP: Your horse's condition may be getting worse and might be even worse still without the steroids. It could be that a higher dose is needed, or a different steroid. There are sometimes concerns that an inflamed gut will not absorb the drug properly, and giving steroid by injection for a few days could help. It is also possible (although unlikely) that he is experiencing side effects from the drugs that are appearing in a similar way, although a short course of prednisolone is unlikely to do that.

What were the original signs of disease, what investigation was done, and what signs are present now?
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Thank you for your replies. Filly has a thickening in a band (by her small colon i think he said), Vet felt it while doing rectal 4 weeks ago. But don't know if she has something else thickened elsewhere, as back in May she had an abdominal scan and the walls of her duodenum were thickened, another scan just over 2 weeks later and this had gone, but scan only shows so much so no way of knowing if there is more small intestine thickened that we couldn't see. She had another scan on her intestines 5 weeks ago and there was nothing unusual. Only diagnostic test left they can do is an exploratory laparotomy, a lot to put my filly through and a huge expense with no guarantee they will find anything, or if they do find something that they can fix it.
Filly is colicky while eating, mostly feeds but also on haylage, hay and grass. Its been going on many months. She will eat half her feed then walk away from it, sometimes she will go back to it 3 or 4 times for a few mouthfuls but eventually she just leaves it. Or she will eat half of it then start holding her legs up against her belly, before walking away from it. Some days she is colicky on and off all day, but she has never had a serious colic episode, its only a mild type of colic, but everyday. Gastrogard makes no difference to her, and she was scoped a few months ago with no ulcers. The only thing that we have given her that has improved her is Doxycycline, she had 8 weeks of it during April and May and the last 5 weeks on it she was eating her feeds fine and had no colic signs at all at anytime. When she finished it she was okay for 4 days then started walking away from her feeds, by 7 days was holding legs against belly and gradually over next week or so went more colicky again, exactly the same as before. Although an antibiotic Doxycycline is apparently a good anti inflammatory too? so we think that's what it was doing for her, so steroids should be even better?
I had 500mg Prednisolne to give her for 14 days, but i only gave her 11 days at 500mg, then 6 days at 250mg as she was getting very strange on it. She was eating haylage okay first 2 days, then for next 7 days didn't eat much haylage at all and wasn't that interested in her feeds. She went very quiet, was lying down bit more than usual, breathing fast while lying down, looking at her belly lots. After the 11th dose her neck seemed very hard and she had a strong digital pulse which i can't normally find, she was stumbling a bit while walking out and very, very quiet so i only gave her 1 sachet a day from then on and i couldn't find the pulse next day and her neck isn't as solid now. She was a bit more interested in her feed then, but was only eating half the feed as usual, held legs up against belly and then lying down. She had also gone very itchy last week and still is today. On Sunday she was lying down on and off all day, looking at her belly a lot while down, and quite a few times breathing quite fast. She had the last of the steroids Sunday eve.
Today she hasn't been lying down as much and seems more her normal self. Still only eating half her feed, still colicky eating it/after it, still itchy. She is 25 months old. She has a distended abdomen which she has had for a few months now. Since Sunday/Monday it has looked a lot bigger. Could some of this just have been side effects?
 
Dab said:
OK but the 'cause' of the thickened intestine needs to be identified, if for example this is caused by ulcers or some other cause then treating with steriods would possibily not be the right way forward.

What happened to diagnostics? and finding the primary cause and treating that rather than just treating the effect?
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Dab said:
What happened to diagnostics? and finding the primary cause and treating that rather than just treating the effect?
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We have no idea what diagnostics have or have not been done in this horse, but in general, diagnosis of equine intestinal disease is extremely challenging. In the awake patient we are limited to the proximal and distal extents of the GIT. I.e. we can gastroscope and take duodenal biopsies, and we can take rectal biopsies. Unfortunately the middle 95% of the bowel is inaccessible, and predictably this is where 95% of the disease is. Ultrasound is a useful tool and will tell us if there is thickened bowel wall (given of course it is not hidden behind gas filled colon at that particular instant), but rarely will give us a cause.

In dogs, cats and humans a lot more can be done endoscopically due to their smaller size and the nature of the digestive tract. Equally, when this is unsuccessful, full thickness biopsies can be taken at surgery. Again, the horse and its relatively unique anaesthetic concerns make this a much more serious proposition.

We also have to look at the diagnostic yield of these tests, and ask ourselves the most important question: will this test change what I do? If it won't change anything then the test should not be done. The two major categories of chronic intestinal disease with bowel wall thickening are inflammatory conditions and neoplastic conditions. In the former steroids are the definitive treatment. In the latter, there is no definitive treatment but steroids can have significant positive effects in the short term. Hindgut ulceration does not typically present as a chronic low grade colic, the signs are of acute colitis, including dehydration, diarrhoea. There are also usually obvious historical factors (e.g. recent high doses of non-steroidal drugs).
 
Filly doesn't have cancer or anything to suggest neoplastic conditions at the moment, that's what was being looked for on rectal 4 weeks ago because of a just above normal calcium test. A different test for calcium was sent off and came back normal. SAA test done at same time was normal too. White blood cells normal but again too many lymphocytes, slightly anaemic, normal fibrinogen, liver and kidneys normal.

Blood and peritoneal fluid was tested for leukaemia in Feb, nothing found. She was gastroscoped, nothing found. Not done any biopsies. Didn't do a glucose absorption test because when she started eating again she put weight on really quickly and her condition today is very good.

Filly just stopped eating 8 months ago (17 months old), had a temperature first day only, was very quiet, mildly colicky. Had bute and antibiotics for 8 days, wormed with panacur 5 day just in case, (had already had equest 6 weeks before) still wasn't eating much, after finishing antibiotics/bute she did start to eat bit more haylage but wasn't interested in feed, she would sometimes look at her belly . Nothing in bloods except anaemia. After about 8 weeks of only eating one net haylage a day and picking at feeds tried her on gastrogard, while on this she started doing the colicky stuff. Bloods then just below normal protein, still anaemic, white blood cells normal but too many lymphocytes. Was scoped then and found nothing, belly tap normal except too much of it and too many lymphocytes. She was very gradually losing weight from not eating enough. She has never had diarrhoea or colitis, and never had bute before this started. Tried Prednisolne (250mg) and after 6 days she seemed worse so went on doxycyline in case of bacterial infection. After 6 days doxycyline she started eating (also day 12 prednisolone), she was still bit colicky on and off but she was much better and eating properly at last. Had 4 weeks doxycycline altogether, only did 14 days Prednisolne. Finished doxycyline (mid March) and wasn't too bad first week but by end of second week was lying down lots and very colicky again. So i asked if she could go back on the doxycyline because at that time she had a positive blood serology test for a bacterial infection foals get that she was too old to have (and that i now know by testing some of my other horses that she was possibly exposed to 18 days before all this started.) After another 8 weeks doxycyline during April and May (first abdominal scan was done after 6 weeks doxycycline) and seeming better for 5 weeks she is now almost the same as she was back in March.
These steroids have done nothing for her that i can see.
 
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Silverfire said:
My filly has just had 2 weeks of Prednisolone (for thickened intestine/daily low grade colic) and she is worse now than she was before she had it. Ive googled Prednisolone and read lots of things about the benefits of it and also done a search on here, but nothing says why it makes some horses worse. Vet treating her is away at the moment so can't ask him. Anyone know why it makes some horses worse? Thanks for any replies.
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I never updated this. I forgot to put in my original posts that Silverfire was also quidding a great deal due to diastemas. I later found out - after talking to a specialist -that the problem with steroids is that if a horse has an infection anywhere in its body then steroids will make this worse. They also increase blood flow and they also slow the movement of food through the gut with the side effect of constipation, which is not good in a horse already living with an impaction or in a horse quidding on hay because half chewed food then moves slower through the horses gut putting it at risk of impactions. Food packing into diastema can make gums very sore which can lead to gum infections. Combine all that and you can get an idea of why steroids had a bad affect on my horse Silverfire.
 
Its now October 2017, five years since those posts were written. After that Silverfire had 7.5 months doxycycline and showed almost no colic signs apart from twice while eating feed, she had the doxycycline to treat that thickened bit of gut which was thought to be causing her problems. After that last post in July 2012 Silverfire had a rectal exam, the thickening was still there as when vet touched it she leapt in air, then she spent two and a half hours lay down in her stable repeatedly yawning, looking at her belly, breathing fast in pain and sweating. This was eight days after finishing steroids and she had been on doxycycline those eight days at time of rectal exam. It was nine weeks later before she could eat feeds all in one go, then she could eat as much feed as she wanted but then a week later she could no longer chew hay...she just quid and quid and quid... So then she had to live on soft feeds for next couple months, just aswell she could eat feed okay by then else she would of been in trouble. She had diastema and peripheral caries and these were apparently reason she couldnt chew hay even on doxycycline and metacam. But eventually the quidding got a bit less and she could eat hay even if she quid a lot. That was sort of sorted in March 2014 which if you are interested you can read about in my other post about diastemas.
The thickened bit of gut was felt five times by original vet last time being Sept 2014. A different vet last year couldnt find it so dont know if she still has it. I no longer use the original vet.
Im just updating a few old posts in case they are ever any use to anyone in the future because everything I write in my posts is true, whether everything I've been told by vets is true is another matter...
 
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Yes, Preds only mask a problem and do not actually deal or cure a problem, my husband has been on Preds on and off for years with serious side effects, not only for health but also behaviourally as well. As well as having horses we also own a cattery and kennels and always try to avoid Preds at all costs and seek alternative medication be in conventional or holistic. If you do have to use them you should wean on them and wean off them very very slowly. Horrible stuff, would avoid them at all costs.
 
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