Since Cash came to live at Wyvern Oaks a little more than a year ago, we've been dealing with on-again-off-again diarrhea. He'd be a little loose for a few days, then fine for weeks. Or he'd have flat splats (gross) for a week, and then be loose for weeks before and after. He'd be fine for a month or two, then we'd start all over again.
With my vet's advice, I tried a ton of different things. I took him off ground flax and magnesium, both of which can cause loose stool. I gave him alfalfa. I changed hay. I stopped the alfalfa. I changed hay again. I tried turnout on grass, and no grass. I changed feeds. I had his teeth done. I had him checked for worms (none). I PowerPac'ed him anyway. I had him checked for sand (he had a little), then used SandClear as directed. I tried aloe juice, in case his stomach was bothering him. Some things seemed to make a little difference - for example, the SandClear firmed things up for the week he was on it, but once I took him off, he had diarrhea again. But for the most part, it would come and go with no explanation. So. Frustrating.
Finally, I wrote my vet a long, detailed email about what I'd done on which dates, and what had helped and what hadn't. Apparently, his on-off problems were quite atypical of the most common issues - sand and worms. Ulcers generally do not cause diarrhea, so my attempts with aloe were in vain. Some horses are sensitive to flax and magnesium, but since he was not on either of those, we could rule them out. And while he is older, he still has all his teeth and they are in good shape (except one), plus he is on a high-quality senior feed with lots of fiber, so diet should not be causing the problem.
We were left with two possibilities. The first was tapeworms, which Panecure will not get. I bought him a tube of Equimaxx and dosed him right away. The second was somewhat more worrisome, and also somewhat more likely, given his history of colic. Something, such as an entrolith, benign mass, or even cancerous tumor, could be causing inflammation of the cecum, which is where water is absorbed. Inflammation interferes with water absorption, resulting in diarrhea.
We talked options. A blood test is unlikely to show any abnormalities, since organs have to be something like 70% damaged before anything will show up in the blood. Ultrasound is out of the question, since you can't see that far into a horse. Exploratory surgery is really the only way to determine what's going on, but at 24, he is not a candidate. Besides, regardless of what the cause is, the treatment is the same: low-level steroids to reduce the inflammation. We started off two weeks ago with 10 Dexamathazol 1x/day, and tomorrow we go down to 1x/day. We'll probably try to get him to 1x every other day and then stop altogether to see if I can treat him only on an as-needed basis, but based on my vet's experience, that's pretty unlikely.
So far it's working - he hasn't had a single runny poo since we started the Dex. The good news is that it's working, and he's no longer at risk for dehydration... the bad news is that it's working, which means that there's something going on inside. My vet reassured me that he's had a handful of older horses with similar symptoms who have lived for years with low doses of Dex - he's treating a 27 year old mare right now. Frankly, I'm shocked Cash has made it this far, since we've had so many instances of really awful colic through the years (I actually went to the vet's to put him down once when he was 17, after an awful night where they thought he had ruptured his intestine. Somehow, he pulled through.). Plus, he's a pink-skinned horse, and it's pretty amazing we haven't dealt with skin cancer yet. And... have I mentioned that he's sound? Simply, totally, and completely amazing, against all odds!
Given all that, I'll take one pill per day, if it means he can keep doing cool stuff like this:
Photo courtesy of Azulox Photography. TW is aboard. Go Spotted Pony!