The dangers of texting your vet (sort of NSFW)

So I was texting with my vet yesterday about dexamethazone dosages for Echo for the pulse therapy we want to try for his headshaking. As I was texting, I noticed that my iPhone auto-corrects "dex" to "sex". Suddenly, my innocent medical questions took on a whole new meaning. This was the text conversation I *almost* had with my vet:

So, how much sex do I need to give him every day? How often should I give it? Twice daily or is it OK to just give it at night?

And then...

Can I order sex online or do I need to come to the office to get it? 

And this morning, after we got the dosage protocol from another vet:

I'll give him sex right now since it says to do so in the morning. Thanks!

Fortunately I caught the autocorrect before I sent the texts, but I texted my vet after to tell about the near-miss. At least she's got a great sense of humor!

And the hits just keep on coming - Echo has been diagnosed with Headshaking Syndrome

I was planning for this post to be cute pictures of the kitties, with lots of happiness to counteract my earlier posts, but it's not to be. I don't know what I did to piss of the universe, but seriously, I'm at the end of my rope. To top off Oberon's death, trouble with all three of our vehicles (which resulted in the very untimely purchase of a new truck), and 7 chickens dying in last week's heat wave, Echo was diagnosed yesterday with Headshaking Syndrome.

Insert a whole lot of four-letter words here. And crying. Lots of crying.

Remember this post about Echo's ulcers, where I mentioned that he was flipping his head and not eating? I got a video of him doing it. (Note that the stuff on the ground that he's eating is soaked beet pulp, which he had just dumped out of his tub. The green bucket on the fence has 2 scoops of soaked Senior feed in it.)

At the time, I thought this behavior was ulcer-related - that is, he was flipping his head and not eating because his belly hurt him too much to eat. Turns out, it's not ulcer-related at all. Instead, it's a syndrome where the horse involuntarily flips or shakes his head in a vertical motion. The tell-tale action is the sudden jerk, like a bee flew up his nose. Horses also frantically rub their noses/faces on anything, often causing sores or cuts. It most commonly occurs in TB geldings between 7-9 years of age. It can be seasonal, with summer being the worst time. The initial trigger is unknown -there are over 60 proposed triggers, but the research shows nothing concrete.

What causes the sudden jerk is a response to neuropathic pain along the trigeminal nerves in the face. Vets think it's a sudden, sharp pain like the pain of a migraine headache in a human. Can you even imagine trying to eat your dinner, and every time you try, it feels like someone is stabbing you in the face? Or when we take a break during a ride, every time we stop, he insistently rubs his head/nose HARD on his LF leg. I thought it was a bad habit from the track, but it's a symptom of Headshaking Syndrome. In fact, he rubs so hard and so often on posts, trees, ANYTHING, that he's got cuts on his nose. My poor, poor Echo.

I've been wracking my brain as to when this started. I called Adopted Horse Mom yesterday (in tears, ugh), and we talked about if he'd done it during the month he was with her (Feb 20-March 15). He had not. I was not able to ride much the first month he was here (March 15-April 15) due to a bite to the saddle area and his mangled RF hoof, so I would not have had the opportunity to notice anything during that time. I remember my first few jumping lessons on Echo (April 15th-ish), he flipped his nose a few times when we were first warming up, and Paige commented about flies. In between May 19 and July 1, I did a number of dressage lessons where Echo snorted and sneezed when we started working, and Jeanne commented about allergies. The frantic rubbing of his face has been pretty consistent since I started dressage lessons (I remember commenting to JD during our first lesson on May 19 that it seemed to be a habit). Then somewhere between June 28 and June 30th he wouldn't eat his dinner, and that's when I really started to get worried.

Then I started trying to figure out if anything had changed. He's on a ton of supplements so it's possible that one of those was the trigger. My vet wants me to take him off everything and stop feeding him hard feed, and provide him with an all-alfalfa diet. I am really, really hesitant to do this for several reasons:

• I've had a really hard time getting weight on him. He currently gets 15 lbs of Senior per day, including a bedtime snack. He got the same feed when he was at Adopted Horse Mom's and didn't show any symptoms, so I'm pretty sure it's not the feed. 
• The ulcer meds (Zantac and Omeprazole) I've been giving him have helped TREMENDOUSLY - he's back to his snuggly self, and we even had a nice grooming session the other night where I got all his itchy spots and he made silly faces (as opposed to him pacing frantically, pawing, wringing his tail, and trying to kick while I groomed him just two weeks ago). He's halfway through a six-week course and I'm afraid that if we quit now, the ulcers are just going to come back worse than ever and he's going to be even more miserable. Also, he was exhibiting mild headshaking symptoms BEFORE I put him on Omeprazole the first time, so it's very unlikely that it's the trigger.
• He doesn't eat alfalfa. I've tried pellets, cubes, flakes, and chopped. He won't touch pellets. The cubes he will eat if hand-fed as treats, but he won't touch them if they are soaked. He eats the leaves off the flakes and leaves everything else. He sort of eats chopped alfalfa, but only if it's mixed with Senior and only in small quantities. Also, for me to get 15 lbs of alfalfa down his throat every day, I would have to keep him in a stall during the day. He HATES being stall-kept, paces, and chews the walls, (even if I keep his BFF Cash with him) plus it's not good for his ulcers. I can't win.

I thought about when I'd seen him doing it, and figured out that he mostly won't eat his dinner. He generally polishes off his breakfast well enough, and his bedtime snack is no problem. I've seen him flip his head while eating hay too, during the day, but he seems to graze peacefully enough when he's out in the late evening. Many horses that are headshakers stop doing it when they are in a dark stall, because light exacerbates the problem. As a test, I went out this morning and fed a little earlier than usual, and left the barn lights off. Echo ate steadily, with no flipping or pausing - until the sun started to come up. I put his fly mask on in hopes that it would offer him a little protection, and after a bit of encouragement, he finished his breakfast, again with no symptoms. Last night I snuck out to the barn, again leaving the lights off, and watched him eat hay. No flipping or rubbing. Looking at my notes, his symptoms have also been markedly better during dinner time for the last several days, but we've had rain and it's been quite overcast. Given all these things together, I think his headshaking is caused by bright sunlight. I also think that since it started showing up in late spring/early summer, that it's seasonal. 

After reading everything I could about it last night, I'm pretty down. There are some treatments we can try, but most of them aren't very effective. Most horse owners seem to try a bunch of things and hope that one works. So here's the plan as of right now:

• I've ordered him a Guardian Mask, which blocks 95% of UV rays. If I'm right and his is photic, this should work miracles. 
• I've ordered him muzzle nets for riding. The constant contact of the net seems to help some horses - it's worth a try since I cannot ride him in a big mask at shows (assuming I have some hope of riding and showing him).
• We're going to try a dex pulse - four days of high doses of dex, every 21 to 28 days. It helps some horses, not others. It would be nice if it worked for Echo.
• Melatonin helps some horses, has low side effects, and I can get it OTC at Costco. However, it must be given at 5pm every day, year'round. It sort of fakes the horse out that it's always winter, so it can help horses that are seasonal headshakers.
• Long-term nerve blocks (lasting 2-4 months) seem to work in about 70% of cases. On one hand, I really like this option, because it means that Echo would be pain-free. On the other hand, he won't be able to feel his face at all, and that seems like a bad thing. 
• We may try cyproheptadine, which is an antihistamine and seratonin antagonist. It's definitely way down on my list of options, because side effects include colic and sedation. It's also a testable substance, and it sometimes work for a while and then stops..

So there you have it. I'd like the universe to please stop now. I'm usually really good at rolling with the punches, but I'm finding it really hard to cope. I am so physically and emotionally drained right now, I don't have anything left. In the grand scheme of world problems, I know this isn't that big of a thing, but right now it feels huge. I really hope that we're able to find a way to help Echo, and soon. It's hard to see him in pain.

Dealing with loss

We’ve lost two horses this year – Saga in January after several months of ever-worsening mystery lameness, and now Oberon, suddenly, due to a twisted and displaced intestine from gas colic. I’ve owned horses for 17 years (Cash is my first horse) and these are the first ones I’ve had to put down. Both were young, healthy, and in their prime. To say it sucks is an understatement.

The good news in both cases is that I have absolutely no doubt in my mind, no second guesses, that we made the right decision at the right time for both of them. In Saga’s case there was literally nothing we could do, which we knew when we put him down but the true severity of the situation was revealed via necropsy. In Oberon’s case, colic surgery may have helped him. I say “may” because there are no guarantees.  The reality of surgery is that while some horses do great, others take 6 months to a year to recover, or never fully recover. There are lots of second surgeries, complications, and plenty of deaths on the table. I’m not knocking anybody who chooses to do surgery, it’s an individual decision (and not an easy one), but it’s something that we are not prepared to do.

As for how I’m dealing with things, the answer is OK. Yesterday I was on-and-off sniffly and didn’t get much done at work. The outpouring of love from the people who knew Oberon has been incredible. My poor husband is, as you might imagine, very upset and raw. What makes it worse is that he’s on a ship in Alaska right now, and not even accessible by phone. Imagine sending your husband an email that goes something like, “Honey, there’s no easy way to say this, but your horse is colicking and has a displaced intestine. Surgery is the only option and we've already discussed not going that route. I’m so sorry. Let me know when you get this.” That’s probably the worst email I've written in my entire life. Luckily we did manage to chat for a bit via Gmail, and I sent him emails from my phone when we were at the vet in the final moments, so he knew what was going on. Still, not being able to say goodbye in person must be awful. I’m very glad I got to be with both Oberon and Saga at the end. I’m also glad that it was fast and painless. Thank goodness for small mercies.

I don’t think saying goodbye ever gets easier, but maybe it gets… I don’t know, more real? Many years ago I was faced with putting Cash down due to impaction colic. We drove out to the hospital where he’d been all night to put him down. I’d come to say goodbye to him, but when we got there he was more comfortable so we decided to wait. We stayed with him all day, hugging him, grooming him, just loving on him. Somehow, by some miracle, he pulled through. Since that day, I think I’ve accepted – really accepted - that our time with them is fleeting. You could literally, at any moment, have to make that decision. In that moment with Cash, it went from being a theoretical “this is what I’d do if I had to say goodbye” to a real, in-your-face understanding of what it’s like and what you have to do for your horse. I was on the edge of the cliff that day, and by the grace of whatever deity you believe in, I got to step back. But I've never, ever forgotten that we’re really always on the edge of that cliff, most of us just don’t realize it. You might have to step off it at any moment, and every day you don’t is one more to be thankful for.

Saturday night I hit that cliff when the vet said “gas colic with impaction and displacement”. I had to sit down. I knew what it meant, but we agreed to try fluids to see if the impaction would resolve and allow the gas behind it to escape and let the intestine move back into place. Oberon was kept comfortable the entire time, and was feeling good enough at the end (due to the drugs) that he had some carrots, acted like his usual annoying self, and gave me a "hug" when I gave him a last hug from his dad. Sadly, medical treatments weren't enough – the displacement included a twist that we didn't know about until the necropsy was performed. But in the end, it wasn't a hard decision to make - it was the only one to make, because we’d already made it. There was a certain peace in knowing that we knew what we were going to do, because we’d discussed it before.

So I guess… be as prepared as you can. Really think about it and plan for it… it’s not fun, but it’s easier to make decisions ahead of time than try to make them when emotions are high. Know what you’re going to do, and know what your limits are. Try not to second guess yourself. Listen to your vet and your horse, even though your heart is breaking.

And give them one last hug. Every damn day.

Oberon: June 1 2002 - July 14 2013

Colic takes too many of them too fast and too young.

Rest in peace, Oberon. I hope that wherever you are, the bucket of treats is bottomless. 

Echo's ulcers are giving me ulcers

When Echo first arrived at Wyvern Oaks, I was concerned that he had ulcers. He pawed, he chewed his lead rope, he hated being groomed. He wasn't a very good eater, and despite getting huge quantities of high-quality senior grain, you could see every rib. Ulcers can manifest themselves in a number of ways and these were all on the list, so I chatted with my vet about options. We discussed scoping but because hind gut ulcers can't be seen on a scope, opted not to do that. Instead, we decided to try the cheap form of omeprazole, the active ingredient in GastroGaurd. They are fondly known on CotH as "blue pop rocks", and are the granulated, coated form of the drug. We also threw in some magnesium and aloe juice, both of which coat the stomach to help relieve symptoms. Plus, he was out on 24/7 turnout with hay and/or grass in front of him at all times.

After a month of treatment, Echo was a different horse. He had almost completely stopped pawing, even in the trailer. He didn't bite his lead rope. He was fine with being groomed, and had gotten really good about picking up his feet. He was polishing off all his food and was looking plump and fit at the hunter show last weekend. I'd stopped with the omeprazole and was just using the aloe and Mg for maintenance, and was patting myself on the back about being such a good horse mom and all.

And then last Thursday, he wouldn't eat his dinner. Kept acting like he was going to take a bite and then flipping his head. It was the strangest thing - I wish I'd gotten it on video. After an hour he'd only eaten half of his feed. Argh. I started giving him omeprazole again the next day.

This weekend, things got worse. He pawed in the trailer whenever it was stopped. He pawed like a lunatic in the barn aisle, no matter how many times I yelled at him to quit. Not only did he chew his lead while I groomed, he started chewing on the wood half-walls. He pinned his ears, wrung his tail, and kicked out while I was grooming him. Awesome. Practically overnight, there were ribs that hadn't been there a week ago. I noticed chew marks on the water troughs when I went to scrub them out Sunday afternoon. Horses with ulcers often chew things in an effort to find some comfort, as the saliva produced by chewing helps to neutralize stomach acid. I felt like the worst horse mom ever, for him to be in that much pain.

I put a call into my vet first thing Monday. We discussed symptoms and options, and agreed that we're going to have to treat him again and then put him on a maintenance dose. I also asked about using ranitidine (Zantac) to help make him feel better while the omeprazole works. See, ranitidine inhibits acid production, but only for a brief while, whereas omeprazole is a proton pump inhibitor. So omeprazole actually helps the ulcers heal, and Zantac helps reduce the pain while they're healing.

Soo, starting last night (Monday), I began giving Echo 20 crushed ranitidine pills on top of a small serving of grain, about 30 minutes before mealtime. This helps give it time to work, with the idea that eating won't be painful. And either it works miracles or the omeprazole has started working, because he polished off his dinner for the first time in several days. Breakfast and dinner today have been likewise consumed, thank goodness. I've ordered more omeprazole, and we'll likely do a 6 week course this time, then see about doing a maintenance dose or using a supplement like SmartGut to help him. He'll likely get ranitidine tablets and probably the treatment dose of omeprazole any time we haul - which is pretty much every weekend, since I haul to lessons.

As for how to change his lifestyle so that he's got less stress in his life, that's a hard one. He's out 24/7 with hay or grass in front of him at all times. We've had a bit of a hectic schedule for the last three weeks, with two shows and an XC schooling session, so I probably need to cut back a bit there. Still, I try to haul to at least one, sometimes two, lessons per week, so that will be an ongoing concern. Hopefully we can come up with a long-term maintenance plan that works for him and doesn't stress him out too much.

At least Costco carries large bottles of ranitidine for cheap? Because seriously, I may start taking it myself.