What's new on the Harv front?
First, I bought about 15 lbs of Equus Magnificus, his favorite gooey molasses ball treats. The box arrived yesterday and I fed him most of a bag last night.
Second, I called New Bolton for a phone consult. My goal was to find out how this might progress and whether he is at risk for bladder rupture.
The vet I talked to consulted with "a team" of more experienced vets, including a neurologist, and she called my regular vet. Then she called me back. I so appreciate their willingness to do this and that is why they are my go-to facility for tough problems. They said...
- Based on what they know (without doing diagnostic tests) they think Harv has Cauda Equina Syndrome or EPM. Both are neurological. It could be other things.
- Diagnosing EPM at their facility would involve a spinal tap. EPM treatment is $1200 to $1500/month. There is a cheaper treatment (Rebalance?) that is $280-400/month that is less well-known.
- Harv is not a likely risk for bladder rupture, as the urine will take the path of least resistance, the opening into the sheath, barring blockage.
- She advised against routine bladder flushing as too risky, and said it should not be necessary.
- The sediment that was in his urine is not uncommon or necessarily pathological.
- His incontinence could be caused by "not enough squeezey" in the bladder (my words) or by a spasm of the sphincter. These are treated differently, with different drugs. Drugs for the non-squeezey problem are expensive. Not sure about the sphincter issue.
- She suggested Harv be tested for Cushings, to see if it might be contributing to the progression.
- She suggested a low dose of steroids as a generic treatment to make him more comfortable.
- Harv's incontinence problem is fairly common (although it does not seem common from what I'm reading and talking to other people).
I'm going to have the vet out again to do a blood test and check his vitals in about two weeks. I'll talk to her about some of the drugs that NB recommended and ask about the steroids. I worry about laminitis and suspect that is why my regular vet did not recommend it.
I carry some guilt for choosing not to treat for EPM. If it were Riley, yes, I would at least consider it, not because I value him more but because he is so young, and he deserves to "have a chance" of living his life. Harv, my beloved old dude, will get the best care I can afford for him, but I can't go into that much debt for a treatment that may or may not work. I am thankful that Harv seems to be so comfortable and happy.
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There's a clinical study on the less expensive, newer EPM treatment: http://www.jarvm.com/articles/Vol10Iss1/Ellison.pdf
ReplyDeleteI think you're following the right path. My goal with the old guys is to keep them comfortable and happy without heroics.
ReplyDeleteYou have given, and continue to give Harv a wonderful life. IMHO it would be almost cruel to subject him to invasive testing and treatment. Palliative care really seems the way to go with making him as comfortable as possible, for as long as possible.
ReplyDeleteThey will probably want to test for Cushing before giving steroids. Cushings is an overproduction of steroids.
ReplyDeletehttp://ayearwithhorses.blogspot.com/p/epm-and-lyme.html
ReplyDeleteThe author of the blog above has three horses who have been treated for EPM. I doubt the treatment is as expensive as you described here. I believe the author would be more than happy to offer her input if you reached out to her.
Best wishes.
Had a similar situation when my old horse had colic and surgery was recommended. Fortunately, they were able to bring him around with drug treatment and his own determination. Sounds as if Harv is comfortable, and that's the most important thing.
ReplyDeleteI understand the guilty feeling you wrote about, we chose to do the same and instead focus on giving her a great summer and early fall (we said goodbye last November). Some folks were critical of our decision but I know deep down that we did what was best for her. We chose quality over quantity.
ReplyDelete