Page 8 - Winter 12/13

Do all Horses with Acute Grass Sickness need to be put down? By Juris Tolpeznikovs, FEVA Vice President, Latvia
Grass sickness is known to be a highly fatal disease of all equids. The disease was first described in the early 20th cen- tury in the British Isles. Even now, after 100 years of observations and research, little is known about the disease and there are few good treatment plans. Because of the poor prognosis and few options for treatment, almost all the sick hoses are put down. Obviously, if there could be any hope for saving the life of an affected horse, it will be highly appreciated.
Grass sickness has never been recorded in Latvia, although there are recorded cases in some neighbouring countries like Sweden, Finland and Germany.
CASE STORY
In February 2012, an 8 year old Latvian Warm blood mare got sick. Clinical signs were first noticed at 11 am, just after the morning meal. The owner mentioned that the mare was just “a bit off”. She was looking at her belly and breathing with difficulty. Rectal temperature was almost 40.0o C. The owner decided that this was just colic, and he gave her Nux Vomica (1). No improvement was noted and the owner called his veterinarian.
History: The mare lives outside at all times in a pasture and has free access to hay. There is no previous history of any other illnesses. At the time of occurrence outside temperatures were around 0o C and the snow depth around 20 cm.
Clinical Examination: Pulse 100 beats per minute; rectal temperature 40. 0o C; respiratory rate 40 per minute. Mucous membranes were red and moist. Nostrils were wide open. There was ptosis. The mare stood with her back slightly arched , with the front feet slightly back and the hind feet slightly forward. She was unwilling to move, but did not tend to go down or roll. The mare was depressed. She looked asleep with her head held low – the poll was held at the height of the withers or around 10 cm higher. The mare was trembling behind the elbows and at the stifle region. She refused any feed or water if offered. No defecation or urina- tion was seen at the time of examination and on abdominal auscultation there were no gut sounds in any of the four quadrants. No signs of laminitis were detected. Nasogastric intubation was not done.
Rectal Palpation: The uterus was voluminous (as if just after foaling, but the mare had never had a foal) and very atonic. Both ovaries were situated quite cranial and close to the midline. Intestinal loops were palpable and felt quite filled with liquid, although flappy (not distend- ed); all intestines were lying on the ventral
abdominal wall. None of the gut walls were thickened. .
Primary Diagnosis: Colic, paralytic ileus of unknown cause.
The prognosis for this mare was obviously quite poor. Since there are no equine surgical facilities available in Latvia to refer the horse for possible exploratory abdominal surgery or intensive care treatment, the owners were interested in attempting treatment by any prac- tical means. Our practice has recently been introducing homeopathic treatment and the owner was interested in pursuing this methodology. We strived to select the most appropriate homeopathic therapy in an attempt to save this mare. Initially, Bryonia (2) 30c was administered with no clinical effect, Opium (3) 30c followed.
After Opium there was a slight improve- ment in the appearance of the horse. She showed some more interest in her surround- ings and looked like she wanted to walk. She suddenly laid down, and looked brighter than before treatment. There was no change in the abdominal motility – still no sounds on auscul- tation at all.
At this point we researched the literature to develop a list of differential diagnoses. Grass sickness was selected as a possible diagnosis with grave outcome. Ptosis was used as a clue.
The homeopathic guide (4) described Gelsemium (5) as the first choice treatment for grass sickness. Gelsemium 200c was adminis- tered. Within 5 minutes some gut sounds were heard on abdominal auscultation. The dose was repeated twice every 15 minutes. After that, the mare looked much brighter. A dose of ‘Tramadol’ was given intravenously. Instructions were given to the owner to dose Gelsemium every 2 hours.
At a recheck evaluation approximately 16 hours later the mare was still alive and looked brighter Abdominal motility was auscultated in both dorsal quadrants. During those hours the mare had passed some hard faecal balls. After trying some other homeopathic drugs, which did not show much positive action, Gelsemium 1M (6) was selected (and given by the owner ). The response was quite remarkable, and Gelsemium was repeated at hourly intervals for 5 treatments . Following this course of treat- ment the owner found the horse to be com- pletely recovered. After a couple days where feed was withdrawn the mare was returned to the pasture with the other horses and free access to feed. This was not the regime as advised but the owner found it better for the horse. During the first days at pasture she twice showed mild signs of abdominal discomfort (the owner thought this was associated with
urination) but the signs disappeared after repeating a dose of Gelsemium.
After 14 days the mare had a relapse. She showed signs of abdominal discomfort, which did not respond to two doses of Gelsemium (200c and 1M). The mare was out in pasture with other horses, eating well, having normal defecation.
On clinical examination, pulse, respiration, and rectal temperature were within normal lim- its. The mare tried to urinate and could not uri- nate in a stream; she only dribbled. She had slightly reduced abdominal sounds on auscul- tation. She had reduced tail tone with almost no resistance to any sort of manipulation. On rectal examination the uterus and intestines were nor- mal, but the bladder was distended and atonic. During examination the mare appeared unsteady on her feet. Checking on the walk with a sway test she had very weak lateral stability. The mare had rear limb graded as 1/3. She was allowed to walk in a paddock and she soon laid down in lateral recumbency on the snow. The mare did not appear to be in pain, and appeared to enjoy being allowed to lie down.
Clinically her condition resembled cauda equina neuritis. Treatment was again homeo- pathic The treatment drugs were selected using quite simple homeopathic software (7). Sulphur 200c and Causticum 30c were given. At this time recovery was not as dynamic as the previ- ous time, but soon after dosing the mare appeared in a somewhat better mood. The owner was instructed on further
administration of these medications. Twelve hours later the mare was fully recovered from her ataxia and bladder atony.
DISCUSSION
It is very difficult to make an absolute diagnosis without more complete diag- nostic and laboratory support. In this case we made the diagnoses based purely on clinical findings. Although there are many sources in the literature that describe the predominant signs of grass sickness, no good case reports describing full treat- ments and outcomes were available. In this case not all the “classical” signs of grass sickness were present. No drooling of saliva and no patchy sweating were observed. The mare had a high fever, which is not regarded as characteristic of grass sickness. Atonic uterus is also not mentioned in descriptions.
Therefore, even if we cannot definitive- ly state this mare had grass sickness, the list of differential diagnoses is not expan- sive. Enteritis is a possible diagnosis, as she had signs of toxemia. Because of the outcome of this case, intestinal obstruc- tion is quite unlikely.
6
Continued on page 10