PPID, Inflammatory Bowel Disease, Corticosteroids

Tracy H

Hello All,
Am a regular reader at ECIR Horse but have come here in case anyone has had a similar experience. 20 year old warmblood, very healthy and sound until late July of this year. Horse has always been excellent drinker with non stop appetite. Not super easy keeper, but well maintained on primarily pasture/hay and small amount of lowish 15% NSC grain. 

In late July, weight loss, starting to lose topline, slight lethargy, but big problem with thermoregulation. Significant sweating during both exercise and turnout. Water consumption way up but with sweating, probably good. No signs of laminitis inc. x-rays. Full blood chem, tick borne disease and ACTH bloodwork done 1st week August. All normal except ACTH at 99. (Cornell Lab) Run Insulin and Leptin (both come back at very bottom end of normal. Start on Prascend. Horse is know to be hyper sensitive to meds so slow titre over 10 days to 1mg. No adverse effects. Appetite excellent as always, and water consumption is normal. Improvement noted in thermoregulation after four weeks, energy level better, gained back a little weight. At 6 weeks of 1 mg (late Sept), retest ACTH. Result is 49. Plan is stay at 1mg thru December and then retest. 

Late October, horse begins to show odd drinking behavior. "Testing" or "playing with water" before he drinks.Has also stopped dunking hay which he does about 50% of meals. This is new behavior. Check mouth, try bottled water, etc. Nothing. Since consumption amount is fine, will discuss with vet at next visit. 

Three weeks ago, horse is still eating well but a bit more slowly, and water consumption stops overnight. Manure is a little dry. Call vet; to thwart possible impaction, feed and hay pulled, Prascend stopped, and three days of IV fluids and enteral fluids via nasogastric tube. Horse is only allowed small handfuls of wet hay as manure is still coming thru. Third day, oil passes. Horse is STARVING (at least in his mind) and finally at least drinks 1 gallon on his own. Day four restart Prascend at 1/2 dose and small small amount of hay. Horse is drinking on his own. Plan is stay 1/2 dose Prascend for four days and then go back to 1 mg. Two days later horse is exhibiting spasmodic colic during eating. Off to vet hospital. Abdominal ultra sound shows moderate to significant inflammation of small intestine. Scope shows no sign of ulcers, problems with esophagus, etc. but inflammation of of first part of small intestine is visible. Biopsy performed. Result show esinophils, likely caused by immune response to something, diagnosed as Inflammatory Bowel Disease. (explained as similar to what happens to people who have celiac disease if they consume gluten). Hard part is figuring out what the something is? Horse is now eating soaked timothy pellets, still on .50 mg Prascend and drinking at hospital.  Bad news is treatment is Corticosteroids. Obviously contra-indicated for PPID horse, but potential impaction due to inflammation is more dire problem. Decision to go back to 1mg Prascend and start steroids. Three days IV Dexamethasone then switch to oral prednisolone as it has a slightly lower risk for inducing laminitis. Horse comes home  doing okay and drinking, although with 6 soaking wet meals of timothy pellets, not enormous amounts. Then drinking stops. Attending vet is concerned that end of seasonal rise, Prascend dose might be the problem. Stop Prascend for two days. Day two horse drinks a little and is as bright and alert and famished as he's been for whole ordeal, scarfing the pellet soup down.  Restart Prascend at .50 mg. Next day, no drinking and eating slowly again.

FYI - When they were scoping him, I asked for a full check of his teeth, gums, etc. they didn't find anything.

Sorry this is so long but I am wondering....
1. Does anyone have experience with Prascend where drinking is more of a problem than eating? Whatever is going on, the drinking stops and he still eats but not the scarfing it down he usually does? I should say that this horse is as food motivated as they come. Eating is his life.

2. Like causes of the IBD are protein sources in grains or some other thing he ingests in hay or pasture....but could be medication. Has anyone had a horse with inflammation of the bowel related to Prascend dose?

3. Is it possible or likely that at this time of the year, he just needs less Prascend?

Thank you all so much in advance. Any insight is most welcome.

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