Hard swollen sheath


Donna Powell
 

Hello,
I've been getting great information and help from all of you here, but now I have a problem that I'm not sure how to fix.  I did try searching, but I didn't find an answer.  Ulysses sheath is swollen and hard on the left side. While he has had a swollen sheath it hasn't been hard before.  I can tell it bothers him at times as he will rest that leg.  I feel it could be either IR or CPL, Chronic Progressive Lymphodema.  How do I tell the difference and does it really matter if it can be fixed? And how do I fix this.  I had hoped that movement would resolve this, but it hasn't. If I call the vet it will mean steroids and antibiotics and I really don't want to go in that direction as that always seems to set him back.  He isn't too badly stressed over this, eating well, is finally going out of the stall after the March/April attack of the midges that torment him so.  Attitude great, bright eyed, full of himself if he thinks he can get what he wants. He isn't moving around much and has lost his alpha status recently to his younger (by 2 years) buddy.  His thrush has flared, but I think I have that getting under control.  Over all this year has been an improvement in his health, every year a little better, this year most issues were resolved quicker than in the past. I think it is due to being put on .8mg compounded pergolide, I noticed a huge improvement. At the end of February he started turning brown, I increased his zn/cu 3 times and he started getting black again and now in the last few days he is getting real brown again.
This swollen/hard sheath is has me worried.  What do I need to do?
Thank you,
Donna Powell, Beaufort, SC ECIR Mayt 2011 NRCPlus0214 NAT0414
ECHistory8

 




janieclougher@...
 

Hi, Donna - what a great case history; it really makes it easy to follow Ulysses' health issues.  I would have loved to have seen him fox-hunting!

I put this out there for your consideration (and Dr. Kellon, you may jump in and say I am out to lunch on this one) .  Some horses need their ACTH to be in the teens to be comfortable. I wonder if  doing a TRH stim test might give you some numbers that would allow your vet to feel more comfortable with increasing the pergolide dose. I do know that there are false positives with the TRH stim test.  This looks to me very much like a case of treat the horse and not the numbers - if increasing the pergolide to .8 mg helped, but he is still not quite right, then a trial increase would seem to me to be indicated. (but you somehow have to get your vet on board with this)

I do wonder about iron overload, since his hair coat browning keeps recurring, and resolves with increases in copper and zinc.

Otherwise, you are doing everything you can.  I am glad to see he is getting J-herb to help circulation (may help with the chronic progressive lymphedema) And it is very encouraging to see him improving, even if slightly, every year.  The thrush could be from the CPL, from not quite enough copper and zinc (I know his diet is balanced, but he may be fighting iron overload), or because he really does need more pergolide.

Meanwhile, back to the sheath.  Is it painful?  Is the one side warmer than the other? Will he tolerate some cold hosing at the same time as a massage?  That is standard treatment for many types of edema, whether in the limbs or elsewhere.  If it is inflamed fat due to IR, this won't make much difference, but if it is a lymph drainage problem it might help. If it persists or gets worse, you will have to call in your vet (but you don't have to go with the steroids or antibiotics if you know that sets Ulysses back)

He is one lucky boy to have you in his camp.


  ....Ulysses sheath is swollen and hard on the left side. While he has had a swollen sheath it hasn't been hard before.  I can tell it bothers him at times as he will rest that leg.....

Thank you,
Donna Powell, Beaufort, SC ECIR Mayt 2011 NRCPlus0214 NAT0414
ECHistory8

 




 

Donna - How bad are the deer flies in your part of SC?  Right now they are bad at my house in Summerville and poor Buster's sheath is swollen on one side also (he is not I/R or Cushings).  The deer flies seem to like the inner thigh and sheaths and udders.  Could it possibly be flies?  I've been spraying my herd twice a day.

Jean and Amber in SC
August 2004


Kerry Isherwood
 

Re: swollen sheath--

Dont mean to be dense, but could it be that he may need his sheath cleaned? One of my geldings gets quite uncomfortable when he's overdue & his sheath will swell on occasion. I have to clean him every other week in the summer, much to my delight (not...)

Sorry if the suggestionis painfully obtuse but sometimes the obvious stuff is overlooked :)

Kerry in NY
Sept 2014


Donna Powell
 

Thanks Kerry.  No, sheath cleaning is a regular happening around here.  No, it is something else.
 


From: "kerry.isherwood@... [EquineCushings]"
To: EquineCushings@...
Sent: Monday, June 8, 2015 9:05 AM
Subject: [EquineCushings] Re: Hard swollen sheath

Re:  swollen sheath--

Dont mean to be dense, but could it be that he may need his sheath cleaned?  One of my geldings gets quite uncomfortable when he's overdue & his sheath will swell on occasion. I have to clean him every other  week in the summer, much to my delight (not...)

Sorry if the suggestionis painfully obtuse but sometimes the obvious stuff is overlooked :)

Kerry in NY
Sept 2014

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Donna Powell
 

Jean, Thanks.  The biting monsters are not an issue, although if you trail ride one or two might attack.  Barn and dry lot are bug free for now.  With the departure of the midges, the biting monsters have not appeared.  Don't even need bug spray right now.
This is something that is new to him/us and started in the last 9 months or so and with exercise got better but with the arrival of the midges and no exercise has swollen, gotten hard and will not go down.  It is sore for him at times.


From: "JKemmerer@... [EquineCushings]"
To: EquineCushings@...
Sent: Monday, June 8, 2015 8:45 AM
Subject: [EquineCushings] Re: Hard swollen sheath



Donna - How bad are the deer flies in your part of SC?  Right now they are bad at my house in Summerville and poor Buster's sheath is swollen on one side also (he is not I/R or Cushings).  The deer flies seem to like the inner thigh and sheaths and udders.  Could it possibly be flies?  I've been spraying my herd twice a day.

Jean and Amber in SC
August 2004




Eleanor Kellon, VMD
 


---In EquineCushings@..., <janieclougher@...> wrote :

I put this out there for your consideration (and Dr. Kellon, you may jump in and say I am out to lunch on this one) .  Some horses need their ACTH to be in the teens to be comfortable. I wonder if  doing a TRH stim test might give you some numbers that would allow your vet to feel more comfortable with increasing the pergolide dose.
= = = = = = = = = = =

I know exactly what you're saying but an excellent natural alternative to the TRH stimulation is to check ACTH during the seasonal rise and his was only 28 last September. Also hard to believe that 0.8 mg pergolide could be doing much in a 1750 pound horse.  Also can't get too excited about IR when his insulin has always been under 11.

CPL won't involve the sheath.  I agree insect related or inflammation from infection (check between the sheath and the inner thigh) is much more likely.  Also agree that cleaning the sheath is in order.

The coat discoloration returning is interesting, as is the time frame.  This comes from either insufficient melanin pigmentation, or oxidation of the melanin.  Copper and zinc are important both for their roles in producing melanin and also in the antioxidant enzyme system superoxide dismutase which protects the melanin. Iron overload and oxidation by sunlight is probably the most common scenario but I have also seen the coat changes from other pro-oxidants like overexposure to pesticides and probably toxic minerals other than iron which can cause problems by displacing iron from ferritin and transferrin.

Thrush is commonly reported to flare with CPL, although the reason for this is far from clear.  CPL also goes hand in hand with mites and/or bacterial infections, presumed to be secondary but are they really?  Hypersensitivity/allergy to mites has also been mentioned.  If you put these things together with complaints about runny eyes and hypersensitivity/allergy to biting flies, a picture emerges of an immune system skewed toward TH2 responses (allergy, inflammation) and poor on cell medicated responses.

Boosting antioxidant capacity is important in controlling the symptoms and avoiding secondary damage to the immune system from exaggerated oxidative reactions.  Balanced minerals and vitamin E, flax, ALCar are central to this.  Jiaogulan and Spirulina also have antioxidant effects.

Supporting glutatione levels is also very important to antioxidant protection.  I usually use glutamine for this but in this case would suggest methionine 10 grams daily.  In addition to providing cysteine for glutathione production, you get detoxification potential.

Spirulina can also influence the immune system away from TH2/allergic responses but a dose of 3 tablespoons is much too low for this horse.  It should be increased to at least 7.

Might also consider the TH1 immunostimulator levamisole, 1 mg/kg daily, skip on weeks you give ivermectin.  There are several products sold as dewormers for ruminants or you can get the pure powder as packaged for aquariums:

99% Pure Levamisole HCl Powder

 



Eleanor in Pa
www.drkellon.com
EC Co-owner
Feb 2001


 


Donna Powell
 

Jaini,
Thanks for some good ideas.  I have hosed and messaged and it doesn't seem to make a difference...so must be inflamed IR fat.  It is painful at times.
I had thought that having his ACTH in the teens might help too.  Maybe the vet will go for a "trail".
 


From: "janieclougher@... [EquineCushings]"
To: EquineCushings@...
Sent: Monday, June 8, 2015 12:47 AM
Subject: [EquineCushings] Re: Hard swollen sheath

 This looks to me very much like a case of treat the horse and not the numbers - if increasing the pergolide to .8 mg helped, but he is still not quite right, then a trial increase would seem to me to be indicated. (but you somehow have to get your vet on board with this)

Meanwhile, back to the sheath.  Is it painful?  Is the one side warmer than the other? Will he tolerate some cold hosing at the same time as a massage?  That is standard treatment for many types of edema, whether in the limbs or elsewhere.  If it is inflamed fat due to IR, this won't make much difference, but if it is a lymph drainage problem it might help. If it persists or gets worse, you will have to call in your vet (but you don't have to go with the steroids or antibiotics if you know that sets Ulysses back)
Jaini (BVSc),Merlin,Maggie,Gypsy
BC 09
ECIR mod/support



janieclougher@...
 

Thanks for that totally awesome post, Dr. Kellon.  You da bomb!

(and I am blushing for missing the significance of the ACTH of 28 during the seasonal rise!)







 


Kathy Brinkerhoff
 

Hi Jaini,

Can you please expand on the significance of the ACTH of 28 during the seasonal rise for Ulysses.

Would you still recommend getting his ACTH in the mid teens?  

If a 0.8 mg dose of Pergolide is probably insignificant for a 1750# Draft should he even be on pergolide or should he be on a higher dose?!

I am not connecting the dots. :-)

Thank you,

Kathy Brinkerhoff

SE/WI  10/12









 


Kathy Brinkerhoff
 

Hi Dr. Kellon & Mods,

I did a search on Levamisole in the message archives and quite a few messages came up from over the years.  I would still like to ask how  you determine in which situations you should consider using it?   Do you use it year long or for just a limited course of treatment?    


Thank you.

Kathy Brinkerhoff

SE/WI  10/12




 


Sharon Manning
 

Hi there,
My guy Blaze had this very issue. I posted about it not too long ago.
When he was diagnosed for ppid and started on his compounded pergo it went down in just a matter of days. It was so large and hard lumps on both sides. One side being worse than the other. He looked like a volleyball with two testicles attached. He also had Edema in his chest area. He had gained weight during our very cold winter and he was already over weight. I measured his long coat and it was 5 inches long! When he got wet it would curl up. I new he was cushings as this will be my third horse but vet would not write scrip because his blood work was sent to Michigan state(false neg). It was really cold and that altered the numbers for everything looks like, esp. The thyroid. ((Think my vet would have known that)) but NO I had to find that out here$$$$. Vet took the lymph direction instead. Cleaned the sheath, said it was very dirty....(she must not know dirty...) Needless to say I asked dr k about the steroids before I gave them (thank god) and got my head together and weighted for the weather to warm. As soon as it stabilized at a fair temp I got the vet out again with all the directions for Cornell and tested again. As she was driving out the drive way I started him on left over pracasend. He was better in just a couple of days. By the time the vet confirmed ppid he was a different horse. She has now written a scrip for compounded and I can say after a couple of months he appears to have lost some weight but it could just be the reduction in edema. His sheath is much much better with still some hardness.(he is very obese) The swelling is all gone and no longer looks as if he is a stallion. He looks very good with the exception of weight and his personality has a little more of a spark. I stared him also on CoQ10 to see if that might help with the fat inflammation ( he has been on the recommendation diet for 6 plus years). I warn you it is expensive, so not sure I can keep it up but will let all know if it seems to help. Hope blazes story helps you.
Sharon
East TN
2006

Sent from my iPhone
Please forgive any errors


janieclougher@...
 

Hi Kathy,

During the seasonal rise, a PPID horse will have much more of an elevation in ACTH than a normal horse.   An ACTH of 28 in a horse during the seasonal rise (assuming he is not on pergolide) pretty much rules out Cushings;  while an ACTH during May or June, when it should be lowest, puts that horse squarely into the "Grey area; re-test during seasonal rise"  category. 

Since it looks like Ulysses had a mid-August ACTH of 28, it also looks like he is not Cushings.  My idea of using the TRH stim test was unnecessary because of this August result.

Therefore, he shouldn't be on pergolide; it is possible that the improvement of signs after the  introduction of the pergolide in October, and raising it .2 mg in January, is a coincidence/red herring. Ulysses has a lot of confounding factors, between the CPL and various allergies.

IF he was truly PPID, then under the circumstances I would recommend getting ACTH into the mid-teens if possible.  However, it looks like I was running down the wrong trail!

Regarding dose: as Dr. Kellon says, the correct dose of pergolide is the one that controls the ACTH.




---In EquineCushings@..., <kathbrink@...> wrote :

Hi Jaini,

Can you please expand on the significance of the ACTH of 28 during the seasonal rise for Ulysses.

Would you still recommend getting his ACTH in the mid teens?  

If a 0.8 mg dose of Pergolide is probably insignificant for a 1750# Draft should he even be on pergolide or should he be on a higher dose?!

I am not connecting the dots. :-)

Thank you,

Kathy Brinkerhoff

SE/WI  10/12









 


Sharon Manning
 

Holly cow that just went so fast and far over my head I'm dizzy! :-)
Think I will save that and re read about ten plus times.
Sharon
E tn
2006


Sent from my iPhone
Please forgive any errors


Donna Powell
 

Me too....and I'm the one who has the horse with the hard swollen sheath....still reading and digesting info....


From: "Sharon Manning partnernaturally@... [EquineCushings]"
To: "EquineCushings@..."
Sent: Tuesday, June 9, 2015 8:27 PM
Subject: [EquineCushings] Re: Hard swollen sheath

Holly cow that just went so fast and far over my head I'm dizzy! :-)
Think I will save that and re read about ten plus times.
Sharon
E tn
2006







Donna Powell
 

Am still struggling with hard swollen sheath on LEFT side only.  Have taken everyone's suggestions to heart which is why I am so long in responding to last postings.  I was doing what was suggested and needed the time to see if anything had any impact.

1. Sheath not dirty, gets cleaned regularly and de-beaned as needed...he is very easy to clean and de bean because of years of handling there. I also clean under the tail where it attaches to body and between legs and at the back of sheath. No odor.
2. Cold water hosing did not have any effect. He did not object to cold hosing, did not care one way or the other.
3. Exercise has not had any effect.
4. Vet has no suggestions.
5. It gets a tad bigger and then a tad smaller....overall not any change.
6. No heat and it does hurt him occasionally, he will flatten his ears at times, other times enjoys me scratching it gently.  He does rest that leg more then usual and of course more than the other hind leg.
7. His temp is normal.
8. Massage had no effect, massaged when he allowed which was/is more often than not.

Dr. K suggested a dewormer for fish tanks that I just today ordered, sorry do not have details and scared to leave this message and look it up for fear of this message disappearing.  Will start it when it arrives hopefully this week.

Just to remind, this started in March 2015...yes, at the beginning of bug season.  And has continued even though bugs are not a problem for the first time in years.  We did have the midge season, short and over with for some time now.
I am having trouble releasing the idea that he isn't a Cushings guy. I did get my vet to prescribe .8mg of pergolide, but I am told this is not enough for a 1750lb horse.  He did show improvement in all other areas of his health when he started the pergolide and did not have the veil.  Actually, he is having one of the best years yet with the exception of this hard swollen sheath.
I have not had time to update CH as I am struggling with horse issues, but it is mostly up to date...no new tests...just increases in J-Herb and I realised that originally I left off some of his symptoms of loss of top line, lethargy, course late shedding winter coat, excessive urination, periods of not sweating when he should be...all have improved with addition of Pergolide.  Sorry, hard to get it right with so much input to learn. In July LEFT ear started itching and is itching more now. He presents it to me and I almost dig for brain matter....ear is clean, no ich, no signs of bugs/mites no sores internally.

Now what can I do?
Thank you all for your input and suggestions, this has been a life saver for this guy.

Donna, Beaufort, SC 5/2011 GS NRCPlus0213 NAT0413

ECHistory8

 


 


Donna Powell
 

Dr. Kellon,

I have ordered the Levamisole HCI.  As to dosing...do I just stop it the day before I worm and not use it for 7 days afterward?  And is this something I do year round?

Thank you,
Donna, Beaufort, SC, 5/11 NRCPlus0213 NAT0413 GS


Eleanor Kellon, VMD
 




---In EquineCushings@..., <midnightstarulysses@...> wrote :

Dr. Kellon,

I have ordered the Levamisole HCI.  As to dosing...do I just stop it the day before I worm and not use it for 7 days afterward?  And is this something I do year round?
====================

Stop for 2 to 3 days before and after. Let's see if it has any effects after a few weeks and take it from there.

How is his coat color?

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Donna Powell
 

Color is brown brown brown and other shire is even worse. Ulysses's coat is brown, but not as brown as other shire, but is now has that allergy dusty look.  As of August 1, he and the other shire started to up the issues they were having....still better this year than in other years though.  (left ears itching, scratches and they do not go out on grass, increased appetite.)
Thank you for answering me and being such a huge help to my guys.
Donna, Beaufort, SC ECIR 5/2011 NRCPlus0213 NAT0413
ECHistory8

 


gchris fairbanks <cc.fairbanks0554@...>
 

I have one with a larger swollen sheath this year.i do the cold water ,downward slight massage,bug spray,antihitamine gel over counter.He seems better.this horse has skin issues,very sensitive.good luck~chris fairbanks,yerington,nv 7/15

On Aug 4, 2015 4:13 AM, "midnightstarulysses@... [EquineCushings]" <EquineCushings@...> wrote:
 

Am still struggling with hard swollen sheath on LEFT side only.  Have taken everyone's suggestions to heart which is why I am so long in responding to last postings.  I was doing what was suggested and needed the time to see if anything had any impact.

1. Sheath not dirty, gets cleaned regularly and de-beaned as needed...he is very easy to clean and de bean because of years of handling there. I also clean under the tail where it attaches to body and between legs and at the back of sheath. No odor.
2. Cold water hosing did not have any effect. He did not object to cold hosing, did not care one way or the other.
3. Exercise has not had any effect.
4. Vet has no suggestions.
5. It gets a tad bigger and then a tad smaller....overall not any change.
6. No heat and it does hurt him occasionally, he will flatten his ears at times, other times enjoys me scratching it gently.  He does rest that leg more then usual and of course more than the other hind leg.
7. His temp is normal.
8. Massage had no effect, massaged when he allowed which was/is more often than not.

Dr. K suggested a dewormer for fish tanks that I just today ordered, sorry do not have details and scared to leave this message and look it up for fear of this message disappearing.  Will start it when it arrives hopefully this week.

Just to remind, this started in March 2015...yes, at the beginning of bug season.  And has continued even though bugs are not a problem for the first time in years.  We did have the midge season, short and over with for some time now.
I am having trouble releasing the idea that he isn't a Cushings guy. I did get my vet to prescribe .8mg of pergolide, but I am told this is not enough for a 1750lb horse.  He did show improvement in all other areas of his health when he started the pergolide and did not have the veil.  Actually, he is having one of the best years yet with the exception of this hard swollen sheath.
I have not had time to update CH as I am struggling with horse issues, but it is mostly up to date...no new tests...just increases in J-Herb and I realised that originally I left off some of his symptoms of loss of top line, lethargy, course late shedding winter coat, excessive urination, periods of not sweating when he should be...all have improved with addition of Pergolide.  Sorry, hard to get it right with so much input to learn. In July LEFT ear started itching and is itching more now. He presents it to me and I almost dig for brain matter....ear is clean, no ich, no signs of bugs/mites no sores internally.

Now what can I do?
Thank you all for your input and suggestions, this has been a life saver for this guy.

Donna, Beaufort, SC 5/2011 GS NRCPlus0213 NAT0413

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