COPD Explained, Part 3: Medications and Supplements

In continuing with my COPD journey and learning how to best help and manage my respiratory affected horse, I wanted to share what I have learned over the last few years and what kinds of options there are available on the market. 

In terms of providing medication for a respiratory compromised horse, it is certainly up to you and your Veterinarian to discuss an ethical and sustainable treatment plan, as there are an abundance of drugs and dosages that are available. As on owner, it doesn't hurt to be educated and know the general gist of most medications and what they do. I find it simplifies things, as Vets are not always able to get it right the first time and with COPD, it truly is a dance of trial and error. 

Being able to follow your horse's diagnosis and treatment plans without seeing gibberish is exclusively important - being able to understand the pros and cons of each and every medication not only allows for you to make the best possible choice for your horse, it helps you understand what to expect or what is considered abnormal.

This is not a complete list - I'm sure over the years there will be more information and more medication that comes to light. Science is ever evolving and I don't claim to know every single thing about COPD or respiratory conditions - I simply have been unlucky enough to experience first-hand in my own horse and have put in the time to understand and research the condition.

I don't have all the answers, but I try to do the very
best I can for my mare.

First things first - always consult with your Vet. Period. 

Playing around with medications and monkeying around with dosages is scary and can lead to additional problems for your animal, so read and utilize this information at your own risk.

That being said, there are a few different medications that you might see be used in your horse's life after being diagnosed with COPD. These medications can be grouped roughly into 5 different categories:

Mixing meds on the way to the barn - not 
weird at all!

1. Antibiotics

Antibiotics are used to treat bacterial infections - some fight a broad spectrum of bacteria, while others are more specialized and focus on a singular bacteria. Simply, they work by killing or decreasing the growth of certain bacteria. With respiratory issues, it's important to recognize if it is due to a bacteria, fungus, or viral infection in order to determine which antibiotic would be useful (or if an antibiotic would be useful at all).

I could rattle off a list of antibiotics and what they do, but I admittedly am not as well-versed in them as I am with bronchodilators and steroids. However, Uniprim, Excenel and Excede are all very common prescriptions. Some are injectables (Excenel and Excede, exclusively) while others are oral (Uniprim). There are other antibiotics on the market that can be administered via a nebulizer, which can be doubly helpful in ensuring the medication is delivered deep within the lungs. It is best to discuss this with your Vet before attempting to nebulize, as not all antibiotics are created equal.

We used primarily albuterol with mixed results - it 
seemed to help short term, but because her symptoms are 
not shortness of breath, it didn't seem to really make a 
huge impact on her overall condition.

2. Bronchodilators

As the name suggests, it is a medication that opens up (dilates) the breathing passages by relaxing the bronchial muscles. They are often used in a situation where the patient is wheezy, breathless, or is experiencing chest tightness. Common bronchodilators include: albuterol (salbutamol), clenbuterol and the less commonly used ipratropium. 

Some owners may be more familiar with clenbuterol's trade name, which is Ventipulmin. This drug can be administered as a injectable or orally in a syrup-style formulation. 

The marest face of them all.

3. Corticosteroids

Corticosteroids are used to fight inflammation which can be synthetically manufactured or produced in the adrenal cortex. They act by lowering inflammation in the body by reducing the production of certain chemicals. While they are effective at reducing the inflammatory response, they are also known as immunosuppressants (ie. cause the body not to fight infection or function as appropriately as it should be).

Steroids should be used with immense caution, as they can predispose certain horses to laminitis and founder, especially when injected. I've learned that nebulized or inhaled corticosteroids are "safer" than injectables because they simply target the lungs whereas injectable are processed throughout the entire body. However, there is scientific findings that nebulized steroids are better suited to "mild" COPD cases whereas injectables are appropriate for more "severe" cases, as the injectable provides relief more immediate than the inhaled steroids.

With my own experience, I found Annie had a lot more abscesses than usual when we were attempting to manage her with steroids. However, this could also be attributed to the fact it was a rather wet year that year as well. Regardless, it definitely made me pause.

Perhaps the most famous steroid most horse owners will be aware of is Dexamethasone. It comes in injectable/ inhalable and oral forms. 

Knowing what "normal" is for your horse is so important.
Getting familiar with their mucus (if they have any discharge),
what it looks like, and when it worsens are all important.

4. Mucolytics

Mucolytics have one job - they increase the output of secretions from the lungs by thinning the mucus. This can be especially helpful for horses who, like Annie, have a build up of mucus and gunk in their lungs whenever they flair. 

There are several different types of mucolytics that are on the market - some are inhalable and some are oral. I have only had experience with Sputolysin which increased an uncomfortable amount of mucus and seemed to clear a lot of gunk from Annie's lungs in a short period of time. Unfortunately, at least for my area, it is an expensive drug, but it works really, really well. 

I've also utilized saline solution (0.9%) in the nebulizer, but did not find it as effective as the sputolysin. 

I should've done a photo of alllll the supplements 
I've tried, but I don't have all of them anymore and
some have since been discarded and/or rehomed.

5. Supplements and "Other" Medications

A lot of what maintains a COPD horse can be attributed to the supportive care and maintenance they receive. While one horse may need nebulized steroids, another may be well supported on a variety of scientifically proven supplements or other medications. 

Keep in mind that there are SO MANY supplements out there and not all are created equal. I strongly encourage anyone to stick to basic products (ie. pure products) to avoid introducing a potential irritant back into the horse's diet (which is why I strongly encourage allergy testing). 

Some good supplements or other medications to consider are the following:

a. Antihistamines - this can be over the counter/ human-grade, but know that the active ingredient must be cetirizine hydrochloride. I've used Zyrtec in the past for Annie, but unfortunately it doesn't seem to do much in her case. Regardless, I've found that its a good 50/50 shot if it'll work for your horse. They're relatively cheap (especially if you live in the States) and although they are a bit of a pain to administer (2x a day), it can be a cheap and easy way to manage COPD symptoms.

b. Jiaogulan - a powder that increase blood flow and supports respiratory health. Typically advised to go hand in hand with spirulina.

c. Spirulina - a powder that is rich in blue-green algae that provides help with the respiratory system and immune system. I did use this with Annie in her early diagnosis stages and did not see an improvement, but we were still fussing around with what worked and didn't to be really sure.

d. Respi-Free - a liquid that contains several different herbs and supportive antioxidating items. I've used this with good results in the past with Annie.

e. Vitamin E - All-around good supplement that supports a variety of functions. In respiratory health, vitamin E supports the immune system and in turn, the lungs themselves. Because most horse owners feed hay, often times their horses are low in vitamin E, as pasture is the only really good source of vitamin E. Additionally, vitamin E helps reduce phlegm (something I am going to be utilizing in Annie! I'll report back with my thoughts!).

f. Cough Free - A supportive pellet that has a lot of good herbs, but also things like flax and oils. I did use this in Annie before I became aware she was allergic to flax. These pellets STINK. They took forever for Annie to even begin to eat and by then we were almost done with the container. I've heard they work for some horses, but again it did not work for me and my circumstances.

g. Air Power - This is a liquid that provides relief for coughing. It is not necessarily meant for long-term use, so is better utilized (in my opinion) in very, very mild cases. I've used it in both horses and it's worked well, but I saw it worked more in Spud than it did in Annie for the circumstance.

h. Aleira - This is a supportive powder that has a mixture of omegas, vitamins, and herbs. While I haven't used it personally, there are rave reviews on a lot of the COPD forums I'm on about this particular supplement. This supplement, in comparison to the one below, is DHA (omega fatty acid) heavy.

i. CEP Daily Lung - Again, a supportive powder that has a variety of herbs and antioxidants. I have not used this one either, but again, its widely approved by a majority of COPD forum members. This supplement, in comparison to the one above, is herbal-heavy.

j. Lung EQ - Mixture of pelleted herbs and antioxidants. This particular mixture does have flax, which again is a red flag to me and my circumstances. 

The list goes on from there - there are endless supplements and mixtures available on the market to combat and support horses with COPD. Perhaps the most frustrating part of this disease (which I've already spoken about), is the lack of consistency across the board - what works for one horse may not work for another and in that, it takes a lot of experimentation and tears of frustration before landing on something that works.

Motion is lotion, always.
Taking adventures in the snowy wilderness is a great
way to get the lungs working!

In my own case, I've found success for several months before my mare's condition has worsened and have had to go back to the drawing board. It is increasingly frustrating and borderline maddening, but it is important to know you are not alone. One of the most helpful comments I have received in the online forums is to take this disease day by day. There is no magic cure and a lot of us are just doing the best we can do for our horses, and that is all we can do.

I still have a few more parts of the series left - Part 4 will be on nebulizers (where to buy, features, how to use, as well as cost effective options), Part 5 will be on feeding options (talking about things like hay cubes, haylage, steamed hay, soaked hay, etc) and if there is more to say, potentially a Part 6!

For those who are wanting to find the first two installments, you can find them here:

Part 1: An Introduction to Respiratory Conditions

Part 2: Diagnostic Tools and Procedures

The Year of Change

It's been a while, Blog Land.

A lot has changed since I last blogged nearly twelve months ago.

My day to day has changed.

My herd has changed.

My goals have changed.

I am still transitioning from a state of high pressure, impossible deadlines, 3am electrical wiring and drywall installations to a calm and quiet sea and it's... weird. My clock seems to tick on endlessly, reminding me that I finally have time to do things other than rearrange gravel and rock or measure and remeasure cabinets. And a weird part of me is almost perturbed at the idea that spending 14 hours a day at the barn isn't on the docket for my weekend plans yet again. 

The past 365+ days of barn building have been emotionally, mentally, and physically exhausting. I remember thinking that the day we brought the horses home that things would almost feel magical, but I think we've been running off of adrenaline, hot dogs (so many hot dogs) and lack of sleep that I haven't had the chance to really let it sink in yet.

Case in point - wiring electrical by flashlight.

I am enjoying it, though, and allowing myself to feel thankful to finally have my own space. There is still a lot left to do, but the bulk of it is complete and we can finally breathe a little bit. As we transition back into the warmer months (ie. Spring 2023), we will be creating more paddocks and subsequently more room for the horses to enjoy their new home. 

If this entire process has taught me anything, it is that anything worth having doesn't come easy and if you want something bad enough, you can make it happen.

This build took a lot of blood, sweat, and tears - literal and copious amounts of each and I could not be any more prouder of my partner than I am now. When I approached him nearly six years ago with drawings and plans of what I wanted for a barn, he simply said, "Oh that's easy."

It was anything but easy, but it's here and it's all mine.
It still looks a little derelict given that there is no siding, but
good things come to those who wait (or something like that).

And not once did he complain, even when we had to shovel snow and ice out of a 4ft deep foundation. Not once did he say, "This it out of our element" - we simply forged onwards and figured it out. And not once did he turn down an opportunity to work on the barn - even when it was rain-slushing sideways or it was a balmy -20C.

This is singlehandedly one of the biggest project's we have taken on as a team, and as we draw a close on the year, I am thankful he has always been my biggest cheerleader and biggest advocate of the entire process. 

Of course, the year did not come without its own bouts of sadness as I laid my sweet Moo to rest. I'm still not ready to talk about it or acknowledge how angry I am that I had to say goodbye. 

But maybe one day. 

Forever three years old.
Forever the very best three year old.
I had sat on her precisely once before this day.

Maybe one day I won't be so angry, and I'll share her story right to the end.

One day, but for now I hold the memory in my heart and in my mind and I hope that wherever she is she is finally free.

Over the last year I've learned that horses hold a special place in my heart, but they are not my entire life. Part of me feels grief over that, but part of me feels relief that there are no external pressures to ride and compete. 

With Annie's COPD worsening over the last few months, I've had to learn to adapt to the health of my horses yet again and although things look a little more bleak and uncertain once again, I feel weirdly humbled to know that whatever comes my way, I can and will deal with it the most graceful and appropriate way possible. 

They already love the new place and immediately
took to snoozing in the soft sand every single night.

I am simply enjoying my horses - eager for warmer days to ride (or drive) or simply hand-walk and be in their presence. I still love them with a fierceness that only a horse-person can understand, but I am also letting go of that part of me that longed for competitions, new tack, early morning lessons and braiding the perfect button braids.

I don't know what the future holds for my special black war horse, and although a large part of me is very nervous to see such serious changes in less than a year, I am reminded yet again that I know my animals better than anyone. And for now, I'll do what needs to be done to protect, nurture, and keep her as well as I can. 

The same goes for a silly little potato pony, who never ceases to keep me on my toes and reminds me to laugh even when I really, really don't want to.

Things are chugging along as they always have - a bit of triumph and a bit of tragedy. Horses are one of the most frustrating yet endearing animals I have ever had in my life (and if anyone has any insight into feeding a cube-only diet, please comment below so we can connect!) and yet, I cannot imagine life without them.

Looking at the back of the property, which will
eventually be grass for her to munch on to her heart's
content.

2022 has been a whirlwind of emotions and change, both good and bad. I'm still sitting with and processing a lot of these big feelings, but I finally feel like I can catch my breath.

For the bad that came out of 2022, I am still thankful, and I am still here - learning to let old dreams die in place of what is best for not only my animals, but for me. 

One day there will be a return to the show ring and one day I may miss the feeling of a really good centerline, but for now I am content. For now, I am happy and so are my horses.

Happy 5 Year Annie-versary

 

And just like that, half a decade has passed.

This morning  I spent some time looking back at all that we've been through the last five years and I can't help but almost laugh at some of my worries and woes that plagued us. The canter struggles seem beyond ridiculous to worry so frantically about.

It's easy to step back and see how insignificant it all was when I can see the bigger picture now. 

Like looking back at her first year showing and 
obsessively worrying about X, Y, Z when all I 
needed to be worried about was giving the horse a
solid experience. (Which, to be fair, I was worried about too ;) )

Although, isn't that always the way? Things seem really bad in the moment, but when you are out of the flames, you can't help but look back and think, "Well, that wasn't that bad."

In the last five years this mare has taught me more about my ability to persevere and to trust my gut instinct more times than I can count. 

Of course, she has also tested me. 

Riding green horses sure is enlightening.

Broke me.

And made me whole all over again.

While I have a good idea of what 2022 has in store for us, I cannot predict everything and am choosing and manifesting that it is going to be a good year.

With the last two years of tumultuous health problems, I can finally see the other side and am hopeful. I feel like we're in a good place and have a good backing of support that we can finally move forwards. Of course, Late Spring will always be a nerve-wracking time as pollen falls and seasonal allergens rear their ugly head but I am remaining hopeful that with the immunotherapy, paddock changes and hay steaming that we have a good solid lead on her triggers. 

This year is going to be full of big, exciting changes and I cannot wait to see my mare's goofy mug poking out over a stall door in my barn. 

Man.

What a crazy journey the last five years have been.

2017:

2018:

2019:

2020:

2021:

While the last two years have looked pretty different, I am looking forward to seeing what this year brings and I am keeping positive that we may just be able to dust off the tall boots once again. Of course, Annie's comfort and health come first, always.

Happy Annie-versary, and here is to many more wonderful healthy years <3

Into Fall and Winter

As promised - a conclusion to the Year 2021.

This kid started ground driving like a good baby and 
even packed a western saddle around like a pro!

Following the decision to stay home from the BVX, I listed my little horse trailer for sale formally and it was sold nearly four days later to the very first person who came to view it. Watching it pull out of the driveway put both a smile on my face and a tear in my eye. That little trailer was the epitome of blood, sweat, and tears and to see her attached to another rig and being funnelled down the road made a lump rise in my throat. 

We had been through a lot together, that little trailer and I. 

And although I was excited to welcome a newer, bigger, and fancier trailer to my life, I owe a lot to that little trailer.

So much love went into this <3

And since my horses continue to fund my Vet's vacation fund, Maizey was started on some ulcer medication and antibiotics for two separate issues. Moreso because I found she was looking a bit weedy and unkempt. I upped her feed during this time as well, and found the most help came from the omeprazole, which helped her fill out quite a lot more. I was quite happy with the end result, as was our Vet when I updated her a month later.

It's amazing the difference ulcer meds make!

With her on the mend, I opted to take Annie and Spud to the covered riding arena an hour away two weeks in a row - once to just gallop around and have fun during a really awful rainstorm and the second time to ride with a friend. Unfortunately, I was not able to ride her much during our second visit to the arena, as any gait higher than a walk ended up in coughing fits despite her nebulizing clear and being on medication and supplements. 

It worked out alright because we just went for a trail ride and I actually was able to ride my friend's Morgan stallion! It was fun, despite the frustration with Annie's breathing.

We ended up trail riding the surrounding area
which was quite nice.

And I got to ride my friends cool little Morgan stallion! 

Since we had a looming Vet appointment to retest Annie for allergies, I sat on my hands a bit and waited until we could make some definitive heads or tails of the situation. I had spent a majority of the Summer adding, removing and reintroducing so many things in attempts to figure out what was causing the reaction. I came no closer to solving the mystery by the time mid-September rolled around and the Vet appointment was staring me in the face.

However, there was a large snafu when the Vet cancelled her trip up to the area, leaving me utterly crushed and frustrated. I licked my wounds for several moments before springing back into action - if anyone could make it still happen, it would be me. I have a hard time taking no for an answer and if I can see some kind of potential resolution, I'll take it.

So, with a plan of sorts, I managed to make a rather confusing and highly involved game plan which involved the following: 

1. Alternate travelling Vet drawing the blood (this alternate Vet only sends blood to the same lab Annie had had hers sent to back in the Summer, and I did not want to use that clinic). I am thankful she offered to draw blood and do an exam on Annie to facilitate what I was trying to achieve, 

2. My old boss at the Small Animal Hospital spinning the blood at his clinic, 

3. Me packaging and sending off the spun blood to the original Vet,

4. The original clinic receiving the blood and shipping to the allergy testing facility.

Once I had the Vets (all 3 of them!) agree to my crazy plan, I immediately went to work purchasing an unholy amount ice packs and a fancy Styrofoam container that keeps items insulated (ie. cold, in this instance). The blood made it to the Vet still frozen, despite the two day layover it took to get there.

We went to a cube-only diet for a while.

Backing this train up slightly, just before we had the appointment for Annie's blood draw and exam, things went from bad to worse with not only Annie, but Spud. As I attempted to alleviate symptoms in one horse, I was battling them in the other. It was quite exhausting and after an entire mental breakdown (which included a panicked phone call to my old 4-H coach wherein I sobbed for nearly half an hour, and a defeated call to my Vet), a new plan was made.

If Spud was exhibiting the same symptoms as Annie was, I needed to eliminate the remainder of the questions to see if things got better, worse, or stayed the same.

I ended up removing dry hay from the horse's diets entirely and stocked up on alfalfa cubes. As per Vet recommendations, both horses were placed on a soaked cube diet for 30 days to see if symptoms persisted or were eliminated.

I pretty much bought out the Feed Store
several times over. 

Why yes that is the top of the pile.
For reference, I am 5'0".

What ensued was 5am wake ups, lunch hour snacks, and 5pm night feeds while working 10-12 hours a day and travelling 30km 3x a day.

I was exhausted.

But - on Day 4 or 5 of the new regime, the unimaginable happened.

Both horses' symptoms ceased. 

When the alternate Vet came and examined Annie, about two and a half weeks into the new feeding routine, we did an overall exam which included listening to her lungs as well as two rebreathe tests. I was exceptionally nervous when they did the rebreathe exam, as Annie has never passed a rebreathe exam since the entire debacle with her lungs started. (As a hilarious sidenote, it took a while for them to get her to breathe deeply, as Mare thought she was wearing her nebulizer, not a bag over her nose and attempted to play with it for several moments before actually paying attention and breathing properly).

Mash face on a rainy day.

Color me absolutely shocked when she passed both tests and her entire exam and the Vet looked at me with a little bit of disbelief in her eyes, "You know, I do believe you... but she's absolutely fine in this exact moment."

The Vet went on to detail that whatever trigger causes Annie's symptoms is not currently affecting her, but if the trigger is reintroduced or brought back, it will cause the symptoms to reoccur again. The phenomenal news is that the Vet cannot hear any crackling, wheezing or anything to suggest there is long term damage to her lungs. Of course, she did also state that she can only go as far as her in-field diagnostic tools allow. Long-time readers may recall that a previous ultrasound in 2019 showed there were some changes to her lungs, however there were not deemed as "severe".

I laughed and shed a few happy tears, knowing that finally I would get the answers of her allergy test and had some good proof that the regime was helping thus far. We chatted some more about the fact that a lot of horses in our area that this Vet has allergy tested seem to be allergic to tree pollen and she recommended if we could relocate the horses, to do so. (As a sidenote, this was already in the works).

Spoiler. They moved.

After the exam, I sent the blood away and conferred with my Vet once again the findings from the alternate Vet, as well as how the soaked cubes diet was going. There was a long discussion which ensued, outlining how I could continue the path we were on with a little less of a wallet dent and some more freedom (we all know I would do what is best for my animals, regardless of cost or time, but I wanted to see if there was a way we could make things comfortable for the both of us).

What came out of it was looking at hay steamers and attempting to put her (and Spud) back on forage full time. I also opted to move Annie and Spud to my old 4-H leader's home in efforts to get her out of the trees and be in an area that could facilitate me using a hay steamer. While I loved where the horses were, it would be impossible to steam hay without some kind of garage or tack shed to do so. Running cord and trying to keep the machine out of the elements would be cumbersome, awkward, and expensive. Additionally, getting Annie out from under the trees would be a plus, of course pending her allergy test results. 

After going back and forth on buying a smaller
unit, I ended up buying the larger unit for a few 
different reasons (to be explained in my review).

The horses were officially moved on October 17th and remained on their cube-only feed regime until I secured and purchased a hay steamer, which is it's own story in and of itself (because of course it is). The long and the short of it, which I'll lay out much better in a review later this year, is that the chests are massively backordered and after a deal was struck with the manufacturer, they basically told me I had to wait 12-16 weeks for my purchase. 

I managed to chase down a tack shop (in the same province as me to boot!) who had 3 models in stock and could send to me ASAP. I went back to the manufacturer and asked if they'd honour the deal, they said no and I basically retorted that I wasn't going to wait 12-16 weeks when I could have one delivered to my door in two days. The amount of money I'd spend on cubes during the time period wouldn't be worth the deal we had made, so I purchased a unit from the tack store with hopes, dreams, and the promise of my first born (kidding... kind of).

Happy Mare.

I was able to start both horses on hay for the first time in over a month on October 26th and we haven't looked back since. It definitely took some finessing and was a bit of a learning curve to utilize (which will be talked about in my review of the product), but I feel like it's down to a science at this point and it certainly has made my horses life (and my life) much, much easier. 

It isn't as easy as tossing hay out and walking away, and it means I'll have to make some adjustments as to how I keep my horses (ie. going back to feeding square bales vs rounds). The time that is eaten up by stuffing a net, as well as the space required to pull apart a roundbale is exponential and is just... not it for me. It is doable for the time being, mostly because that is all I have to feed for now, but in an effort to make my life easier and keep my horses on a regime that clearly works for them, I'll need to consider moving back to square bales and utilize them in my COPD journey with Annie. Of course there is nothing I can do about it now other than patiently wait until haying season 2022 starts to make that adjustment.

My crazy set up - it isn't perfect, but it works for now.
The bale I strip is in behind and the steamer up front.
Of course, with the -29C temperatures I actually 
had to bring the steamer unit home because it kept
freezing and no amount of insulating was helping.

Unfortunately, I wasn't able to ride Annie much during the Fall, as Daylight Savings reared it's ugly head, work doubled down, and we had a side project we were working on that ate up nearly all of my time. But, after years of wishing, hoping and slogging through so much red tape, I was (dare I say it?) happy the reason I wasn't riding was for the much bigger picture.

At some point I'll have to do a post dedicated just to this project, but I'll post some teasers in hopes that someone will guess what we've been up to. 

Any guesses?

On a particularly rainy day, wearing my most beautiful
highlighter flourescent jacket and pants. Standing in what 
will eventually be an aisleway <3

A rear view, and some snow.

Walls. 
Would you believe me if I told you I had to hand shovel most of the snow
inside the foundation out while I was sick?

All covered just in time for a massive amount of snow
incoming nearly two days later. This was taken on December 15th.

We had hoped to be farther along, but there were a few more hurdles in the way which delayed us nearly two and a half weeks and those precious days cost us framing and a roof. With the weather bitterly cold (-29°C or -20°F) and snow incoming for the last several days, we decided to put a lid on it officially on December 17th and let the foundation sit until Spring. Things are ready to rock and roll once the weather warms up and things start to thaw, and once that time comes, there will be no stopping us.

The last piece of the puzzle for the year of course was Annie's allergy panel results, which came to me at a work conference mid-November. Out of the allergens Nextmune tests for, Annie showed reactivity to 23. Perhaps the most interesting (to me anyway), are the items under "Foods". Being allergic to soy and flax is a huge indicator - commercial feeds and grains consistently have these two items in them and trying to avoid soy-based products or flax-based products is nearly unheard of (especially in this area which does not carry an abundance of brands).

Hopefully it shows up big enough to 
be legible on a phone screen.

Before I go any further into it, it's important to know a few things:

1. Grasses section is pollen only - contact or inhaled allergen

2. Food section is during digestion only.

3. Smut mix is a fungus found on grasses (Bermuda and Johnson only).

4. Allergens scoring in the 90s are not of concern; only items over 100, as the test does not have "borderlines".

I am still taking time to go through this report and what it means, as a lot of items are not native to our area and pose no significant risk (ie. Palm trees, Hackberry trees, Bahai grass, etc). Of course, the items that I recognize as being native to us and/or are in foods she could be exposed to have been removed, although I went grain-free a year or so ago so it's kind of a moot point (although helpful to know for supplements). Part of me is trying to figure out the difference between the Cottonwood tree and the Cottonseed itself, so its going to take some dissecting and research to fully understand the results. 

The vials - they come in three different strengths.
I'll go into it at some point here soon.

I officially OK'ed immunotherapy back in mid-November and finally received Annie's specially made vials quite literally just before Christmas. I hesitated on administering them for a while though, as the looming warning from the Vet we had seen in the Summer played over and over in my head. I did in fact begin her immunotherapy process just before the New Year and while we are only four injections in, I can't help but feel optimism and the potential to be able to ride my mare once again - maybe, just maybe like we used to.

There is still so much to learn about COPD and allergies - I am just doing my best to absorb every little thing I can and utilize my knowledge to better the lives of my horses.

And in the near future, looking forward to seeing them comfortably established in my barn.