Thursday, April 1, 2021

COPD Explained, Part 2: Diagnostic Tools and Procedures

A very drunk Annie post-endoscope, being 

One of the most important things as an owner (of any animal, really), is having a rough understanding of the diagnostic tools and procedures that our trusted Vets and Techs perform. Some might say, "Well, this is why they went for the training - so they can help us make the best decision possible for our pet." 

Which isn't untrue.

But, I also firmly believe that advocating for our pets is super important and a majority of that is knowing the process. We might not be able to understand it to the levels that our Vets can, but being able to participate in the discussion and advocate for your animal is a responsibility we all should be so passionate about. 

For some background information - I had to really push to get referred to a secondary clinic upon receiving Annie's initial diagnosis. The ideology with some veterinary professionals is that COPD is COPD - wet your hay and reduce dust in your stable, use this drug when things get bad. Done and done.

Out in the open air is best, but not always possible
in some situations and doesn't always resolve
the problem.

Except, my experience and Annie's overall health did not improve with the very mild housekeeping changes and being told, "There isn't really anything else to do... its environmental and you have to manage it better," was very, very frustrating. While I understand that a lot of clinics are limited to what kinds of diagnostics they can run and they are simply doing the best they can with the information they can obtain, I spent a lot of hours changing, modifying and removing things from Annie's life to see if I could make a sustainable change. Much like hundreds of other owners just like me - it didn't work and it made me upset, frustrated, and annoyed at myself for letting my horse down repeatedly. 

It was during this time I found the Faceb00k groups and posted a lengthy SOS message, asking for any and all help. I received an influx of information that quite honestly overwhelmed me at first. There were SO many options I did not know about and so many more diagnostics that could be run that were not talked about during many frustrated e-mail exchanges and phone calls. 

I felt a sense of relief - there were more things that could be done to help my horse and to garner more information about her specific condition. And that alone, made me feel hopeful. 

It made me hopeful that we could get back to this - enjoying
the sunshine and some long trails with my best girl!

I started off by researching the different procedures used to diagnose COPD horses and what information they would provide and started to cross-reference these procedures with clinics in the area to see if they were able to perform them. Long time readers will know I travelled 7+ hrs one way to a clinic that performed a variety of procedures on Annie - and ironically enough, the very first tracheal wash in years. In fact, they had to order tubing and tools because the resident vet hadn't done one in a very, very long time.

So let's dive in - you have a suspected COPD horse or a COPD horse you are trying to manage. What kind of diagnostics can you or do you want to look into? 

(It should go without saying, do NOT attempt any of these procedures yourself. These are meant to be done by a certified veterinary professional and some of them, in a clean and sterile environment).

Respiratory rates and lung sounds will be monitored as part of 
the regular examination.

1. General Exam

The first and foremost of every appointment is a general wellness exam - listening to the horse's respiratory and heart rates, as well as taking their temperature and examining their overall demeanor. This can tell a Veterinarian a lot - such as, if the horse is in respiratory distress and requires emergency medications to assist the lungs in functioning properly. 

A bright-eyed and moderately spirited horse (like Annie), may not show outward symptoms that they are unwell. In fact, one of the comments from the Vet was that she would not have guessed Annie had all that gunk in her lungs based off of how she sounded in her lungs, her respiratory rate and her overall demeanor. 

It looks a bit scary - and can be for some horses - but 
most are pretty reasonable with the entire process.

2. The Rebreathe Test

This can be a moderately confrontational procedure, but it is a basic one that all clinics can perform. Simply put, a bag is placed over the horses nose and "sealed" so the horse is rebreathing exhaled air while the Vet is listening to their lungs for crackling or popping sounds which would indicate damage to the lungs. The rebreathe is a good way of determining this, as it causes the horse to breathe much more intensely. Of course, a horse who is already struggling to breathe is not a necessary candidate for the rebreathe test.

In Annie's first rebreathe, she passed but coughed after the bag was removed. In her second rebreathe, the bag was left on longer and she panicked a bit. She did go into a coughing fit during this, and took a bit to recover from it. It was a bit puzzling for me, considering she marginally passed the first rebreathe but failed the second - so keep this in mind. It does require a level of complacency from your horse (some horses do. not. like. plastic bags over their noses), and a firm handedness from the Vet Tech to hold the bag on steadily.

In both tests, neither Vet who examined Annie heard any lung crackling or popping sounds. Of course, during the exam, horses and Techs and Vets were moving around so it isn't something that is 100% accurate. It can be a good marker for some scenarios, though.

A routine blood draw - there are a variety of different panels 
you can do, but most are similar if you are attempting to assess
the presence of infection.

3. Blood Test

In most cases, Vets will draw blood to search for infection or other diseases that may display on a blood panel. I don't have much to add to this obvious one, as it isn't a very involved procedure but do have one very large cautionary tale: 

This is NOT an accurate indication of infection.

Full stop.

Annie, along with several other horses I have met through the Faceb00k channels had normal blood tests but they did in fact have a large accumulation of mucus and infection in the lungs. 

I had asked the Vet about why Annie's didn't show up and there wasn't really a big answer for me other than, "Sometimes the body compensates." I had asked a few other posters on the groups about their own horses and no one really had an answer either, so it's something to be aware of when you are crossing diagnostics off of your list. 

Would I do a blood test again if I could go back? 

Yes. It had a lot of good information and could have been relevant to her condition (or perhaps another underlying condition which was exacerbating the COPD). 

Food for thought, regardless.

Annie, receiving a tracheal wash at the clinic last year.

4. Tracheal Wash (Transtrachael Wash)

Cornell has a really good article on tracheal wash's here that I've always shared with friends/ those interested in learning more about certain procedures. However, if you don't want to click over and prefer to just read on here, I'll go into some detail about what it's all about!

Tracheal wash's are a procedure where the objective is to collect a lower-tracheal sample (read: NOT into the lungs) to review and diagnose what specimen(s) is present. It can be done in more than just an equine setting and has been used in cows to determine the presence of parasites and other bacteria or viruses, which is pretty cool.

In the case of horses (and also cows, but we're not going to refer to cows anymore other than that point above, haha), the animal is sedated and restrained. The neck will be positioned in a way that allows it to be extended upwards and outwards so that the area where the incision will be is easily accessible and has no potential to be contaminated. 

Once the animal is restrained, sedated and the neck is set, approximately halfway down the neck the Vet will inject a numbing agent and make a small incision to allow the tip of the needle for the tracheal wash to pass through. From there, a large needle with a catheter surrounding it is passed through the incision and through some form of Veterinary magic, the needle is removed and the catheter remains in place in the lower trachea.

Sterile saline will then be injected into the catheter and "washed" down into the trachea. Once it is injected, the Vet will aspirate it back into a syringe to recover most, if not all of the fluid. The fluid that is drawn up will be able to be looked at microscopically. If you have the option to send the slides away for cytologic evaluation, I highly recommend this. Not all Vet clinics are able to perform in-house cytology and it really helps determine what is sitting in the lungs. In Annie's case, the clinic did not have the right dye for the slides and despite them looking at it under a microscope, they couldn't determine all of the findings.

A blurry photo of what was pulled from her 
trachea. Yuck.

The tracheal wash is a good indicator of what degree of inflammatory response is present, and can also determine is in the immediate area. The procedure can also determine what antibiotic is best to treat the infection (if any is present). For example, the bronchoalveolar lavage (BAL) goes further into the lungs whereas the tracheal wash does not. I know I have mentioned in the past "all the gunk in Annie's lungs", but it is only half-true, as the procedure we did only extended down a portion of her trachea. However, it is a good indicator of what is probably brewing further down.

For who don't know or maybe don't remember, Annie's cytology report showed the following: 70% nondegenerate neutrophils (neutrophils are a kind of white blood cell that deals with infections and damaged tissues), 5% lymophocytes (these are responsible for the immune system and low numbers can be indicative of stress, viral infections, or bacterial infections), 25% vaculated macrophages (a phagocytic cell (one that absorbs bacteria and other damaged cells) that tends to group at sites of infection, and a variety of Kirschman spirals (mucus), mild amounts of plant material and rod shaped bacteria which was indicative of a neutrophilic inflammatory response (ie. a higher than normal count of neutrophils in the body, indicating inflammation/ infection) . 

A closer look at the cells collected from a tracheal wash (not Annie's),
revealing mucus (it causes the cells to "line up" and "stick together), as well as
non degenerate neutrophils (arrow) and hundreds of eosinophils. 

As a quite sidenote, if you want more information, South Mountain has a great list of all the different cells in the horses body (along with vitamins and minerals) with a detailed explanation in regards to blood tests. The whole learning curve on cells and what they do is still a mystery to me in some ways, but it's important to research your horse's medical findings to fully understand what it all means. I have been unable to find any concrete research regarding the "normal" levels of cells in a healthy horse, as I imagine it's something that is still being researched and understood.

Injecting sterile saline down the tube as part of a routine
BAL procedure.

5. Bronchoalveolar Lavage (BAL)

As said previously, the bronchoalveolar lavage (BAL) allows the Veterinarian a deeper look into the lungs and to determine what level of inflammation is present. There is arguments that the BAL is "better" than a regular tracheal wash, as it is pulling information from directly down into the lungs itself. However, it may not be available in your clinic (it wasn't for me), so a tracheal wash may be the only way to go.

This sample is indicative of EHV-5. The large cell is a mutlinucleated macrophage, which
contains prominent large nucleoli, indicating an activated state

The BAL is a lot less invasive of a procedure (and can be done out of clinic), but does require some additional gear. Once your horse is sedated, your horse's neck and head will be lifted and stretched to make entry into the trachea much easier. The Veterinarian will insert a tube down into the horse's trachea and into the lower airway. From there, sterile saline (and quite a lot of it) is flushed into the area and pulled back where the liquid will be made into slides and sent away for analysis. One thing to know is that even if some fluid is retained in the lungs, it generally does not cause any issues as the large veins within the lungs rapidly absorb the fluid.  

An endoscopic exam being performed.

6. Endoscope

While it can be confused with a gastroscope (a scope that looks into the stomach; ie: for ulcers), this tool is used to view the contents of the trachea. It is commonly used in COPD cases to determine what is in the trachea, and with some endoscopes, small samples can be taken from identified problem areas. Horses can be sedated or not, as it is widely dependent on if the horse's larynx also needs to be actively viewed (ie. assessing the normal function of the larynx).

In Annie's case, she was sedated and reacted heavily to the endoscope being moved within her trachea. There was a lot of coughing and the poor vet ended up getting a nice coat of mucus on her face and in her hair (we were the very first appointment of the day to boot, oops). The findings were consistent with the tracheal wash - irritation was present in the airways, as well as some mucus along the sides of the trachea. However, it was also noted that the endoscope was performed after the tracheal wash, so findings weren't as severe as they potentially could have been. 

A repeat photo because I can't find a stock
image of a thoracic ultrasound being performed.

7. Ultrasound

While it isn't always a common procedure in the world of diagnosing COPD, it can be very beneficial in determining the overall health of the lungs and what the structures look like from an imaging level. It's important to remember that an ultrasound will only show you the surface of the lungs itself, so while it is not entirely a three dimensional view, it can provide a lot of information about how the lungs are working and if there is any damage present. 

Essentially, your horse will have a large amount of isopropyl alcohol squirted over their barrel and the vet will run their imaging probe over the area as the horse inhales and exhales normally. The Vet can identify any damage, fluid, tumors, or abscesses (etc) easily with this process. In Annie's ultrasound, the damage was easily seen as rippled "waves" instead of a smooth line and was categorized as moderate.

An xray of the fetlock joint, because I couldn't find a photo of 
chest xrays being taken.

8. Radiographs

If needed, a Vet may want to obtain some radiographs of the thoracic region (ie. chest) to further investigate for any potentially missed obstruction or otherwise if your horse is not actively responding to COPD treatments. If an ultrasound is not possible at your Veterinary location, radiographs may be a good option for investigating what the lungs actually look like.

For reference, Annie did not receive any radiographs of her lung/chest region. 

It is typical to do a blood test to determine allergens.

9. Allergy Testing

One of the most underrated and widely misunderstood tools out there is the allergy panel. Based off of what I've seen online and in practice, some Vets swerve away from the idea of allergen testing for reasons I am not privy to, but some seem to recommend it above several other diagnostics. While I have not had the opportunity to have Annie allergy tested since her diagnosis, we are scheduled for an allergen test in May which will hopefully bring about more answers about her condition and her sensitivities. 

So what is an allergy test?

In most cases, it is an blood test performed by a licensed veterinarian that is then sent off to a lab for processing. It can also be a skin test where a small amount of suspected allergens are injected beneath the skin and monitored for a reaction.

An alternative way to test for allergies.

Depending on what lab you use, your horse will be tested for the items/ factors they have on file. I researched several labs extensively, and found that Nextmune (formally Spectrum Labs) is the only equine-approved lab that also tests food sensitivities (ie. rice bran, beet pulp, apples, etc). 

Most labs I found (Heska, Idexx) test for the following: Grasses, Weeds, Trees, and sometimes Fungus/ Molds. 

However, please do your research when deciding what lab to go with. For example, Nextmune tests for: Grasses, Weeds, Trees, Fungi, Foods, Indoor items (ie. shavings (variety of types), wool, etc), Insects and Grains whereas Heska only tests for Grasses, Weeds and Trees. It can be pretty disheartening to spend the money on a test and not get the information you need, so please do the research or ask your Vet what each lab cover, or if there is a possibility of adding additional allergens to the panel itself.

From there, the results will give you a guideline as to what your horses tolerance levels are and if the exposures can be managed externally (ie. a horse allergic to alfalfa being removed from alfalfa hay and only receiving grass hay) there is no further action required. However, if the allergen cannot be completely removed (ie. trees, weeds, etc), immunotherapy is the next step.

Once the test results are received, a special and personalized immunotherapy
shot is developed based off of the specific sensitivities your individual horse has.

Immunotherapy is the process in which the allergens are introduced slowly to allow the body time to build a tolerance level for it (them). It is a series of shots in very small doses (3-5ml) that are injected (there is also an oral series for needle-phobic horses and owners) just under the skin. These injections are given on a set schedule, especially during the beginning of the process as the body is working to become desensitized. From there, injections may be given every month or few months depending on the horse and their requirements. 

As more research and more diagnostic tools are developed and the world of COPD is better understood, I am sure this list will become larger and much more refined. For now, there are several options for owners who are looking to diagnose and improve the lives of their horses. It can be a very frustrating condition, but knowing what options you have and arming yourself with the knowledge is half the battle - in my own case, pushing for "off the beaten path" diagnostics saved my horse additional scarring and trauma to her lungs and the side effects of being on medications long-term. 

If anything - take the time to find out what services your immediate clinic offers and see what procedures would best benefit your scenario. As always, talk with your Vet and develop a game-plan as to what the best options are and being mindful with any financial restrictions you may have in place.

The next installment I am excited for - I'm going to go over medications, what they do and what they are for, the use of the nebulizer (Flexineb) and if it isn't too long and boring, possibly some supplements/ homeopathic options.

Thursday, March 25, 2021

COPD Explained, Part 1: An Introduction to Respiratory Conditions

As stated in previous blog posts, I wanted to take the opportunity to sit down and write out a mini-series of my journey with a COPD horse and what information I have come to find, understand, and follow. I wanted to take the time to talk about nebulizers, medications, and other supplements that I have tried, used, and trusted as I have worked my way through Annie's diagnosis, subsequent flair ups and navigated her way back to becoming a normal riding horse again.

I don't claim to have all the answers - in fact, the very first suggestion I have for anyone facing COPD/ RAO/ asthma/ heaves/ allergy related issues with their horse is to join the following Faceb00k groups that I found amongst my travels, because those wonderful people there are worth their weight in absolute GOLD. 

There is no one size fits all approach to this terribly frustrating and confusing condition, but the amount of support and love I felt from these communities was enough to keep me from completely losing whatever I had left of my mind when things were tough. While one of the three groups seem heavily British-based, there is a lot of good information (and relatively the same ideologies). I noticed there are a few newer technologies we have not implemented as hard over in the States/Canada (like the salt/ oxygen treatment rooms), but it's a good source of informational fodder, ideas, and support.

Salt Room Therapy

So for someone starting out - what does COPD even mean? And why is it that COPD, heaves, asthma, allergies, RAO, etc seem to be interchangeable terms when it comes to respiratory conditions in horses? Believe me, one of the very first things I did was get so overwhelmed with the terminology and the specifics of each condition.

COPD or Chronic Obstructive Pulmonary Disorder is essentially a catch all phrase for a multitude of respiratory ailments and conditions. But, I have found throughout my journey in this that the majority of terms are used interchangeably in both the amateur and professional level. For example, Annie was diagnosed with Recurrent Airway Obstruction by the first vet we saw, but diagnosed with asthma by the second. 

A normally functioning airway is tubular and open, able to 
receive air readily and easily. 
A damaged airway is inflamed, unable to regulate airflow and 
may also show signs of previous damage/stress.

So how do you distinguish the terms and what they mean?

Well - there are some subtle differences in the terminology. For example, asthma is a condition where the horse showcases exercise intolerance - often similar to humans. However, within the horse community and for most intents and purposes - the diagnosed word is not relatively important. In fact, I struggled over the fact one vet wrote "RAO" and another wrote "asthma" and tried hard to distinguish the two when in reality, respiratory illness in horses is not largely explored and a lot remains unknown. And for that reason, most terms are just sitting on the top of a very large umbrella that has yet to be studied and documented. 

The idea of respiratory illness can be categorized by several symptoms - most of which fall in to multiple categories, which is why it makes diagnosing and treating these horses exceptionally difficult. A true asthmatic horse should be exercise intolerant, but my personal mare, who was diagnosed as just that, is not. It can be confusing, because there is no consistency across the board for any of these horses and it makes finding a treatment plan doubly frustrating.

Each time a horse flairs, or reacts to it's environment/ trigger, the lungs
continue to become damaged. The sensitive cilia (hairlike projections on the 
cells), are damaged, broken, or paralyzed. This makes it even harder for a respiratory
compromised horse to recover and lead a normal lifestyle.

Throughout my journey with learning more about COPD, I have found the best way to describe it and all the other associated acronyms and names is simply this: it is a sensitivity to a specific trigger/ allergen that causes an adverse reaction. Full stop. There is no other rhyme or reason for the symptoms, period. For these respiratory sensitive horses, any trigger (whether it be alfalfa hay, dust, mold, or pollen) will evoke any of the reactions I have outlined below. The key, of course, is finding what the trigger is.

Like all conditions, respiratory distress can vary from mild to severe and can include a variety of symptoms. Sometimes, this can be confusing given that chronically severe horses may not exhibit all symptoms, but rather a singular symptom in a critical capacity. 

Difficulty Breathing 
Of course, the main and often most associated symptom with COPD or heaves is the inability for the horse to get a full, deep breath. These horses often have flared nostrils and a distinctive "lurching" of their abdomen as they attempt very hard to pull air in - more notably known as a "heave line". These horses often sound like they are gasping and/or wheezy, as it is similar to someone trying to suck air through a straw. Some horses are affected so severely that they will not eat, drink, or otherwise engage in their paddocks while others can be affected only during exercise - in severe circumstances, weight loss is prevalent. 

A severe heave line.

Most breathing issues worsen during the hotter and more humid parts of the day, which makes it difficult to manage horses who live in desert-like climates. Simply stabling them during the hottest portions of the day is not often helpful, as stagnant air with dust from bedding, hay, and surface molds in the barn can further aggravate their condition.

Respiratory rates can double - even triple - during an intense flair and it's important to know what your horses resting rate is. A good rule of thumb is 8-12bpm, but it is not always an accurate representation of the individual horse. For example, both Annie and Spud hover consistently around 12-14bpm at rest.

Flared nostrils at rest is a very concerning sign.
It's always best to know your horses regular
breathing rates.

The coughing can range from moderate to severe - in more moderate cases it sounds like a simple attempt at clearing the wind-pipe, and the horse is happy enough to continue wandering their paddock as they do so. In more severe cases, the horse will be unable to walk and the head and neck are thrown downwards as a very large (or several large) coughs come to the surface. In some situations, mucus and/or food will expel from the mouth. In the cases of mucus, you need to be very careful you are not dealing with infection.

An accumulation of mucus that Annie coughed out 
Fall of 2019. The white-ish color is indicative of an 
allergic response and the slight yellow-ish tinge
also is signalling the beginning of an infection.
(PSA: This is why it's important to trust your Vet - I texted these photos
and was told "not to worry". I should've trusted my gut.)

In my own horse, I dealt a lot with coughing episodes and mucus production. On the good days, the coughs were spaced out along the course of the day, and on the bad days, the coughs were repetitive and almost unwavering. There was a level of discomfort I could clearly observe in Annie as she had these coughing fits, and several times they produced a thick, white-ish/green globe of mucus that would be expelled from her mouth.

^ A short clip of the coughing we battled in the Summer of 2020.
This was prior to her lung wash/scopes.

Runny Nose/ Eyes
The nostrils may also be the victim of excessive semi-clear fluid or greenish mucus. The consistency is usually sticky malleable - it does not evaporate if you roll it between your fingers. Additionally, the eyes can show tear streaks that extend down the face or have a bit of "gunk" in the corner of the eyeball.

If there is a watery and clear discharge from the nostrils, it is most likely "normal". However, yellow and/or green globules of discharge is not normal and can be indicative of an infection. Of course, other conditions can cause colored discharge (ie. choke), so it's important to examine texture, frequency, and the horse's other external features. 

While this photo is of mucus accumulation when she 
was sick (horse cold) Summer of 2019, it is very similar to
mucus seen in COPD horses.

In my personal experience, Annie had only two symptoms - coughing and mucus production. However, there are horses out there who also have mild COPD that exhibit difficulty breathing and heave lines during times of flair ups.

Which brings me to the next question - what causes this condition? 

Essentially, horses who have lung damage (from environmental factors or illness) are all in the high risk category for getting COPD. 

There are certain horses who are at a higher risk of developing
respiratory conditions.

So what are some examples of this?
1. Excessively stabled horses in dusty environments (think bedding, lack of ventilation, etc.)
2. Horses fed moldy or dusty hay
3. Horses stabled in barns with lack of ventilation
4. Horses stalled or pastured in an area with excessive mold or pollen spores/ allergens
5. Horses who have gotten sick and/or have a compromised immune system.

 In Annie's case, a common horse cold that knocked her on her butt did enough damage to her lungs that she developed sensitivities to certain things in her environment and when exposed to these sensitivities, she simply reacts. 

For a lot of owners on the various Faceb00k pages, sometimes all
it takes is being fed one moldy roundbale to cause permanent damage.
I don't mean to scare people - but I don't think the general population
recognizes how frighteningly easy it is to cause this condition.

With all of this being said, the management of COPD conditions comes down to one thing - locating the trigger and either eliminating it or reducing it to a manageable level. It can be daunting to try to locate the source, especially if you've tried and tested the "obvious" suspects (ie. increasing turn out/ fresh air, removing moldy hay/ feed). No one horse will have the same trigger(s) and display the same symptom(s) - which is singlehandedly one of the most confusing and head-scratching things about this. And even more so - every horse responds differently to different medications, supplements, and tinctures. There is no one size fits all approach here, and it tends to take a lot of guess work to find the right formula (and then the season changes and you have a whole new ball game with the increase of pollen and/or fungi spores in the air). 

One thing to remember is that there IS light at the end of the tunnel - managing a COPD horse is very frustrating, but it also brings a lot of reward when things work out and go accordingly. 

The next installment is going to focus on diagnosing the COPD horse - what kinds of procedures are available, what information they provide, and what kind of diagnostics you can ask your Vet about. There is a definitive learning curve on understanding veterinary medicine and while I do not claim to be a Vet or have the amount of knowledge they do, as a horse owner, we need to be an advocate for our animal. I am passionate about researching and understanding procedures because if I hadn't of taken the time to get that knowledge and ASK for the procedures to be performed, Annie would still be suffering. Outwardly, she was relatively healthy, and the drugs we initially prescribed were working, but it wasn't enough for me. Knowing what the "next steps" were was immeasurably helpful and I hope some of this information lands in the lap of someone who really needs it.

Sunday, March 14, 2021

Waiting for the Snow (to Melt)

The best view <3

Things have been chugging ever forwards in my corner of the globe - the snow is slowly melting away and the days are getting longer (thank you Daylight Savings). We've had several attempts by Mother Nature to "restart" Winter, but thankfully we haven't accumulated much from those little storms. Still, the weather has left much to be desired more recently, but there are brighter (and longer!) days on the horizon and so, I am fervently looking forward to that.

I have been lucky enough that the stars (and weather) aligned several times for me to be able to hack out and hand walk the horses. Due to starting a new job this month (hooray!), my time is a little more crunched than before, as there was limited light by the time I leave the office. However, I am both thankful for a new start and that Daylight Savings is here!

Trying to get media is exceptionally difficult when the only spot 
to rest your phone is nearly waist-height.
However, here it is - playing around with no-pressure
desensitization of a feed bag. She willingly reached
over to it as I held it away and in this moment I am rewarding her
for doing so (note the position of my near hand).

I've continued to work with Maizey in short, moderate pressure training sessions and she's slowly but surely becoming familiarized with different things. As always, raising a young horse takes patience and persistence, so I am just trying to remind myself that her subpar leading skills when I take her out solo will soon become a thing of the past. We just have to keep doing short and simple with her and the insecurities of leaving her buddy behind will become a thing of the past. Since I've wanted to ramp up a bit more of my expectations (ie. stress), as well as having noted a few vice-like behaviors I figured why not start her on some ulcer medication. Back in the Summer I noted she started cribbing when being fed her daily mash and/or while she was eating - it was never  (and still isn't) "bad" in the sense she would abandon her food to crib and if she was fed away from fences or her hay box, she wouldn't seek out cribbing on her own. At the time, I figured it was due to boredom, as she is housed with a geriatric gelding who doesn't really kick up his heels all that much and I was advised not to turn her out on acres and acres of land until we could assess how her lameness did over the course of the next several months. Still, it is something I kept in the back of my brain, as she is a bit more of a nervous horse in general and more and more I have considered that the two items could certainly be linked. Still - no harm no foul to treat even if she doesn't.

Over the last few weeks we've mostly been working on desensitizing - I brought out a feed bag and we played around with it for a few days. Allowing her to sniff it on the ground, hearing it crunch under my feet, and eventually being rubbed with it. When I first brought her to AJ's place last April, hearing the crinkling of feed bags or ziploc bags completely wigged her out - she did NOT like the sound at all. I would keep a wrapper in my pocket and crinkle it as I went about doing chores and after some time, she started to come around. Of course, touching her with said crinkly object was no beuno either, but we've worked pretty hard on accepting grocery bags and the feed bag. As of now, she isn't a fan of being touched with the bag, but warms up to it as we go along. I simply reward for her efforts and calmness when it shows and otherwise ignore the leg shuffling or uncertainty. 

Listening as I step off and on the bag (out of view).
This would have sent her into orbit several months ago!

It's slow going and a bit like watching paint dry in some aspects - I recall during the Summer we had to revisit the flyspray several times over because she was NOT a fan of it misting over her legs or near her poll. I had untangled her mane and tail the other day and for good measure, sprayed over her body with detangler and she looked at me like, "What next?" Suffice to say, I was pretty pleased with that response.

Things will take time and although I would love to push fast forward and get to the "funner" and more interesting stuff, I'm reminding myself to press pause and drink up all the learning opportunities yet to come for her. She's a cautious bean by nature, and working to cultivate a thinking horse vs a reactive horse takes time. 

An unfit, undermuscled and a bit... rotund Momma Bannie who
was unimpressed to be back home after a 40 minute ride (and a 
pleased Spud that we were back and it was snack time).

In addition to playing with Maizey, I've taken Momma Bans out a handful of times and I am elated to report she feels good. Yeah, she's weak and unbalanced and uncoordinated, but she feels ready to work and able to work. Two things she did not feel for a majority of the summer months last year. 

So, I am optimistic for a good return to normal work - perhaps even a few clinics and outings, too! - and although I am a bit nervous about the impeding Spring-time (ie. dust, pollen), I am keeping my fingers crossed she remains unaffected and is healthy and rideable. At the start of the Summer we have an appointment to get her allergy tested, which I hope opens a lot more doors for us in terms of answers and will put an end to my obsessiveness when it comes to feeding new/ different supplements, grains or feeds. 

As always, Spud is doing great. I haven't had the opportunity to take him out in the cart yet, as it is being stored in my Grandma's garage (since we lack the space and storage, and there is none at the new "barn") so until the snow melts and I am able to park it under the roof/awning and toss a tarp on it, we are limited to hand-walking and ponying for the sassy mini. I do intend to ground drive him a few times, but when opportunity for hand-walking allows, I like to take both him and Annie (which would make ground driving a bit difficult to do!).

She really didn't want to go back home, haha.
One of the only horses I've met who will willingly
pass by home just to keep going!

I've slowly begun to enter dates for clinics, shows and fun days into my calendar and have put a marker on the ones I am more interested in attending. For most, the year starts in April, but for those of us without an indoor arena, the season doesn't really get underway until May. While there are a few events in April, neither myself nor Annie will be sane fit enough to attend the first clinics and events of the season (bc I almost parted ways with her just a few days ago when she gave a giant spook during a stretchy trot set and went hard left and my body.... did not, hahah. Thankfully she somehow levitated back under me and quite literally saved my ass. That'll teach me to slip the reins to a fresh horse!). So, we'll sit on our hands for now and wait until the outdoor is free of snow and I can get a few schools in. At least, that is the plan.

How are things in your neck of the woods? Has the snow melted (or are you lucky enough that you don't get snow)?

Sunday, February 28, 2021

Classical Conditioning and Yearlings

When I first got Maizey, I knew I was in over my head a little bit - she was a (mostly) untouched weanling, who was used to being turned out on several hundred acres with her dam and several other foals. Her daily life included her mother, her friends, food, and an occasional human observing from a distance. Her life was pretty simplistic and the basic needs were all met - until one day she was removed from her usual surroundings and weaned from her mother. A small amount of handling occurred, but nothing consistent or concise until she came home.

I remember unloading her at home, unclipping the leadrope in her temp paddock and thinking, "I'm never going to catch her again." 


She wore that halter and catch strap for a few weeks
when I first got her.

She wasn't what I would call wild - but she was certainly fearful. I can understand her apprehension to people, considering a large majority of her interactions with them were linked to mass life changes and brought a lot of confusion. Which, is sometimes the way of things. I couldn't spend several weeks teaching her to lead and load in a trailer to take her home. Of course, we were as gentle and kind as possible, but we also needed to get this horse home. 

Which - if you ever breed horses you intend to sell, please give them the basics. I understand it's "not the way" for some areas or disciplines or people, but giving them a basic start to life is so much easier on everyone and removes a lot of unnecessary stress and turmoil from the animal.

Soapbox rant aside, I've had a lot of fun learning about babies and have made quite a few observations in Maizey's "preschool" education. She's kind and intelligent, but she also is also fear/ reactive-based (like most unhandled horses). Her response to something "scary" (let's use an example of a tarp) is to be on high alert - ready to vacate the area if the threat intensifies. Which, is a pretty normal equine response when you think of it.

So if you are wondering how I got this filly
to walk over something crunchy and weird without
a halter, keep on reading!
I've been picking my brain a bit, wanting to work on piquing her curiosity and have her be confident in herself. I don't want a horse to rely on me for all of it's confidence in awkward or weird situations - I want that horse to be confident in themselves to react in a way that is sensible and makes sense.

As I pondered the best way to encourage and motivate her, I recognized there was a very similar "game" I play with Cedar that has proven to increase his own critical thinking and confidence.

Classical conditioning is a process by which an animal associates a neutral stimulus (ie. tarp, ball, umbrella) with a positive/potent stimulus (ie. food, treats). It is commonly used to chain behaviors in dog training, and while it can be a bit of a "long" process, it allows the dog to think for itself and become confident in their own decisions, knowing that the end result for them is positive. 

In situations of dog reactivity (in Cedar's case), it can be exceptionally beneficial, because it allows the dog to associate the stressors (other dogs) with something positive - this is counter-conditioning, as it relates to a "negative" stimulus. And in Maizey's case, it would serve some of the same purpose. I wanted to harvest and encourage her curiosity, and if Maizey recognized she was getting "paid to play", it may also entice her to explore things a bit more.

 It is a process that starts off rather slow, but in my experience with Maizey (and Cedar), it gains traction relatively quickly. To walk you through how this process work(ed)s for Moo and I, I played around with a very new stimulus (umbrella) and videoed the process as I worked through it.

Before I start, it's important I don't have any expectations - I let Maizey steer the direction of her training journey and it's important that I stay within her comfort zones to cultivate her curiosity and build her confidence. I also choose to not halter or restrain her in any way - she is free to leave if she so chooses, and she is free to maneuver however she likes throughout the process. I simply stand aside and let her do her thing and reward her for exhibiting the behavior I am looking for. 

So what does that look like and how do I determine what behavior I am looking for/ what to reward?

I start off with an object, in this case an umbrella, and stand off to the side with food/ treats. In this situation, it's simply her soaked alfalfa cubes (which I do not recommend, as the umbrella, Maizey, and I all got covered in wet mush lol). I typically use sliced carrots or horse treats if I have any on hand, but I have seen that people have successfully used alfalfa pellets. It's important to use a treat that has value and it's important to remember it's value. In a circumstance where she over-exceeded my expectation, I would dole out treats like crazy (also known as giving her a "jackpot") or switch to a higher value treat (apples, sugar cubes... something your horse REALLY likes) that is different from their usual treat.

It's hard to get the hang of it, but timing is everything and in that case, understanding what earns a "regular" treat, a "jackpot", or a high value treat isn't as important as knowing when to treat.

In the above clip, it shows a pretty normal start to our sessions, which last 15-20 minutes. I simply offer the item and stand to the side and as soon as Maizey shows any kind of interaction with the item, she receives a treat. Something as simple as walking closer to it (if the horse is backed off of the item) or attempting to reach out and touch it are both things I would treat her for. Lipping the umbrella and causing some kind of movement is a pretty big deal, considering she hasn't been exposed to umbrellas before this. 

Since she did so well with the umbrella sitting upright, I decided to move the umbrella around and offer it in a new position.

As I figured, the movement caused her to back off a bit. Which, isn't really the end of the world - as I outlined above, she is free to remove herself from the stimulus if she feels threatened or insecure. I don't acknowledge this or offer any food motivation - my goal isn't to entice her to the umbrella by spoon-feeding her treats all the way there. I may call or cluck at her to walk over, but I don't move, don't rattle the treats, and don't remove the stimulus or make it less intimidating (it's important to know your horses threshold so you don't overface them, especially in the beginning).

It also pays to be patient in this process because:

It may not seem like much, but she held her position, assessed it and decided to move forwards. You can see she is a bit apprehensive about me approaching (it was raining and the drops hitting the inside of the umbrella were a bit loud), but chooses to keep her foot planted and resumes her curiosity.

That single step towards the big, scary umbrella gets a treat - especially in the beginning stages. She made the right decision here, even being uncertain. And showing her she made a good decision piqued her interest and made her brave enough to continue on to do the following:

Moving the umbrella on her own, continuing to explore and becoming confident in herself! 

You can see several instances I could have treated her, but I chose to wait to allow her to play around and explore. Once I saw the umbrella move a few times and her continuing to interact with it, I chose to treat her. I do vocally express how proud I am of her by giving a, "Good girl!" or "There you go!" to encourage her as well.

I let these sessions basically run themselves - seeing where Maizey is uncomfortable or falling short and trying to mend those bridges by simply being patient and offering treats at the right moments.

And eventually, it lends itself to:

 Allowing the umbrella to move, assessing/ processing, and continuing to explore. She is apprehensive when I moved it, but her apprehension is also closely followed by curiosity, which is what I'm trying very hard to harvest in her.

Our umbrella session lasted a whole 12 minutes as per my phone, and it showed a horse starting to develop confidence in herself and the things around her and I'm pretty proud of that. As this is our first session with the umbrella, it still shows a lot of promise for things to come! 

As she develops a bigger and better understanding of the world around her, she'll continue to flourish and become her own advocate, which is the primary reasoning for a lot of this. I had initially assumed that she would become resistant to interacting with the stimuli I provided, but the most she has done is tried to follow me for treats. When this occurs, I simply reposition myself (in the case of the blanket, I walk to the other side of the blanket, encouraging her to follow but not demanding she does so). She caught on pretty quickly that interaction = pay off.

Don't worry, the blanket has a good amount
of holes in it and the sand is pretty dry.
It makes for a good impromptu "tarp".

 For the short amount of time we've been playing with this new training regime, it's paid off in big ways. After an entire summer of endless tarp/ blanket walking, she would still balk at it the first few attempts at passing over. Which, is fine, she was scared pretty bad in the Spring and obviously it's manifested itself somehow. But the above GIFs of her with the blanket are our second session - something that would have never happened had she been haltered and asked to walk over. It's pretty impressive to see her brain turn as she found pretty quickly that treats come when the feet are on the blanket, not the nose. 

It's going to be fun continuing to explore this with her - it warms my heart to see her working outside of her comfort zone without relying on halters and leads to keep her engaged or "with me". Of course, halters and leads have their place in training as well, but this experiment has been really fun and engaging for the both of us.

Which now begs the question(s) - have you done something similar with your horse? What was the outcome?

Sunday, February 21, 2021

An Update of Annie


Time for a recap on this Queen!

My last post on the blog before a rather long (and well needed) break from writing in any formal sense, outlined the absolute chaos of trying to medically diagnose my sweet mare, and trying to understand the fall out from the subsequent vet visits. If you haven't yet read the entire saga (or simply forgot, because it was nearly 100 years ago at this point), I highly suggest giving it a quick study or revisiting it to simply recall the events in their entirety, because a lot of that information is important and relevant in this post.

As the middle of August came, went, and disappeared, I was beyond elated to see my mare returning to a relatively normal state. I was slowly but surely legging her back up, and continuing to do an obscene amount of research and reading regarding COPD - what it all meant and how to address and support concerns as they arrived. I wouldn't even be joking to say I have tried hundreds of dollars worth of allergen-suppressive and allergen-reducing supplements and drugs and tonics and tinctures. The amount of ingredient labels I have scrutinized with a sharp eye, and the amount of flip-flopping I have done between shipping costs and transport fees from the States to Canada has been... expensive and very time consuming.

For a majority of the year, you wouldn't know she was
diagnosed with respiratory issues at all.

We trialed a few holistic and more natural options, as well as veterinarian prescribed allergy meds with lukewarm success. I didn't notice a rather large difference in her mannerisms, and she continued to have a mild cough (mostly once or twice heading into canter). It was rather frustrating, although we were certainly having more good days than bad days. I held on to hope, knowing that these things take time and the multitude of COPD-related F(ace)book groups I was part of kept me motivated (and humbled) that respiratory issues are a process in itself and you need to take it one day at a time.

And so, we started to take it one day at a time - and things were looking promising. Like previously stated, Annie was slowly being legged up again and I finally was able to actually school her for the first time in months. It felt like we might just make it to the other side of this whole debacle. And yet, as I navigated my way through figuring out what would work best in terms of support for her newly diagnosed condition, Annie seemed to have other plans.

Oh, Annie.

You see, not even a day after posting back in August of last year, I noted that Annie's hind left was a bit puffy (that may or may not be why I struggled to publish this post, lest Annie have some kind of trick up her sleeve). I sighed, believing the bit of a gallop she had in the outdoor arena a few days prior was the cause and began the customary cold hosing, poulticing and wrapping so many of us are familiar with. The next day, upon removing the bandages, I noted that the swelling was gone and was relieved to see it did not seem serious. However, a simple glance at her right hind showed that now it was swelling, much like the left had done the day before. 

Confused, but not at all surprised (I mean, when you own a horse like Annie, nothing really surprises you), I cold hosed, poulticed and wrapped both hinds - but not before dosing her with some NSAID support. While I was quite happy to see that her persistent coughing and mucus accumulation was gone, her leg swelling was beginning to worry me. However, I simply assumed she had strained herself galloping around in the outdoor arena.

But what seemed like a "little tweak" seemed to be for naught, as each day that I assessed her, both legs would be in various stages of mild to moderate swelling and as I went through the checklist of what to look for with swelling every single day, I noted a few things: there was no heat accompanying the swelling, she was not lame, cold hosing would help, hand walking/ riding would make the swelling disappear, and constant pressure wraps would remove the swelling. However, within 24 hours it would return. 


Even on the rainy days we hand walked.
So much handwalking.

At this point I figured maybe she wasn't moving around much and started hand-walking her every single day. This improved the swelling but did not prevent it from returning 24 hours later. I lamented my frustrations to a friend, who suggested perhaps the new hay we had just rolled out could be the culprit. In fact, this friend suggested that from the beginning, but I was too stubborn to recognize it could be a relatively "easy" fix. I instead went ahead and shaved down her hind legs and slathered them in some lotions and potions to combat canon crud and Annie enjoyed throwing me for a loop when she randomly went tight-legged for a day or two post-leg shaving treatment.

But, it didn't last.

So, after trying all the tricks in the book without any solution, I scheduled a vet appointment a week and a half out and decided to do a little test to see if the hay could indeed be the culprit. At the beginning of the year, I had secured hay from two sources, as the previous year left slim pickings and most had to source hay outside of their usual suppliers. In doing this, I was able to score some local bales, but also some higher quality bales that are trucked in from outside of our immediate area. I was pretty tickled to have options, as I am pretty limited to what I can use, as storage options where Annie and Spud are are very limited. That being said, I was able to secure more than enough hay (and then twice over, lol) and in August, after the final cuts were done, we switched to the non-local hay.

 I tarped over the leftover bale so the horses couldn't access it and supplemented some local square bales from Maizey's stash across the street and within five days time, guess who's legs went tight and normal again? 

I was pretty pleased and switched them back to the non-local hay before our vet appointment to see if her legs would blow up again and lo and they slowly started to fill once again. I hauled out 3+ hours with friends who also had appointments and saw a Vet who travelled up to the area (she used to run a practice in the area but now lives elsewhere). Of course, when I unloaded Annie after a 3 hour trailer ride, her legs were cold and tight. I swear to God, mare.

Just a casual 3 hour trailer ride for the Vet to check
a mare who decided not to have swollen legs
that day.
Since there wasn't anything to see, the Vet and I mostly chit-chatted and we both agreed that the excess protein in the non-local hay was probably causing the leg swelling. I noted to the Vet that Annie was diagnosed with COPD and I had heard her cough in the paddock a few times during the "leg swelling test" and I was concerned the local hay could be a trigger. The Vet advised that she would rather see a COPD horse with mildly swollen hind legs vs coughing and being on various medications. She did recommend using some pressure wraps and advised to hand walk and get her moving where I could. 

Things started to get better though, as they always did, and Annie did well with the Equiflex Sleeves I ordered. I'll have to do a product review at one point to go more in depth about my experience with it, because I feel like this post is going to be excessively long otherwise!

Looking (filthy) fancy in her pink sleeves.

As the Fall came and went, things were relatively normal - although we still battled the puffy legs. It was certainly made easier with the Equiflex sleeves, and things were chugging along pretty steadily. I managed to continue some relatively easy schooling, given the fact that we had a very, very wet year. I cannot accurately give a number on how many days we had rain, but I just know it was... gross.

We started to get ready for the inevitable Winter and I was able to get things set up pretty early on - given the fact that our usual snowload seemed elusive for the most part. We had some bumps in the road as Annie had periods of regression and success and I started to lose my mind a bit. She presented mid-November with a glob of thick snot affixed to her knee and I sighed, dialed the Vet's number and reached out for more information regarding nebulizers and how they are used as a mucolytic. I had been researching nebulizers for a few months and was starting to lean towards purchasing one to help Annie with her (obvious) mucus accumulation. 

After speaking with our Vet, I took the plunge in purchasing a (very expensive) Flexineb nebulizer and looked forward to seeing what it could do for us and how it would help Annie. I'll have to write a separate post about the Flexineb (I actually want to do a full write up on COPD and what I've found works/ doesn't work, and a bit of a run down of how the Flexineb works, how to clean it, etc. Would any of you be interested in something like that? I haven't found anything that covers the entire use of a Flexineb system (even their own website), and a lot of what I've learned about COPD is what I've strung together from my own Vet's advice, Vet Med articles, F(ace)book posts, blogs, and other horse care websites.

A quick little video of how it looks/ works.
Anyways, we got the Flexineb a week after my birthday and I was pleased to see those sporadic, random coughs, started to disappear. The Flexineb, along with the saline and chelated silver (I promise I'll explain how to choose what to put in the cup and how much liquid, how often, etc if everyone wants me to! It'll definitely take some time to write out properly and show little videos but I would be thrilled to do so!) started to work pretty well and I was happy with the results I was seeing. We did a lot of hand walking and a few rides when the weather allowed, but for the most part, I was busy switching out rain blankets every few days as they would get soaked through after being exposed to the torrential downpours we were receiving.

 With Winter coming and the issue with the non-local hay not fitting properly in the hay feeder (which meant I'd have to unravel the bales until they did fit and then stockpile the unraveled hay), I opted to try out the local hay bales (they are half the size). I was nervous, considering the local square bales seemed to aggravate her, but was pleasantly surprised to see the bale didn't seem to cause any issues and I happily continued to use the Flexineb as part of our regular maintenance routine.

One of our many hand-walking nebulizing adventures.

As I continued to familiarize myself with the Flexineb, it's capabilities, and what kind of support Annie needed from it, I was let go from my position at work. It was a devastating blow, given how the entire situation unfolded, but at the end of the day, I cannot help but feel a small amount of pride in myself for sticking to my morals. It did suck though, especially considering Christmas was just around the corner and an increase of COVID cases in our region made work-forces come to a screeching halt.

And as if 2020 wanted to continue the beatings, Annie went into an awful flare a week and a half before Christmas. I was confused, as she had been on a bale of local hay for over a month without an issue and it seemed as though a few days after another bale went out, she was a coughing, hacking mess. There were a few other external factors that were confusing me - writing it all out, it seems so obvious, but being in the situation is a whole 'nother ball game. I drove myself crazy trying to find a trend or a link somewhere... some place. My gut churned, feeling as though it could be the local hay causing issues, but she had been on a bale of local hay just days prior without issue.

Suffice to say - W.T.F.

These were very, very expensive antibiotics.

As her symptoms worsened, much to my dismay, I once again reached out to my vet who immediately sent up some heavy duty (and expensive!) antibiotics since the mucus Annie was coughing up looked a tinge suspicious. We also put her on steroids and a bronchodialator to use with her Flexineb and I struggled to get ahead of the symptoms. 

Two weeks of pure misery trying to gain traction to only have success and then just as quickly, disaster. The Vet changed dosing of the steroids and bronchodialator and we added a few other things and once again, we would have success and then it would all come crashing down within a few days. I spent hours sitting in the hay feeder, as the rain poured down, timing and counting each cough, each sneeze, and any little movement or improvement. Annie, bless her, never felt completely poorly - she still tucked her butt and galloped around several times, but on the not so good days, you could tell she was pretty frustrated with coughing. I felt for her, and panic-ordered several cough remedies, tonics, and cut out every single hard feet or treat I could for fear it was making things worse. We were down to the basics and I was practically living in the paddock with the horses, obsessing over every single breath (in fact, the Boyfriend called me one afternoon asking if I was planning on coming home, since I had left several hours earlier).

It was so wet that my poor phone could
barely snap a clear photo or video.

As the bale in the feeder was down to the last 100-200lbs, I made the decision to switch back over to the non-local hay (I know, I know, what a fricken back and forth debacle). It took a few hours of fucking around with the giant bale, fitting a hay net, clearing snow, and then finally loading it... but I was glad it was such a nice day (ie not snowing, raining or below 0!) that I didn't mind it. And, instead of continuing to feed the last hundred or so pounds of the local hay, I dragged it all out and disposed of it far from the horses. 

Once the bale was in, I grew a bit worried as the days ticked by and there didn't seem to be any signs of improvement. I stayed the course, however, and within the nine day mark, Annie was pretty much back to normal. I weaned her off of the whole slew of medication she was on, but continued the antibiotics, and carefully started to exercise her a bit again. And as the days continued to pass, she did really, really well. I was able to successfully reintroduce her grainfeeds (I don't feed extruded feeds, but she is mainly given rice bran and beet pulp, as well as supplements) and I finally was able to breathe a sigh of relief. 


There are so many questions I have about this entire saga - namely, why did she do fine with one local bale, but then not the second?? Which brought me to my next plan of attack - allergy testing. 

We are working alongside a local vet to arrange for an allergy panel once roadways are safer and I can actually... yanno... dig my horse trailer out. I'm in no absolute rush to get the panel done, but I know it'll answer so many of the questions I have and remove a lot of fear of "Can I give her this grain?" "What about this hay?". Instead of fighting an invisible trigger, I want to see X, Y, Z in front of me - undeniable proof that they can cause issues and therefore, we can avoid them, minimize them, or implement immunotherapy for them. 

It took some time to get the Vet on board, because I actually had approached this Vet back in August after her diagnosis and several Facebook groups recommended allergy testing to me, and I was given a very abrupt, "We don't do that here." from the receptionist. I am a bit frustrated I didn't push back in the Summer, given how things have turned out now, but I was quite new to the whole allergy/COPD/RAO world and having had just made a 7 hour trek for a lung wash and additional diagnostics, I was a bit overwhelmed and under-educated. 


She's still crazy sassy and playful! We both can't wait for
Spring (although maybe a little pre-ride lunging is
in order, lol).

All of that aside, I convinced the Vet and his team to use the lab I chose instead of their usual lab, as it is one of the only labs that also tests feeds (beet pulp, carrots, apples, molasses, etc). After about a month and a half of combing through labs, what they test for, the availability of immunotheraphy shots, and how concise they are, I managed to lock it down as to what I want to use. Of course, being the middle of Winter and facing sub zero temperatures with a horse trailer still buried behind the snow we did get, it isn't the best time to be hauling one of the worst stretches of highways in our region. So, that will all come in Spring. For now, Annie is stable and happy so we aren't in an absolute hurry. 

It's been an absolute endeavor working my way through this and even more so without the ability to just waltz into a vet clinic that has all the tests and whistles available. And so, we do the best we can and we do our own research to make those educated choices for our horses... and for the most part, I think we are on the right trajectory. I think the most frustrating thing about respiratory illness in horses is that there is no one size fits all approach. The groups on Facebook have been the most enlightening (and it helps they are so dang supportive too), because there are horses who exhibit a lot more symptoms than Annie does, some that exhibit less, some who can tolerate only square bales, some who can only tolerate steamed hay... and the list goes on. It's challenging, and I've learned a lot about the confusing world of respiratory disorders and to not judge people with their horses because chances are, they are trying so fucking hard to get their partner well again. Above all else, it reaffirms that the art of horsemanship does not stop out of the saddle.