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.


Coughing
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)?