Dean's Lunchtime Clinical Club - 20 February 2018 - Nikki Walshe
Nikki Walshe, Lecturer/Assistant Professor in Equine Clinical Studies, spoke at the Clinical Club on 20 February on ‘At a Loss about Weight Loss.' Prior to coming to work with the UCDVH Equine Field Service, Nikki spent six years in clinical practice. The issue of weight loss is something that vets will see a lot of in equine practice and in mixed practice, and Nikki noted that the case she was presenting on taught her a lot about this issue.
Nikki outlined the function approach she takes, looking at where the problem started and where it ends. She detailed eight questions to look at with weight loss cases; the questions concern access to food, wanting to eat, adequate nutrition, ability to masticate, problems with the GIT, infectious and/or inflammatory issues, problems with the organs that help digestion, and finally whether or not the problem is related to the gut at all.
In this particular case, Polly, a 3 year old thoroughbred, had recently been moved to a professional yard for sales prep. She had been losing weight since arriving to the yard (6 – 8 weeks ongoing), was eager to eat but would eat very little and had occasional mild transient colic signs associated with eating. Polly had been wormed 3 times in the last 4 months, and wasn't taking non-steroidal anti-inflammatories, she had a body condition score of 2/5 and no other abnormalities were detected.
Nikki emphasised the importance of focusing on the functional approach questions, before going through the problem list in this case and the range of possible issues – gastric ulcers, liver disease etc. In terms of diagnostics, the following were utilised: dental exam, bloods, urinalysis, faecal sample, gastro scope. What Polly had been de-wormed with and for how long was also looked at; there were no worm eggs in her faecal sample. She was from a low stocking density farm with a good worming protocol, and had been stabled with some paddock turn out. The dental exam showed up sharp enamel points but was otherwise unremarkable and the blood work confirmed that liver disease wasn't an issue. After a number of possible problems were eliminated from the list, a scope was utilised; Nikki thought the issue could be gastric ulcers, but the stomach was clear. An ultrasound showed that the duodenum had a thickened wall; there was increased abdominal fluid, but an abdominocentesis showed no signs of infection.
A glucose absorption test was then used to see if there was a malabsorption problem. In this case, Polly was 5% less than the base level which meant she was suffering from complete malabsorption. Nikki then looked at treatment options to target inflammation. Steroids were prescribed and management of the issue through a simple and hindgut based diet was recommended. Nikki also highlighted the importance of reducing stress in such cases.
In terms of progression, Polly's demeanour improved, as did her appetite. Treatment at home was recommended to include steroids, anthelmintics and management of the problem. The owners, however, decided to seek advice from another vet, who put Polly on anabolic steroids and a high protein diet. Polly subsequently got coronary band lesions and violent colic and was put to sleep soon afterwards. Nikki concluded her presentation by outlining that Polly's issues could actually have been managed quite well, and whilst she would not have been able to race, she could have been used as a broodmare.