What else could it be?

Ben and Ramsey are both doing better.  They are still on pain meds and antibiotics, but they both are acting nearly like their normal selves.

On Friday, I finally started Ben on a course of steroids.  I am not a fan of steroids and I procrastinated about this, but they do have their place and they do seem to be making Ben feel better.  He even broke into a voluntary trot today.  I have cut out all NSAIDs for him and I am slowly lowering the dose of the gabapentin.  He has another ten days of antibiotics and I hope to have tapered all of his meds off by the time they end.  Then, we will see where we really stand.

Ramsey feels well enough to be running around and trying to boss Ben about.  Ben feels well enough to blow him off.  Poor Ramsey is still a very frustrated thwarted tyrant.

I don't think I will ever know what caused all this, but I am still convinced that it is a tick borne disease.  I am even more convinced today because this morning, I got an email from a friend in New Hampshire - she has a mule who just presented with the same symptoms.  What else could it be?

Back Talk

The Ears Have It

The Boys

The boys are doing OK.  Ben is feeling better, although he is still on rather alarmingly high doses of pain meds to keep him that way.  They both seem to be getting past the illness that has caused all of this, but there is still a lot of joint pain.  We are contemplating a short course of steroids for Ben, which should alleviate overall inflammation and joint pain.  If we stop the inflammation, it might not come back.

The only problem with that idea is that steroids are a very bad idea for an animal who has any metabolic issues and is at risk of laminitis.  Ben's metabolic tests came back normal so it should be OK except that he is definitely laminitic in his right front foot.  I have the medication, but I have been weighing the risks and have been procrastinating about giving it to him.

Ramsey seems like his normal self, although he too is on Previcox (an NSAID) for joint pain.  I am also hoping that it might help prevent laminitis developing.  That is my greatest fear for him right now and I am doing everything I can think of to protect his bad foot.  Since he is already missing a third of his coffin bone, I am not sure he could recover from laminitis.  

One of the other symptoms I have noticed is that both have lost the shine and softness to their coats.  It is especially noticeable on Ramsey because he is usually very soft, sleek and silky.

They are both feeling better though and my hope is that what they need now is to finish their 30 days of antibiotics and time will fix the rest.

We are in the middle of an ice storm now, but yesterday, we had one brief day of sun.  Maybe it will help.  

In the Mist

Roller Coasters

Have I ever mentioned that I hat roller coasters?  Absolutely loath them.  I'm sure it has something to do with a near death experience on one when I 4 or 5 years old.  Or maybe it's just the whole up-down-jerking sideways-screaming people-flashing lights horror of the things that I hate so much.

This week has felt like that.

In my last update I said that Ramsey was doing well and the antibiotics seemed to be on top of the mystery disease.  Then....on Monday, he came up lame.

He was not as severe as Ben, but this is Ramsey we are talking about and Ramsey has enough troubles without this.  I have put him on Previcox as well as the antibiotics and he is doing OK.  I've wrapped his bad foot because I wrap that foot if he twitches an ear wrong and I am watching him like a hawk.

I don't know what else to do and neither does anyone else.  I've talked with Cornell and the Donkey Sanctuary and my vet probably dreads the sound of my name at this point.  I have to just hope that this thing responds to the meds or runs its course without causing too much damage.

I rather hesitate to say it, but I think Ben is doing better.  He has had three good days in a row and that is a first since this all began on December 30.  I had x-rays of his feet taken and he has become laminitic in his right front foot.  He had some white line separation in that foot that I have been battling so it was already weakened.  I trimmed the hoof-wall back a little bit to lake the pressure off the lamina, brought his heel down by a couple of millimeters and packed the foot with dental impression material to provide cushion and sole support.  Today, he is walking almost normally.  

I am trying to wean him off some of the pain meds and, so far, it is going OK, which I take as a good sign.  He is also getting rather ornery about having drugs shoved into him and he complained very loudly that I was late with breakfast this morning, which is another good sign.

All of the blood work came back normal with the exception that his vitamin E levels are low.  He gets supplemental E so I was little surprised.  However, vit. E is a very fragile vitamin that is the first to diminish in stored feed.  About half of his hay ration right now is actually left over from last year so I should have upped the E levels.  I just didn't think of it.  Fortunately, that is easy to fix and I have already addressed it.

His ACTH and insulin levels were fine so he does not have Cushings and if he is insulin resistant (which I figure all donkeys inherently are), it is well compensated by his low sugar diet.

So, that is where we are.  I would like to think this miserable roller coaster is finally pulling in to the landing platform where we can all get off, but you can't trust the nasty, horrid things.  It is going to be a while before I feel like we are off this awful train and even longer before I feel OK about any of this.

Update

Ramsey is doing better today.  I was able to start treatment for him almost as soon as his symptoms appeared and that has made a big difference.  twenty four hours on minocycline and he is just about his normal hugable, lovable, demanding self.

Ben though....I am worried about Ben. He is holding to this pattern he has been in: looking better then getting worse.  Yesterday, he looked OK. He was bright-eyed, good appetite, moving around although still stiff.

Today, he is noticeably more sore, depressed, lethargic and poor appetite. His temp was 97.5. I put a heavier blanket on him and he perked up a little bit, but there is no good reason for him to be cold.

I will be talking with the vet again in the morning and will probably call Cornell again as well.  They have not been very helpful so far.  As soon as they hear the words "lame donkey", they assume it is laminitis and tell me to put him on a low-sugar diet.  Which he is already on.  Now that there is a second donkey sick with the same symptoms and a fever, I doubt they will blow me off so quickly.

I'm just going to keep doling out drugs and see what tomorrow brings.  

Just Shoot Me Now

Where to start....

It's been a roller coaster week.  Ben was feeling OK once the gabapenten kicked in for him.  We started him on the minocycline on Wednesday.  Thursday, he felt awful, but I think it was the antibiotic making him feel sick.

Friday morning, I spoke with the vet again and we decided that Ben would need to show some real improvement by Monday or he needs to either go to Cornell or I need to make a decision that I really don't want to make.

By Friday night, he was feeling somewhat better and I began to have some hope that the antibiotics were finally starting to help.  I do think there is some genuine improvement, but I am rather hesitant to call it that because we have been in this cycle where it looks like he gets better, then he crashes and ends up worse then ever.

He is finally off the banamine and on bute instead, which is much safer for him.  I am taking that as a good sign.  Today, he is moving around and his appetite and interest in life are back, although he still has a lot of joint and muscle pain.

***

Then.....I went out this morning and found Ramsey standing in the exact same spot Ben was in two weeks ago with most of the same symptoms.  The only difference is that Ramsey has a fever and Ben did not, at least not by the time I checked.  I could have missed a mild fever in Ben that precluded his symptoms because donkeys do not show signs of fever the way other animals do.

Ramsey's symptoms are much milder than Ben's were, it is not a holiday weekend and I have the right drugs on hand and started him on them immediately.  I am very hopeful that he will respond faster than Ben and get over this in a day or two.

***

We still do not know what is causing this.  The fact that Ramsey is now sick raises the specter of an infectious disease.  However, they have had no contact with other animals and I never go anywhere, so where did it come from?

I still think this is likely Lyme disease.  Two years ago, they all got Lyme disease at the same time.  I see no reason why it wouldn't happen again.

The symptoms I see in Ramsey are:

• Sudden fever
• Chills with hard shivering even under his blanket
• Joint and muscle pain
• Withdrawn, depressed aspect
• Loss of appetite

Treatment: Banamine controls the pain and brings the fever down.  Minocycline to treat the infection. 

Ben's Treatment: Bute for pain and inflammation, omeprazole to treat ulcers caused by two weeks of banamine, gabapenten for chronic pain, minocycline to treat infection. 

My treatment: Someone needs to book a room for me at the nearest psych ward.

Ben Update

A quick update on Ben....

All of the blood tests we have run so far have come back totally normal.  There are a couple that have been sent out to Cornell that we are still waiting for.

The gabapenten (neuronton) experiment has been very interesting.  Ben is getting it twice a day and just got his 5th dose.  Initially, I saw no improvement and was getting really skeptical about continuing with it.  It did seem to make Ben a bit drowsy at first and he laid down for several very long naps.  I don't think this was a bad thing.  Ben has been lying down a lot because of pain, but not really resting well.  The gabapenten seemed to help him rest more comfortably and really sleep.

When I went out last night after work to give him his 4th dose, he was clearly feeling a bit better.  He tried to run away from me and he argued with me about having more nasty drugs shoved down his gullet, which I took as a good sign.  Today, Ben is still moving very slowly and carefully, but he is moving and his appetite has returned to its normal insatiability.

Now that he is moving around a bit more, it is increasingly obvious that this is not foot pain.  He moves like he has arthritis in every joint, which is exactly what I expect he does have.

My take on the gababpenten so far is that it takes at least 24-36 hours to show any real benefit, but does help quite a lot once it kicks in.  This is not a cure for what ails Ben, it is just a pain medication that is helping him feel better.  We are still working on treating the real problem.  However, Ben was getting increasingly depressed and in growing pain.  He was starting to loose his appetite and a donkey who won't eat is at major risk of life-threatening complications so anything that helps him feel better is a good thing.

The gababpenten was recommended to me by Cornell because they were certain that Ben had laminitis and this in one of the drugs they are using to treat that.  It is also used to treat other chronic, neuropathic pain.  This is not a drug you are going to reach for to treat minor problems, but if you are dealing with acute laminitis or some other hard to treat chronic pain, it might be worth doing some research and having a conversation with your vet about it.

The medication for treating Lyme came in this afternoon and I have started Ben on those as well.  I am very much hoping that this works and we see some real improvement soon.

If it Quacks Like a Duck...

The vet was out again this afternoon and we really gave Ben a going over.  Despite the fact that everyone says this is laminitis triggered by some unknown problem, neither of us has been completely convinced of this.  Ben is in a lot of pain and is lame in all four legs, but he just does not move the way a laminitic animal generally does and he is not responding to treatment.

We got out the hoof testers and, low and behold, Ben shows no sign of pain when we test his feet. However, he does show pain in all of his major joints and his back.  Regardless of the test results (which are notoriously inaccurate), I am still about 88% sure that this is some kind of tick borne disease.  

We drew lots of blood for more tests and we are trying a slightly experimental drug on Ben.  He is now on gabapentin (also called neuronton), which has been used in people and dogs for many years. However, its use is new in equines. We don't know if it will help, but he has plateaued with the banamine and needs something else. Depending on what the blood tests have to say, we are also planning on treating him for Lyme because if it quacks like a duck and walks like a duck, I think we should shoot it like a duck - with a shotgun.

Running the Hamster Wheel

I would like to say that Ben is all better.  Unfortunately, he is not.

We still have no idea what triggered all of this although I am still suspicious of a tick-borne disease.  One of the big problems with donkeys is that they when one thing goes wrong, regardless of cause, they are highly prone to get laminitis as a secondary problem.  That is where we are now.  I don't know what infectious agent triggered all of this, but Ben is now clearly laminitic in all four feet.

That puts us right square on the hamster wheel.  There is nothing quite so controversial to treat as laminits.  The reason it is controversial is that there are no good treatments.

The key to getting laminitis under control is to find out what triggered it and treat that.  Except I can't do that because I don't know what triggered this.  Ben was perfectly fine and healthy one day and not the next.  He is already on a low sugar/low starch diet, which would normally be the first thing to do.

I've talked to all the experts I could find and here are a few of the suggestions:

Ben has laminits and you should ice his feet.  It is 6 degrees out and there is snow on the ground.  His feet can't get any more iced than that.

Ben has winter laminitis and you should keep his feet and legs warm.  Lets all hope this one is bullshit because it is now -6 degrees out.

He needs NSAID's to keep the inflammation under control.

He has to stop all NSAID's now because they slow healing and cause ulcers.  

I could go on, but I have had enough of the hamster wheel for tonight.  I am going to go check on Ben and the rest of the herd then take a hot bath, because even hamsters need to get off the wheel sometimes.

Uncertain

The vet came out yesterday to see Ben.  By the time she got here, he looked 98% normal and seemed to be doing really well.  We drew some blood for a few tests and agreed to continue his antibiotics and wean him off of banamine and onto previcox (pain med), because it is safer.  We both thought we had this under control.

This morning, Ben was in trouble again.  He was very sore and lying down too much.  I put him back on banamine and when he went out and laid down on the ice for an hour and refused to get up, I gave him some more.  That finally worked and he is back on his feet and moving around, albeit very slowly and carefully.

Ben's Lyme test came back negative and his other blood test came back normal.  He shows signs of 50% muscle pain and 50% foot pain.  We can't tell if one is causing the other or vice versa.

I've sent a long letter off to the UK Donkey Sanctuary to see if they have any words of wisdom for us.  We sure could use some.

Big Ben

Ben is continuing to feel a little better each day, though there is still some lameness and soreness. The vet is finally going to come out tomorrow and run some tests.  I have mixed feelings about it at this point as Ben is responding to my treatment and I am not sure the tests will really be helpful, but I need more medication for him and they won't give it to me without seeing him.  They were not very eager to see him last Friday when I wasn't sure he would live through the weekend, but quite keen now.

Thus is the way of the world.  It will be nice if we can at least get some real answers.  I have a nagging suspicion that those will be elusive.

Meanwhile, Ben is feeling mostly OK and continues to enjoy his most favorite pastime - food.  Ben does love his food.

Throughout all of this, Ben's appetite remained well intact.  If this particular donkey ever stops eating, then I will really know his world is ending.

And just because it is a miserable, dreary day and its been a miserable week, here is a random puppy video from a couple years ago.

The 24 Hour Mark

We hit the 24 hour mark in antibiotic treatment this morning and Ben started to show some improvement.

A rare bit of sunshine didn't hurt.

By this evening, at 36 hours, there is definite improvement.  I am thrilled by this, but also a bit depressed and scared.  I am certain now that this whole episode is Lyme disease.

Again.

That adds up to a 100% infection rate for this property.  What the hell am I supposed to do about that?  Nukes really do seem like the only answer.

Happy New Year.