Waiting for answers

Hello old sports,

I thought I would give you all a little update. I know, right? Two posts in one month!? Gasp, it's just like the old days before Spode started working in the non-horse world! Spode tells me that people have been wondering how I am, so I figure I owe ya one.

I've been on my course of steroids for about a month now, but they haven't helped me one bit. My respiration rate is still too high and my breathing effort is too evident at the end of the day. Still can't go for a ride with Spode as I start snorting and am unable to hold a trot. I can manage a bit of running in the field sometimes, but not for very long. So I'm coming off of them now and will be finished them in about a week.

I still look pretty damn good, if I do say so myself. 

Originally, we were going to try a second steroid in March, but the vets consulted and don't see the point since the steroid I'm on now made absolutely no difference to me. Instead, the plan of action now is to continue resting (sorry, Spode, still no riding) and return to the hospital in April for a recheck of my lungs. The vet said she is feeling highly doubtful that I can ever return to being ridden now since I didn't respond to the steroids, but the only way to know for certain what is going on in my lungs is to have that chest x-ray again and see what changes are there. Best case scenario would be no changes as it would mean my disease is slow progressing or maybe even stable now. I daren't hope for clear x-rays. The vet didn't think that was in the realm of possibilities, especially as my symptoms haven't changed except to get ever so slightly worse... but I am miraculous in some ways so maybe I will still surprise everyone!

But if there are negative changes, as upsetting as that would be, then it should at least give us a better understanding of what my prognosis and life expectancy will be. If the vets can't see any changes, then they want to do that lung biopsy to see precisely what is going on with my cells and what amount of scarring I have already and if there are any more medications we could possibly try depending on what they find. This biopsy would also definitively tell us whether I can hope to return to work one day or not... if the x-rays don't already provide that answer clearly. If the x-rays have negative changes then the vet said all there is to do is keep me comfortable for as long as we can. The vet suggested that, no matter what they see or don't see, Spode shouldn't get her hopes up that I will be a riding horse again since this has progressed negatively over almost 7 months now despite trying 4 different medications. Still not quite sure how to process that, so let's just wait for April's news, shall we? 

So things are still up in the air, really. Still waiting for clearer answers on what exactly this disease will mean for the rest of my life. Thankfully my favourite regular vet is finally back from his injury as well so maybe he will have some additional ideas when I go to the hospital again.

Spode just finished her half term holiday so we've had a nice vacation together and I've been groomed like crazy. Not that it has left me clean because I go and roll in the mud every day without fail. Hey, I'm just being nice. What else is Spode going to do if she has no mud to clean off of me?! It's been lovely and warm, and the grass is getting a little bit tastier every day. Spring is definitely in the air, and I am content eating my food and enjoying Spode's company. Life is okay, just a little anxiety-provoking at the same time. I let Spode worry about that when she's at home, but we can ignore all the vet notes and research when we're together. We still successfully live in the moment and just enjoy each other's company. That's what really matters anyway, isn't it?

I really, really like my food!

Until later, old sports. I shall update you all in April.

Jay.

A scary diagnosis, but it won't stop me

Hello old sports,

In my last post, I explained to you that I had been waiting and waiting to update my blog until I found out what was wrong with me. And after almost 6 months, I was still waiting.

Well, in some ways the wait is over. In others, I now have even bigger questions than before. So, let me explain.

Spode was on orders to increase my exercise to see if that helped or worsened my breathing issues. Spode tried this for a few weeks, but in the end it was just not working out. I was miserable and started trying to stop her from taking me in the lunge pen. I had no change in how much I was snorting, and worst of all I just couldn't get the energy to do what she asked. Nothing could get me to trot some times, and it was starting to break both our hearts making me do it, so Spode called the vets again and sent me to the horse hospital. For the third time, might I add! I wonder just how many vets I've seen in my 5 and a half years with Spode in two countries (4 if you count my layover--I did see vets in Amsterdam and France, too!)? Too many for this horse to count.

At the hospital, I was trotted around and the vets agreed with my lack of energy, relatively "minor" respiratory issue, and exercise intolerance, but weren't concerned it was anything too serious. In fact, they were more concerned with my hind legs being stiff, but that was just from the trailer ride I think. Normally I feel fine.

After these observations, off I went for another ultrasound, another endoscopy (ugh, seriously the worst!) and chest x-rays. It was all very intense but worth it in the end. My repeated ultrasound showed increased roughening of my lung walls but still nothing too drastic, though admittedly it's a bit tricky due to my size. The x-ray, on the other hand, revealed a major problem. I was diagnosed with interstitial pneumonia. To put it in basic horse terms for you, the fluid filled space around my lungs that takes oxygen out of the air inhaled and puts it into my blood is all swollen, all over my lungs. The vets couldn't tell if this was permanent scarring or not, as the lungs are not regenerative and so are easily permanently damaged.  Based on the fact that my breathing has been a problem for almost 6 months, it's not looking good in that regard. So finally, I understand what has happened. I have been breathing faster and struggling to exercise because I'm not getting as much oxygen into my blood stream. No wonder I've been feeling breathless when I run.

During the endoscopy, they took cells out of my lungs to test them for viruses, bacteria, and general inflammation. They've done this before already, but it was not as detailed due to the tube not reaching down all the way to my lungs last time (another big horse problem). So last time, we only saw inflammation and assumed it was asthma.

This deeper test revealed an even worse problem than interstitial pneumonia. It showed chronic inflammation based on my cell counts (already knew that), some evidence of blood in my lungs, and unfortunately I also tested positive for EHV-5, meaning I was infected with it sometime ago. Now, most horses are exposed to EHV-5 in their lives. There's no vaccine for this strain, and it's so common that for most horses it poses no problem whatsoever. In fact, until recently they thought it was not related to any issues at all. Nearly every horse in the world has been exposed to it. But some horses, and I am one of the unlucky ones it seems (possibly due to my already compromised immune system caused by my first major issue: leptospirosis/uveitis), respond negatively to it. Therefore I was given a new diagnosis: suspected Equine Multinodular Pulmonary Fibrosis (EMPF). They cannot say with 100% certainty that this is what I have right now, but EHV-5 is almost only found in lung fluid of affected horses, and the fact that I have interstitial pneumonia means it's even more likely. They have never had a case of EMPF that didn't test positive for EHV-5. So it's extremely likely that this is what I have. A lung biopsy would guarantee it, but Spode doesn't want me to do that as it's invasive and risky, especially for a horse my size. Even if it's not EMPF and just regular interstitial pneumonia, it's not looking good regardless.

Now, Spode has explained all this to me, so basically it means that I will have lung scarring caused by the pneumonia--once it's progressed further, it should eventually be seen by x-ray as it shows up as blobs of scar tissue, which first starts with lung wall roughening (which I already have). EMPF is only a very recently discovered disease and is quite rare. Unfortunately, there are only a handful of cases of horses surviving this disease, so the prognosis is poor. It's been a shock to me, and to everyone Spode has told, really. Mostly because I look great: I'm shiny, good weight, and happy to wander round and have a huge appetite as always. Aside from breathing faster and having a heave line at night and the snorting when exercising, I look totally normal. Everyone is hoping this means I have a better chance of survival. Most horses (and people with this disease) have a life expectancy of 2-5 years. How I respond to treatment will give the vets a better idea of my prognosis. I have definitely worsened since August, but not as fast as many horses who get this disease, so my hooves are crossed for a good chance of long term survival in my case. There is no cure for the disease, but a few lucky horses respond well to steroids to at least stop the progression.

So that's where I'm at. Spode and I are wrapping our heads round it and taking it all in. I've been on steroids for a week and half with no luck so far. It's the same steroid I tried back in November which didn't help, but we're hoping a longer course might do the trick. So I'm staying on this steroid for a few more weeks to see if it does anything to my respiration rate. After that I will try a month of another steroid (the same one I was on for my temporary blindness. What a life I've had).

If nothing works, then I will just go into a very early retirement. I won't be able to be ridden because it could damage my lungs more if I'm pushed further than I feel up to. I need to decide when I want to run and when I want to rest, and it's a bit hard to tell that to Spode during a ride. Retirement was certainly not what I expected to be saying at only 7 years old, but life is strange, isn't it? I think Spode will miss the riding, but as long as I'm happy and pain-free, she's happy to retire me for as long as possible. We'll see how the next 2 months go. Maybe I'll be a miracle horse. I already have, according to Spode. She doesn't mean the fact I came back from temporary blindness not once, but twice. Nor the fact that I was given a guarded prognosis last year when diagnosed with inflammatory bowel disease, which I bounced back from easily. No, it's how I've helped her in countless ways. 

A massive appetite is surely a great sign, right? 

I have a heave line after being outside and moving around all day, but I also have a big belly and no weight loss=positive!

I'll let everyone know how I do with these steroid plans. Now that we've both got to terms with the news, Spode is determined to carry on as normal. After the initial shock, she's decided to keep her chin up and stay positive. Like I said, I look great and my personality is the same as always. So we're going to enjoy every moment at the stable, and to remain positive due to the fact that I am not losing weight like many horses with severe EMPF. Maybe I will be the miracle horse once again, with these positive signs of health. They don't call me The Great Gatsby for nothing, old sports. I really am great!

Until later, old sports.


Jay.