Echocardiogram

Friday morning I woke up queasy. I was nervous about Eeyore’s appointment. Would I be told he had to be retired? What would I do then? Was all the hard work over the last 6+ months for nothing? How would my Big Orange Doofus take to pasture puff life?

The hour drive flew by as my mind raced and soon I was unloading him into a cushy stall to await the internist who listened to his history then put the stethoscope to his heart.

Grade 2/6 murmur present. Well, darn. There went the hope it was transient and due to dehydration or electrolyte imbalance.

She said that it was a diastolic murmur, a better prognosis than a systolic one and unlikely to cause syncope under stress. Diastolic murmurs tend to have longer term complications as the ventricles enlarge over time from the increase in blood and pressure. This can lead to congestive heart failure. The question was what was causing his murmur and an echocardiogram was needed for that.

Of course I agreed and we moved into a treatment room where she shaved a small patch along his girth area and hooked up EKG leads. She watched for any arrhythmias and was happy when he was regular. One complication off the check list.

Eeyore had been the perfect patient to this point. She had complimented him several times and like all prior vets who have seen him said “he is a really cool horse. I like him a lot”. He doesn’t like his girth area touched though. Doesn’t like it scratched. Doesn’t like it groomed. Tolerates the girth as long as it is memory foam. When she jammed the ultrasound wand into his girth to see his heart, he freaked out a little. Nothing terrible, but his heart rate soared and he became fidgety. Two things that impede the process of the echo.

We tried putting him in the stocks but that made him even more anxious so he got some sedation. Not the best thing for an echo as it can change the heart parameters, but she remained confident we would get a solid reading anyway.

After the sedation he was a perfect gentleman and she was able to look at both sides and get really good images. There was a lot of good news. Heart wall thickness was normal, heart chambers were also normal in size. No arrhythmia detected. All major vessels coming into/out of the heart were normal. No pulmonary back flow.

But there was also some not so great news. He has mitral valve prolapse with mitral regurgitation. The mitral valve opens in systole to allow blood to be pumped from the atrium to the ventricle and then closes to prevent blood leaving during diastole. In Eeyore, the valve doesn’t shut properly so that blood seeps backwards during diastole causing the extra heart sound. He was born with this and it 100% was present in 2008 at his PPE. You will be spared a rant about the uselessness of a PPE that can’t even catch a grade 2 murmur that a professional should most certainly hear. If she had, I would have passed on him. But that’s not relevant right now.

As far as heart anomalies go, MVP is the best one you can get. It doesn’t progress and rarely causes issues alone unless the valve is degenerative in nature. She did see one spot on the valve that was a bit thicker than it should be but nothing that overly alarmed her. She wants me to do yearly echos to watch it. A degenerative valve is an issue and will cause deterioration over time but she doesn’t think that will be the case for him.

Prognosis? Pretty darn good all things considered. She gave the green light to ride as much as I want and followed that up by saying he is fat and I need to ride more. I’ll take a prescription for more saddle time any day, thankyouverymuch.

As an aside she recommended scoping for ulcers due to his recent gastritis but uh…no. I’m not made of money and he is fat, sassy and shiny. He shows no symptoms and beyond travel he has no lifestyle risk factors. I still went ahead and had Dusty order me a months worth of gastroguard and will treat just to be on the safe side. No harm in treating but I won’t put him through a scope for no reason.

Then I opened my darn mouth and asked if bloodwork would be of any value. Of course she said yes, so we ran a CBC and basic chem panel. I loaded Eeyore up as I waited for results. Mostly all came back normal except for his GGT level was off the charts high. She explained that this is related to his liver/gallbladder and usually a high value is consistent with cholecystitis.

The value can get high after a colic/gastritis episode which he had had only 5 days prior. Or it could be liver toxicity. She recommended a liver ultrasound and a biopsy. I asked if I could ignore it and she said no. Liver disease can be a serious issue.

Huh?

At this point I got frustrated. If one more vet sees my horse and diagnosis a potentially very serious issue incidentally while seeing him for something completely unrelated, I’m going to take up riding cows. This is ridiculous.

I told her I would have the husband re run his bloodwork and recheck the value in 2 weeks which should be sufficient time for any acute problem to resolve. If it was still off the charts high, we would do the ultrasound and go from there but it darn well better be normal because this horse is killing me.

As of right now, once the shoe he ripped off on Wednesday gets put back on on Monday, I’m cleared to ride to my heart’s desire and then some to get him in better shape. She doesn’t believe his recent change in energy has anything to do with his heart or liver and is behavioral/fitness related. Which brings up a whole other series of questions that will only make this post even longer, so I’ll save it for another day.

Team Orange Doofus is back at it folks!! Only not at WR next week because a) I missed the deadline with all this stuff and b) between the emergency vet visit Sunday and this one Friday I’m out nearly $2,000 in unexpected vet bills so uh…yeah no showing right now.