0711Singapore Warmblood, dysuria, nitrofurazone ointment, exertional rhabdomyolysis, tied up, pet health and welfare educational for animal lovers, excerpts from The Glamorous Vets, Singapore, sponsored by  AsiaHomes Internet.

The horse has great difficulty peeing.

Three yellow code words flashed on the left hand corner of the television screen at seven in the still bright March evening.  One of them was Battle Axe and it meant that my reservist platoon was recalled under the mobilisation exercise.  My phone rang. I expected the call to be from my sergeant who would be responsible for contacting all soldiers in his platoon. We must assemble at the camp before midnight, preferably earlier.  
 Warmblood enjoying his grains
"My horse passed a small amount of urine and he took a long time to do it," said Mr Hoffman over the phone. He had just finished riding the horse and had hosed down the twelve-year-old handsome Warmblood gelding and noticed the problem.  Normally the gentle big horse would pee only inside the stable after bathing.   

"Did he pass dark brown urine?" I asked thinking that the horse might be suffering from a mild case of exertional rhabdomyolysis or breakdown of the muscle cells after exercise leading to discoloured urine. This condition is known as tying up. 

In severe cases, affected horses exhibit a stiff gait, muscles become cramped and the horse would be reluctant to move.  The causes include vitamin E and selenium deficiency, electrolyte imbalances, heat exhaustion in endurance horses, hypothyroidism and abnormal calcium regulation. High blood serum levels of muscle enzymes such as creatine kinase (CK), lactate dehydrogenase (LDH) and aspartate transaminase (AST) are found in the blood. The serum CK elevation indicates muscle cells breakdown while LDH and AST increase with muscle and liver necrosis. 

Mr Hoffman said the horse had passed brownish urine.  "Walk the horse for a while, massage its bladder area and if he had not passed urine, let me know," I said as I ironed my uniform, hunted for my beret and polished my boots. 

The Warmblood still could not urinate. I made a house call as this was an emergency and could not wait till tomorrow.  The bladder could fill up and rupture.  

He had a calm demeanour and was heavily muscled, a candidate for exertional rhabdomyolysis. 

"Did he drink his usual amount today?" The answer was no. Usually he drank half the container of water. I could see that the container was 90% full.  He could then become dehydrated and the kidney would fail if the dying necrotic muscle cells could not be excreted by the kidneys. This would lead to myohaemoglobinuria manifested by a dark reddish brown urine.

I placed my ear onto his stomach area but could not hear any intestinal sounds.  Most horses, like people, have some ringing digestive sounds in their abdomen as the intestines move the food along. 

No smell of sweat as Mr Hoffman had bathed him very thoroughly.  The Warmblood did not move or object to my head on his belly.  His abdominal muscles were shivering slightly and his tummy was tucked up. 

Was he suffering from colic? As if reading my mind, he  passed around 10 greenish yellow golf-ball-sized stools in a mass on the wood shavings. No smell from the faeces unlike dog stools.  Mr Hoffman said: "He could not be having colic as he could pass stools!  What was the cause of his problem?" 

I palpated his foreskin and prepuce. He did not kick me. He was cool. There was no pain.  No injuries. No wounds.  His penis came out and down from the preputial opening. But no urine.
He was not in distress.  Somehow, many animal patients behave normally when the veterinarian is examining them. Don't expect him to strain to pass urine. I had to take the Owner's words.

"Don't feed the oat grains," I said as Mr Hoffman went to fill up the feed bin.  "Hay will do for tonight." 

Mr Hoffman held the horse while I injected 30 ml of the anti-spasmodic and antibiotic into the jugular vein. The Warmblood did not object. There was no need to be wary of him. I injected the antispasmodic medicine slowly as some horses would react to it by being highly strung.  As 15 ml went into the big jugular, the stable lights failed.  There was total darkness. It was a cool black cloudless night peppered with stars but it was too dark. 

Mr Hoffman ran out of the stable. He switched on the lights as the stable lights had a timer which cuts off the electricity in fifteen minutes.  The horse looked dazed, his eyes being glassy. 

Around ten minutes later, he was pawing the wood shavings. This was a good sign.  The horse pushed his back legs further back and the front legs a bit forward.  A thin stream of urine, light yellow, the normal colour was passed weakly and directly into the saw dust for around four seconds. Probably a thousand ml of urine, not much for a big horse.  Mr Hoffman was away preparing the feed. He felt relieved, as much as his horse felt relieved of a full bladder. 

The drug was working. I was glad too. Another seven minutes passed. The horse urinated strongly this time.  At least five thousand ml of light yellow urine was passed.  Without difficulty.
He now had a good appetite. It was nearly ten o'clock.     

"Was there any changes introduced recently?" I asked.  Mr Hoffman showed me a white bottle of nitrofurazone ointment. This was applied to the cuts and wounds of the horse's limbs and back on Saturday.  The horse could have licked off the yellow liquid and the nitrofurazone could have irritated the bladder, causing pain and spasm.  

Mr Hoffman offered me some ointment to touch and said: "This ointment burns my fingers, so I guess it will burn the bladder." I said it might not be the cause of the problem.

"Was there any unusual behaviour recently?" I asked.  

"He cantered non-stop in the lunging ring for more than ten minutes yesterday." said Mr Hoffman. "He never did that before."  Cantering was a faster movement short of a gallop.   The lunging ring was used to let the horse trot in circles with the Owner holding a rope.  Could nitrofurazone make a horse high spirited?

As if this was not enough, Mr Hoffman exclaimed: "The horse bucked this evening and kept doing so!"  Looking at the horse who always looked calm, I could not imagine him to behave wildly on the hilly track of Bukit Timah.  Why would the horse spring into the air with the back arched?  Fortunately, Mr Hoffman, a tall but not taller than his horse of 650 kg, is an experienced rider.        

Warmblood feeling the Singapore's hot and humid noon time So, was nitrofurazone the culprit or was it the hot weather as Singapore had high daily temperatures of over 33 degrees Celsius recently.  Singaporeans working in air conditioned offices had complained.  This poor Warmblood was also dry coated and could not sweat freely.  I saw him panting away on a hot noon three weeks ago as he rested on the wood shavings.  He did not have an air conditioned stable.  Did the heat and humidity and the grains fed to him combine to affect his brain and consequently his behaviour?

I was worried for him as his unruly behaviour could cost him his life. He could be shot and given to the lions at the Zoo if Mr Hoffman did not want him anymore. I doubt this would ever happen as long as Mr Hoffman was alive. However, Mr Hoffman would be leaving Singapore in 2 months' time as his  expatriate father would complete his employment contract. 

What would happen to this Warmblood?  He was tall, even by Caucasian standards of height.  Big and muscular. At least 17 hands. It would cost more than US$12,000 in freight to fly him to the USA and Mr Hoffman was a teenager and might not be able to afford the fees.  This would be the end.  

He was saved from the bullet as Mr Hoffman adopted him. His previous owner had wanted to euthanase him two years ago. In Singapore, healthy unwanted horses are lion's meat as there are no retirement homes for horses.    

I had to ask Mr Hoffman what would be the fate of this horse. Mr Hoffman said: "He would go back with me. Dad had agreed to pay his airfare."  What a kind father this must be. 

I said to Mr Hoffman, "You must study hard if you want to be a horse veterinarian or a horse trainer. I guess you must have read the novel "The Horse Whisperer?"

Mr Hoffman said he was not impressed with the book although I thought it was a fascinating story which was made into a movie.  I was glad that this magnificent Warmblood, a cross between the best of Arab horse with speed and agility and European stock with calm temperament would not be shot. He would make a good horse for dressage. 

The exact diagnosis was not known.  Blood samples were not taken as it would cost Mr Hoffman more money and in practice, the least cost to the Owner, the better it would be.  

It was one of those cases I could not forget. There was still time to rush to the Army camp.  


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