Tuesday, August 19, 2014

The Lump: Part 4 - The Horse Hospital

My poor Maggie is staying over at the horse hospital. I'm sad :( I hardly know what to do with my evenings this week without having her at the barn to visit. (Then I again I have a pretty good idea of what I'll be doing: hanging with my husband, maybe cleaning the kitchen, hopefully working on the blog pages a bit. I'm still sad though...)

Yesterday I used a vacation day from work to trailer Maggie up to Myhre Equine in Dover, NH. The trailer ride up went smoothly and so did the intake exam. Dr.Vin, their internal medicine specialist could find no abnormalities with her physically. As I've said in previous posts, with hyperthyroidism we'd expect to see a poor hair coat, an underweight body condition, and a ravenous appetite. She has none of those clinical signs. 

Dr. Vin does Maggie's intake exam.
She went in for her scintigraphy next. Dr. Myhre injected her with a radioactive iodine isotope and then the techs positioned her in front of the machine. 

Maggie gets her thyroid scanned
She was nice and drunk for this so that she would hold still. At least that was the theory - I've found that when Maggie gets sedated she seems to be fairly lazy about holding herself up straight so she likes to sway and shift her weight. The poor techs had to redo several of the scans to get a good image. At one point, and unfortunately I had wandered down he hall for a moment just when this happened, Maggie got quite tired of holding herself up and tried to take a nap (read: fall down onto) the surgical cart in the room. This was the result:

Oops. Hope they don't add that on to by bill.

After getting her scan, Maggie had to go to the isolation ward. I felt quite bad for her because there were no other horses staying there at the time (which is why they call it isolation...) She has to stay in there for 24 hours until the radioactive iodine leaves her system. During that time all her dirty bedding has to be disposed of as hazardous waste because she's literally peeing radioactivity.

Poor radioactive Maggie in her isolation stall.
I actually spent quite a bit of time there yesterday between waiting for Maggie's scan to be completed, the results processed, and being able to talk to the vet again. I got to watch some interesting stuff in the meantime including a horse getting scoped for ulcers, another having joint injections, and another getting a lameness evaluation. 


A horse being scoped for ulcers.
I was able to talk to Dr. Vin again after he had gotten the chance to confer with Dr. Myhre about Maggie's scan results. He says it definitely shows that the right lobe (the lumpy one) is the overactive one. But there were still some weird results...something about a ratio being less than normal when it was expected to be greater than normal due to the hyperthyroid...honestly, I need to do some more reading on that before I speak any more to it. 

What we decided to do was draw blood again for another (yes, another) thyroid panel. They'll also take blood and test for ACTH, for which increased levels are an indicator of Cushing's disease. Even though Cushing's disease is primarily a disease of the pituitary gland, hormones from the pituitary gland could affect the thyroid. The blood is going to Cornell for testing and will hopefully be expedited so that we can get the results back on Thursday. If the thyroid panel comes back as still elevated, the vets said they would actually recommend surgery right away to take out the right lobe instead of doing a biopsy first. 

So that's a little scary...but I see the logic. The right lobe is obviously abnormal and appears to be at least most of the reason for the elevated thyroid hormone levels. Taking a biopsy first would most likely give us either inconclusive results or perhaps even more reason to proceed with the surgery. If we go ahead with the surgery we can send a piece of the thyroid lobe out for histopathology to see if there's anything really wrong with it (like it being cancerous after all) after it;s already out, thus saving us the extra procedure of having the biopsy.

It's all a bit confusing and a good bit emotionally taxing as well.  I trust the vets though - even though this is quite an unusual case. We'll talk again after the blood results come back and go from there. 

Has anyone else ever decided to put a horse through a preventative/ preemptive surgery? What was it for and how did it go?

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