Faced with a rare lung disease plus a liver disease that was virtually unknown, it took a team effort to save Chance.
At twenty-seven Chance is an older horse, but he still enjoys going for a ride with his owner. Last winter Chance started losing weight and energy. A visit to his veterinarian resulted in several abnormal blood tests that made her concerned about his liver, so she referred him to the OSU Veterinary Teaching Hospital (VTH) for further evaluation.
Dr. Ana Pacheco is a large animal internal medicine specialist at VTH. She examined Chance, performed an ultrasound, and ordered a complete blood workup. The ultrasound showed an unexpected result: not only did his liver appear abnormal, but also his lungs. Dr. Pacheco ordered x-rays of his chest which revealed large nodules on his lungs. She had those biopsied and sent the tissue to the Oregon Veterinary Diagnostic Laboratory. The pathologist at the lab found severe inflammation and fibrosis of Chance’s lungs, and diagnosed Equine Multinodular Pulmonary Fibrosis (EMPF), in conjunction with equine herpesvirus. The big surprise: they also found herpes and fibrosis in his liver.
EMPF was first discovered in horses in 2007. Equine herpes in the liver is very rare. So Dr. Pacheco was faced with a lung disease that had only recently been studied, and a liver disease that was virtually unknown.
Dr. Karen Labbe, a veterinarian who was completing a fellowship at the VTH, was part of the team caring for Chance. She combed through recently published studies, and was able to find a couple of cases in an Australian journal where horses with EMPF also had liver fibrosis. With that information, she and Dr. Pacheco decided to start Chance on four weeks of steroids to bring down inflammation and slow the progress of the fibrosis. They also put him on a new diet of hay-free alfalfa feed.
The prognosis for EMPF treatment is fair to poor, but at his one-month checkup, Chance showed significant improvement in weight gain and body condition, and his liver tests were close to normal. His chest x-rays showed significant reduction of the fibrosis.
At his next check up, six months later, Chance showed even more improvement in both his lungs and liver. “Most important was his incredible improvement in attitude and body condition,’ says. Dr. Pacheco. “He was 145 pounds heavier than when he first came into the hospital. He made an amazing recovery.”
Dr. Pacheco recognizes that the team approach at the VTH is a big advantage in treating her patients. “We have so many opportunities to collaborate,” she says. “I can work with radiologists, and pathologists, and other specialists. We also have great equipment and great technicians. It’s a big group who are involved in caring for our patients.”
Chance is currently feeling good and enjoying a normal life. “He has slowly gotten better and better,” says his trainer, Tobey Spitzer. “I started working him slowly on the ground and now I am riding him. He looks beautiful!”