Izzy is once again on Prednisolone for his reaction to gnats and other biting insects. We finished last year on a positive note; all of the corticosteroids helped control his reaction to the bites. Wanting to get a head start on the season, I started with the Prednisolone two weeks ago (with my vet's approval).

Last year, we only did two shows while Izzy was on the drug, so I didn't do a lot of research. Based on USEF's Drugs and Medications guidelines, the detectable time is seven days, so I followed that protocol for both shows. Since we're doing more than two shows this year, I decided to find out exactly what the rule is for administering Predisolone. I emailed US Equestrian over the weekend, and by Monday morning I had a response.

If you've ever needed to consult the USEF Guidelines for Drugs and Medications pamphlet, you'll know that it's pretty comprehensive, but not necessarily easy to find what you're looking for. Just because a drug is prohibited doesn't mean you can't use it. The biggest issue is when you can use it. For that, you need to determine how long the drug is detectable. For some drugs, that might mean merely hours, but for others, it may mean days, weeks, or even months.

There are other drugs like Pergolide/Prascend, that are prohibited, but riders can apply for a Therapeutic Use Exemption which permits the rider to administer the drug as prescribed. Speedy was the beneficiary of a TUE. Equally confusing are the Medication Report Forms. For some drugs and medications, riders can still give certain banned substances up to 24 hours before a show as long as they fill out an MRF.

To my surprise - we all know I don't think too much of US Equestrian,​ I received a reply to my email from an actual person. Not only was there a reply, but it was actually useful. Sarah, who I assume is a member of the Equine Drugs and Medication Program, clarified the rule for me by quoting the actual language from page 16 under the Guidelines for the Therapeutic Use of Dexamethasone and Other Corticosteroids. Alternative Number 3 spells it out pretty clearly, and the good news is that I can continue giving the Prednisolone up to 24 hours prior to competing as long as I complete an MRP. Izzy's skin will appreciate that.

What makes US Equestrian's Drugs and Medications rules so confusing is that there are prohibited substances that can still be given as long as:

• a Therapeutic Use Exemption has been granted - like for Pergolide
• a Medical Report Form is completed - like for Predisolone

There are also plenty of drugs and medications that aren't on the prohibited substance list, like omeprazole (UlcerGard), but if you choose to give them, you should cover your butt by completing an MRF just in case.

To further gunk up the works, there is an entirely separate page dedicated to FEI prohibited substances. Things like, wait for it ... Pergolide. That's right, Pergolide is fine for Fourth Level horses but not for Prix St. Georges. I don't tend to give drugs or medications with any frequency, at least not until this past year or so, so navigating the minutiae of the guidelines has been time consuming.

Speedy's Prascend was the first drug I've ever needed to give daily. Now with Izzy's ulcery tummy and sensitive skin, it looks like the USEF Guidelines for Drugs and Medications pamphlet will be moved to the front of my pile of show materials.

It's just one more thing ...

On Tuesday, I took my students on a field trip to Bakersfield Large Animal Hospital (BLAH). It was virtual of course, but I sure had fun doing it. Early spring is when I typically take my boys in for their spring vaccinations and dental work. It's also when my vet does a thorough hands-on job of assessing their general health: body condition, gut sounds, eyes, temperature, and so on. I usually ask questions, and we also discuss Speedy's PPID, commonly referred to as Cushing's Disease.

Since our appointment fell during the school day, I asked my students if they wanted to come along. Not everyone did of course, but I had a few takers, including their brothers and sisters who wanted to see a real horse. The appointment was for 2:00, so I instructed my kiddos to login to our Google Meet anytime after 2:00. I deliberately arrived 30 minutes early so I  could get my boys settled before setting up my iPad and establishing an internet connection.

Dr. Tolley is a great vet. He's extremely knowledgeable, pleasant to work with, and well educated. Even after more than thirty years in practice, he still participates in learning opportunities, and loves to answer questions - mine at least. So when I told him what I was planning to do, he thought it sounded like a great idea.

Speedy was up first, as usual, so after weighing him outside - he came in at 970 pounds, I set up my iPad in the bay where Dr. Tolley does most of his work. The office manager happily gave me the wifi code, and suddenly, we were live! It took a few minutes for kids to jump on board, but once I started seeing their faces, the field trip began.

The kids are used to seeing my face on their screens, and I have long since gotten over seeing myself on a screen, but Dr. Tolley hadn't yet done anything in the COVID virtual world. I was really grateful for his attempts to interact with my students by explaining what he was doing. I hadn't expected him to do that. Of course, dental work is usually quite loud, so for most of the time, no one could hear anything over the machines.

When he wasn't using power tools, Dr. Tolley showed the kids his equipment and explained what it was for. He also showed them the inside of Speedy's mouth and counted teeth and explained what the different teeth do. When a student asked if horses can bite, Dr. Tolley showed them Speedy's canine teeth and explained that those were fighting teeth, the ones horses use to bite each other. He also told them that girls don't have those teeth.

As Dr. Tolley continued using his power tools, I walked around the hospital pointing out different things and explained what types of things the doctors do there like taking x-rays and helping sick horses. I also carried my iPad outside so the kids could see the pens for sick or recovering horses. 

Once Dr. Tolley had finished up with Speedy and all questions had been asked and answered, we thanked Dr. Tolley, and I thanked my students for coming along with me. I am not sure how exciting it was, but since we haven't done a field trip in so long, it seemed like an experience that was at least worth trying out. I said goodbye to my students and we hung up.

Once Speedy was resting comfortably in the drunk tank - Dr. Tolley had to give him two doses of sedative, we brought Izzy in for his dental work and vaccinations. Of course we also put him on the scale on the way in - he came in at 1,350 pounds. I was really happy to see that because that was his weight two years ago before he started having some intermittent tummy trouble. Last year he weighed around 1,270 pounds, and I just couldn't get the weight back on him.

I showed Dr. Tolley the bag of GastroElm that i brought along with me and explained how beneficial it has been for Izzy. We talked about gastric ulcers and other gastrointestinal issues. Dr. Tolley agreed with my approach: reducing Izzy's stress level during rides (I've been working on that) and continuing with the GastroElm, increasing it as needed. Izzy's weight gain started right after I introduced the GastroElm, so I know it is helping.

I always enjoying going to BLAH. All of the staff are friendly, helpful, and looking for ways to better serve their clients. I am pretty sure this was the first virtual field trip that Dr. Tolley has ever done, and I am grateful. With kids being sequestered in their homes for so long, they're missing out on life experiences that are crucial for their development.

The kids have been asking to see the horses. I am not sure if this is what they meant, but it was at least something!

For most equestrians, there is no such thing as a "minor" colic. For us, every colic feels like a pretty, huge, major crisis. Am I right?

On Thanksgiving morning, Izzy was NQR - not quite right for the uninitiated. NQR is really hard to see, so when someone asks what's wrong, the answer sounds overly dramatic: Well, he walked away from me. His poop is kind of ploppy. He laid down but then got back up. He pawed once. Those are not things that should raise an eyebrow. Put them all together though, and you're likely looking at a horse that is about to have a serious problem.

If you're ever in a crisis situation, I am your gal. I do not freak out, ever. Once the dust has settled, yes, I sometimes fall apart out, but never during. While I was grooming Izzy, the ranch owner told me what she had observed that morning - a weird roll accompanied by some pawing and some seriously sloppy poop. I listened and watched my big brown horse. I agreed that those things put together didn't sound good.  

I didn't panic though. I exchanged my grooming bucket for a thermometer and stethoscope and then worked the problem. Izzy's temperature was a healthy 99.6 degrees. His gut sounds were noisy, but that was preferable to quiet which is what he had at the show in early November. His skin tenting was excellent and his capillary refill time was instant, all signs of a hydrated horse. All systems looked normal except that he had very loose stools, and even more telling was that he didn't want anything to do with me. I called the vet.

Since it was Thanksgiving day, the office was closed, but Dr. Gonzalez gave me a call back. I gave him a quick run down of Izzy's symptoms and asked what he thought. Right away he told me what he would do if he came out - sedation, painkiller, tubing, and electrolytes. I told him what I had on hand - a brand new tube of Banamine paste and powdered electrolytes.

While Dr. Gonzalez knows me, he's not my regular vet. We know each other, but not well. Dr. Tolley, my vet of nearly twenty years, knows how I do things, and I know how he does things. We frequently discuss treatments over the phone, and he knows what I am comfortable doing. Working with Dr. Gonzalez was a little harder because we don't have that same relationship. In the end, we worked out a plan that I would follow by myself. I told him to enjoy his Thanksgiving dinner with family and that I would call later in the day if Izzy didn't respond well.

Dr. Gonzalez's treatment plan included a long list of items:

• a 750 pound dose of Banamine paste for pain
• a one ounce dose of powdered electrolytes administered orally via catheter syringe to encourage drinking even though Izzy had drunk more than a normal amount the night before
• removal of all feed
• clearing away all manure so that we could count and examine subsequent piles
• a float test: I used a long rectal glove to pick up a handful of fresh poop. I flipped the glove inside out so that the poop was inside the glove. I added water to the glove so that the poop would float. Any sand would settle into the fingers of the gloves. After waiting a few minutes, no sand was visible
• wait and watch

While he shouldn't have felt better so quickly, after just fifteen or twenty minutes it was clear that whatever was bothering Izzy was passing. Banamine administered orally should take at least 30 minutes before the effects are felt. Per Dr. Gonzalez's instructions, I waited and watched. When Izzy started nosing around his water trough, I grabbed the hose and turned it on low. Izzy loves to play in the water, and water is always good for nearly every kind of colic.

LikeI knew he would, Izzy happily lapped and slurped water for several minutes. Over the next fifteen minutes he returned to his water trough several times for longer and longer draughts of water. By then, I knew he would probably just improve with time, so the ranch owner and I agreed that she would come out every few hours and check on him.

Throughout the day she texted me photos of his poop piles. Each one was more solid than the one before. Only horse people, right? By early evening, his poop was firm and he was obviously hungry. She fed him the hay we had pulled out earlier in the morning.

By Friday morning, Izzy was bright eyed and starving. The ranch owner gave him a slightly smaller breakfast than normal with the plan to feed again at lunchtime. I cleaned his poop piles, counting as I went. They were all firm and solid. His gut sounds were strong and steady, and his capillary refill was instant. I called Bakersfield Large Animal Hospital and asked to speak with Dr. Tolley.

I explained what Dr. Gonzalez and I had discussed even though Dr. Gonzalez had already talked it over with Dr. Tolley. Dr. Tolley agreed with the treatment and asked me to add a week or so of Psyllium just in case it was a sand colic. I also added extra water to his beet pulp and gave him electrolytes through the weekend. Since everything looked great, Dr. Tolley said I could ride on Saturday which I did.

In the end, we think that since Izzy didn't get his regular beet pulp ration (which is loaded with water) while I was visiting my parents, he might have been a bit dehydrated. I rode him lightly on Wednesday afternoon, and he drank a ton on Wednesday night. What we saw on Thursday morning might have been a small impaction working itself free, but who knows.

Colic isn't something to take lightly, but it's always a relief when it's just a mild version. While It might seem a bit costly to keep so many medications on hand, it's a lot cheaper than an emergency vet visit on a holiday. 

Thanksgiving gave me a lot to be thankful for.

US Equestrian has a fairly comprehensive guide that outlines which drugs are permitted and which drugs are not. Even so, some questions don't have a definitive, ready-to-go answer. Case in point, prednisolone.

Izzy was recently prescribed prednisolone for his Seasonal Recurrent Dermatitis (SSRD) which is being caused by midges. My vet reminded me to check out the withdrawal time with my dressage governing body, US Equestrian. While I was in his office, we quickly found the 2020 USEF Guidelines for Drugs and Medications. We located the Common Prohibited Substances page and quickly scrolled through the list. Prednisolone was not on either list (permitted with MRF and no MRF accepted). I assured him that I would dig more deeply.

Knowing that a steroid had to be on some list somewhere, I later started flipping through the pages, reading a bit more closely. On page 8 of the 2020 guide, page 12 of the 2019 guide, there is a list that details how long drugs remain detectable. Prednisolone is not on the list, but methylprednisolone is, and it's detectable for 14 days. That got me worried.

I spent a fair amount of time asking Google to describe the differences between methylprednisolone and prednisolone. The only results I got were for methylprednisolone and prednisone. I called my vet back. He assured me that methylprednisolone and prednisolone are indeed two different medications. Methylprednisolone is much more powerful and acts more quickly. Prednisolone falls under the category of "corticosteroids other than methylprednisolone and isoflupredone, e.g. triamcinolone and betamethasone."

The issue for Izzy is how long the drug is detectable. We have a show in less than two weeks. We have another show two weeks after that. Since the detectable time for methylprednisolone is two weeks, he wouldn't have been able to have a dose for a full month. That would not have been good.

Fortunately, the detectable time for other corticosteroids like prednisolone is seven days. This means we can't follow my vet's initial treatment plan of two weeks of 20 tablets a day followed by two weeks of 18 tablets a day followed by ... you get the idea. Instead, he'll get his last dose on Friday. He'll be off the medication for a week for a two-day show October 24th and 25th. He'll then get another week of the prednisolone, and then he'll go off it for another week so that we can go to another two-day show November 7th and 8th. He'll then go back on the prednisolone until November 30th.

Fortunately, Izzy has had enough medication - IV, oral, and topical, that his skin has finally healed over, and he is no longer itchy. Of course our cool evenings have probably helped nearly as much as the drugs. Our lows have been in the 50s which has no doubt annoyed the midges. I just hope that being off the prednisolone for a week won't allow the little boogers to gain a new foothold.

Fingers crossed! 

It's tough to be so well loved, especially when it's by a gnat. Or midges. Or no-see-ums. Officially they're called Ceratopogonidae, and they think Izzy is a buffet of yumminess. Poor Guy. According to Wikipedia, there are more than 5,000 species of the little buggers, and they cover the planet from south of the arctic to north of Antarctica. Their bites are painful and can cause intensely itchy lesions. Izzy will vouch for that last bit.

Last summer, Izzy rubbed out a bit of his tail and nearly all of his mane. I knew he was itchy, but with fly spray and frequent showers, he made it through the buggy season with his skin pretty well intact. This year, he's been a hot mess. I've tried no less than a dozen products, many of which claim to be cure-alls for Seasonal Recurrent Dermatitis (SSRD), colloquially known as both summer itch and sweet itch. In short, the itchiness is a medical condition in horses caused by an allergic response to the bites of midges. Or as I like to call them, little bastards.

When I took Izzy to see Dr. Tolley for his fall vaccinations, we formulated a plan to deal with the itchy skin medically instead of just topically. I've already mentioned this, but Dr. Tolley gave Izzy a shot of dexamethasone, a steroid that treats inflammation. I also took home a jar of Triamcinolone acetonide, another ​corticosteroid used topically to treat various skin conditions. On Monday, I drove back out to pick up a bottle of prednisolone tablets, a corticosteroid that decreases inflammatory or immune responses.

None of these drugs are particularly cheap, especially the prednisolone. In fact when I calculated the cost of Izzy's new allergy pills, I gulped in dismay. A bottle of 500 pills costs $115 which sounds really cheap until you consider how many pills a day he'll be getting. Here's Dr. Tolley's plan beginning on Monday going through December 1:

• 20 pills a day for two weeks.
• 20 pills every other day for two weeks.
• 18 pills every other day for two weeks.
• 16 pills every other day for two weeks.

At the end of eight weeks, which is what this plan covers, we'll be right at November 30th. I only have 500 pills, but this plan calls for 658 pills which means I'll need to go grab another bottle. Each pill comes in at $0.23, so to cover the entire eight weeks, I'll spend $151.34. That's doable, and I've certainly spent a lot more on other things.

Next spring is when I'll start to feel the pinch. By then, we hope to start him on 16 pills every other day from April 1 though December 1. That works out to approximately 240 a pills a month ($55) for eight months ($441). I need a new envelope.

The good news is that one of the steroids Dr. Tolley gave is working. Or more likely, some combination of two of them is giving Izzy some relief. Last night, all of his itchy spots were smooth with no raw skin showing. His forehead looked nearly healed, and his shoulders had new hair coming in. I wish I had thought to take a picture because he's nearly black now. His yellow coat has quickly been replaced by his black winter coat. That, too, usually fades by February, but for the month of November, he's normally quite dark.

I know he will feel so much better after just a few more days, and the cool weekend that's in store will help even more. I wish they made a Zyrtec or Claritin for horses where one pill a night did the trick. Fortunately, the pills dissolve completely in his beat pulp, and he wolfs them down without batting an eye.

Now I need to start shopping the online pharmacies to see if I can knock a few dollars off each bottle. Every little bit helps.