Mechanical founder


Maria Duran
 

Hi all,

I need some opinions and help with a horse diagnosed with osteomyelitis in the left scapula-humerus joint. The horse is a rescue, he had a bad injury that got infected and the infection reached the bone. We found him totally lame and in a very bad condition. The case is in "the horse mouth" so I only put here a brief summary.

The problem is that the horse is not carrying weight over the left hoof which carries in the air and walks by transferring all his weight in the hinds like in a levade. The left hoof is stressed with all the extra weight and the horse has begun to tilt his weight over the hinds to alleviate the right front limb. This is a very risky and critical situation.

The trimmer has adviced this https://youtu.be/EYflQe_0MLU technique  that involves sugardine and a half ball of poriexpan attached to the hind hooves and the right front hoof. I don´t think sealing the hooves with sugardine as seen in the video has any good effect to a laminitic horse and moistening structures can be detrimental for founder but I don´t have experience so need yours.

I would also like to know what´s your opinion about the half ball of poriexpan (also seen in the video), is there any science behind this? The trimmer says it helps the coffin bone not to sink by putting preassure. Is there any good experience with this? Would be something to try?

Any advice to have him comfortable and avoid founder is very very welcome. We are encouraging him to lay down as much as possible, but even with the difficulty he has to move, he is very stuborn and only rests two or three times per day.

Thank you all in advance.

María Durán.
Madrid, Spain.


Sherry Morse
 

Hi Maria,

This might a translation challenge for us but this article on Sugardine might help: https://www.americanfarriers.com/articles/5090-sugardine---a-stinky-gooey-mess-that-works-when-treating-wound-injuries?utm_source=omail&utm_medium=email&utm_campaign=deu&utm_content=afj&oly_enc_id=5790E2314467D9Y

When I think of Sugardine it's both as a drawing and drying use so I don't think it will make the hooves softer. 

As far as the half ball of poriexpan...I'd like Lavinia's opinion on that.  To me it's similar to the idea of the Steward clogs which means the trim has to be correct, but I'd rather see a flat piece used than something that's going to have a rounded bottom which I think would affect the balance of the horse. 

Is there any way this horse can be put in a sling to alleviate the pressure on the other legs?
--
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
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Maria Duran
 

Sherry, thank you so much for your quick help. I enjoyed a lot the reading!

I know sugar and betadine are drying agents, but I was imaginning that bit of moisture sealed and packed into a hoof with the ball and the tape all around not letting the hoof to dry or transpire and my gut shrinked a bit. Maybe there is some reason to use it after all. I am also worried about the balance of the horse which is already compromised and don´t know if the pressing ball can really push up or hold the coffin bone in place to some extent. It makes sense but don´t know.

We can put him on slings, but we have two concerns, one is the sling passing under the injured armpit and another one is he will lose very quickly condition and he is in that critical balance where he has developed big rump muscles to compensate for his condition and if he loses that or the hability to move, we will be dealing with a big horse not able to get up anymore and a vicious circle started.

The surgeon doesn´t give us the prognosis for the surgery, he says maybe good, maybe bad but surely hell. Budget is around 9.000 euros and at least 2 months in the hospital. Anyway he says we must keep him for an extra month on antibiotics before we even think about surgery.

Yesterday´s ultrasound of the wound says it is clear of infection but he didn´t want to perform x rays so don´t know about the joint. 

Thank you again.


Lavinia Fiscaletti
 
Edited

I Maria,

So sorry this boy is going thru this.

It seems that you need to know what the condition of the joint/nerve is in order to be able to make realistic and responsible decisions regarding his future. The key to this entire situation is going to be whether you can alleviate the pain in the shoulder/get the nerve generating signals so that the leg is functional on some level. Everything else is going to be a band-aid, if it helps at all. If a sling situation could be devised, it sounds like that would help him be able to rest for at least some part of the time. He may not be laying down because to get down and up without being able to use the damages shoulder is both extremely difficult and very painful for him. He may be laying down only when he is literally no longer able to remain standing from exhaustion/pain. He also knows he is vulnerable while down, which is not a situation any horse is going to be comfortable with, esp. one who also knows how difficult it is for him to regain his footing.

Sugardine isn't going to hurt nor help prevent or treat a mechanical founder situation. Getting the mechanics of the trim on the three supporting limbs as tight as possible, then supporting them with dense-yet-conformable padding in boots is the best thing you can do. Adding a good bevel to the treads of the boots all the way around would give you the eased breakover without sacrificing traction and surface area. Boots also make it easier to put on/take off and change padding as needed. Well fitted Soft Ride boots might be a good option, as they have the dense, wedged pad + frog support. Whether that will be enough to keep the "good" feet from foundering or not is unknown - it will be a precarious, day-to-day situation. Wrapping the legs to provide additional support to them might also be considered.

Sherry is correct - the poriexpan ball looks like a similar idea to a Stewart clog-type appliance. The only thing it will do is allow the horse to easily break over in any direction, but it doesn't actually provide support to the back half of the foot to help stabilize the bony column, as the surface against the foot is hard and flat. To help support the coffin bone and bony column, the palmer surface of the padding needs to conform to the bottom of the foot yet retain some give so there is never constant pressure being applied to the sole/frog. This is why Styrofoam is recommended during active founders, as it conforms to the contours of the bottom of the foot and can be stacked under the back half to provide more support there while relieving pressure in the front half of the foot.

My additional concern with the half-ball, esp. under both the hind feet, would be that there just isn't enough surface area and traction on the ground for the horse to balance, so it might make it more likely that he would slip and fall. Unless it is dangerous to get boots oh/off, I also wouldn't recommend attaching appliances of any kind to any of his feet as again, that means constant pressure on the soles/frogs, which are deleterious to those structures.

--
Lavinia
Jan 2005, RI

Moderator/ECIR Support


Maria Duran
 

Hi Lavinia,

Thank you so much for this detailed and helpful answer.

We have three different opinions in all this voragine. Vets that say to put him down, vets advicing surgery and one who says, lets wait and see how he does. It is all very difficult. Also we have heard from vets that there might be tendon retraction and mine says it is just the radial nerve the one that is keeping the horse from using the limb what coincides with the surgeon. There are reccomendations for cutting the tendons in the surgery, then saying that is not necessary, you know...everyone has its own opinion about the horse. For the ones that are close to him day by day, we all under our non expert opinion, say that the horse is not ready to go and he has bright eyes, eating very well, moving besides his limitations, has made friendship with two mares in the paddock near him, he is very very alive. 

He also has started to move the front leg as if he was pretending to walk and sometimes he even put a bit of weight on it. I am hoping the joint can be fussioned by itself. There are some videos in The Horse Mouth. I have asked Dr. Kellon about ALCar being an option to help with the nerve regeneration. You would be surprised as I am, seing how easily he gets up, he is an expert. I believe he is not concerned about being down, he trusts and is quiet in an individual paddock so I think that´s not a factor.

About pain, it is difficult to tell but if he has, devil´s claw is in charge of that at least as good as NSAIDs as we weanned him off them and he is not showing more pain than before, however he needed EQzone twice daily before. My vet says he is not on much pain because of the nerve damage.

I don´t know why but today he is walking better, not so much tilting over the hinds, just a tiny bit. I hope tomorrow is the same.

Trim is good in my opinion, I like his trimmer and we put him on boots yesterday (maybe this is the reason why today he is better) also has leg protection, thanks for suggesting it. About the boots, I will ask but I believe he has EQboots. Are these ones as good as the Soft rides?

How much time do you suggest to put him in the sling per day? This is difficult for me to tell.

I understand your explanation about the ball of poriexpan but I am thinking one thing, the pressure would be transferred to the sole through the center of the ball as this is the most prominent part, so even if the base is flat, it would be trasnferred to that place. Am I in a wrong thinking process and the forces would still be spread over the whole sole? Is not styrofoam the same as poriexpan? I am confused with what you said about the "giving" of the material.

I am going to translate all this to the trimmer Lavinia so that he has a new perspective, he is not used to laminitis of founder but it is a very honest person an a good trimmer who listens.

So, do you say that the poriexpan does not have enough "give"?

Thank you!







Lavinia Fiscaletti
 
Edited

Hi Maria,

Had to do more searching on what porexan is. Looks like it is similar to what we call styrofoam. If you had it in a sheet, rather than a ball, I think it would work temporarily as it will crush down. We were making the assumption that it was a much firmer material - sorry. As it sounds like you may need to do this for some time, it seems that padded boots would be a lot easier for everyone involved.

Sorry, having a senior moment: what are the EQ boots?

--
Lavinia
Jan 2005, RI

Moderator/ECIR Support


Maria Duran
 

Hi Lavinia,

Yes there are sheets of poriexpan in different thicknesses. Just wanted to know the difference thank you. He will be on boots. 

He has EQ boots in the hinds and a glued floating boot in the right front hoof. These are the EQ boots https://www.eqboots.com/en

Do you have a guessing for how much time is convenient to have him on the sling daily to alleviate weight bearing? We are going to spread sand in the paddock to encourage him to lay down more but if it doesn't happen, he will be on the sling for some time daily. He is doing much better with the boots, much much better 

Thank you.


Lavinia Fiscaletti
 
Edited

Looks like the EQ boots are similar to the Soft Rides, from what I can find on their website. They don't really show you what the actual pad looks like and I can't seem to find a description of what it is made of (although that may be there in Spanish somewhere).

The sling use will need to be figured out between you, the vets and the horse.

--
Lavinia
Jan 2005, RI

Moderator/ECIR Support


Maria Duran
 

Thank you so much Lavinia.

Mandela is doing much better since on boots as I was guessing and the trimmer will not do the poriexpan protocol after telling him your opinion.

He looks quite happy even with all his miserable condition and lately really acts like a normal horse regarding attitude. Had a mild colic after deworming but he is very happy right now. i hope we can manage his condition. We are all trying hard for him.

Thank you so much to you and Sherry for the help.


Maria Duran
 

Just wanted to say that Mandela has clearly begun to move the shoulder forward as if he was walking when he moves! I can´t believe it. He is better and his hooves are doing well by now, he moves like a rabit as he can´t put weight over the front left hoof but he is throwing it forwards as he tries to step and for months has been totally dead, zero movement.

He also looks so much happier.

I think or want to believe it is the ALCar that is working, what else can be? When I learned it was the radial nerve who was not allowing the leg to move even a mm, I thought we could try and see. We didn´t make any change in his treatment. It is happening after about 20 days from the first dose. I believe Dr. Kellon will read it here also. Just wanted to share it here.


Bobbie Day
 

That’s great news Maria, you are such a Angel for these horses. They are so blessed to have you.


Maria Duran
 

Thank you Bobbie,

We are a team, everyone is very supportive and working hard for him. I wish he can recover, he will be off antibiotics very soon.


Lavinia Fiscaletti
 

Great news, Maria. Thanks for the update.

--
Lavinia
Jan 2005, RI

Moderator/ECIR Support