Acute laminitis mustang seeking input


Makendra Silverman - NS
 

Thank you, I've completed Arrow's case history (2007 Mustang Mare, undiagnosed IR) and uploaded photos of body and hooves. Hard to think straight in crisis mode but she is comfortable now in boots and I am looking for what else to do to help her through this. At present she isn't comfortable lifting front feet up for more than a few seconds but is comfortable walking in soft ride boots (wearing 24/7 at present). She is on 1 Equioxx, 1 per day, started today. I thought she was improving Thursday but then took a bad turn Friday. Scary and frustrating as I have been working so hard to make sure she is getting better and learning, learning, learning myself.  

-Has anyone seen adding salt to cause issues for IR horse? A nutritionist told me this once and so I had stopped adding salt to her mash last fall. Restarted salt a week ago with emergency diet.

I would love input if anyone sees red flags or has ideas on what I can/should do for her. I am not seeing dramatic improvement from the emergency diet and I am hesitant to block her for trim. Am hoping she'll improve enough for trim ASAP however. 

Here is some background, much of which is also on the case history:
-She has never foundered before but has undiagnosed IR I believe. I just found calculator this week and 9-2019 tests are HIGH RISK
-Bloodwork at Cornell for Metabolic Panel, awaiting results (sent in Thursday 3/31)
-Acute laminitis started on 4/1/2021 (Friday afternoon). Gave 1g bute as per vet, in Soft Ride Boots. In pain without boots. Not a laminitic stance but I can see her pain and she is very hesitant to walk without boots. Seems quite happy with Cloud boots. Bright eyed, eager, hungry, interactive (doing tricks to see if she can get a treat etc). In deeply bedded stall with 10x10' paddock for now. 
-Sometimes can feel a pulse but overall her legs and feet are warmer than usual. Felt sharp pulse in RF on Thursday 4/1. 
-Has been on emergency diet for a week but mostly on an even lower sugar hay (5.2 ESC + starch and soaked) for past three days {fed over four feedings in slow feeder hay net.} Has been eating low sugar hay since 3-20 (7.9 ESC + Starch BUT with higher 15.5% protein, about 1400g per day and I have found a few stems of alfalfa which normally she's ok with in a bit of hand-grazing). She has been on low sugar tested hay since summer 2019 at least minus Jan/Feb when low sugar hay I ordered ended up being a second cutting of the same field (12.3 ESC+Starch). 
-One week ago she was at the best she's been in some months and increasing exercise, losing weight and sound with decreasing crestiness and I could feel her ribs.
-Starting Monday of last week she starting getting crestier and continued into week increasing in crest and weight. Udder seemed normal until acute pain started Friday- now tender and full. 
-Not sure of trigger (eating a little grass on our walks ? back tight causing stifle soreness? too strong a workout though it seemed appropriate step up? tiny amount of rasping to front hooves in effort to improve medial-lateral balance by me? I started adding plain white salt- no iodine about a week ago as well? She has a small herpes outbreak on nose from my foster pony who is 4 and came with warts- could virus be adding to this? Do any of these factors seem problematic? She got a few mouthfuls of chicken feed on 4/1 as well but seemed great morning of 4/2... acute in afternoon of 4/2)
-Started California Trace and mineral balancing to hay (feeding at 1.5% of current bodyweight). Also started tri-aminos from My Best Horse today. 
-She was on Dynamite Easy Balance starting 3-17-21 and with access to free choice minerals. I pulled her off all these on 3/31 with concern of adding too much iron to her diet.
-She has been dewormed 2x/year, Ivermectrin in the spring and Quest plus in the fall. Annual fecal egg counts always 0. Saw notes on Quest plus being dangerous for future.
-We have a small place but she and friends have a drylot with access to stall and I've been walking her and doing groundwork and strength rehab for past two months 6 days/week. 
-Have input from rehab barefoot trimmer to improve current trim but she won't lift up front feet for me to trim and I need to bring her to him 1hr away so need her to be stable. He's awaiting xrays to be taken Monday 4/5 as well. 

Notes which may or may not be crucial or helpful:
Noticed strong reaction to apple cider vinegar/water treatment to center sulcus of frog starting one week ago. Thought at first it was smell but she had been fine so perhaps a deeper infection? Have been treating with ACV and Desitin and Arti-Mud to improve frog for past three weeks. Never reactive before.
-She was shod in front as per vet in effort to reduce hoof tenderness (I wouldn't do that now) but she was in front shoes for first and last time Sept 2020- Jan 2021. Toes got longer, overall health of hooves decreased. Negative Plantar Angle in hinds? Hinds have not changed much and always minimal trims as she wears them down quite well. Past four years of on and off lameness and more limited work are hurtful. 
-I suspect she is overloaded on iron as I have not sufficiently been balancing Zn and Cu over the past 11 years in captivity and looking back, supplements that I thought were taking care of her needs were far too low in Zn and Cu and Mg. 
-Ordered basic water test awaiting results (we have city water and city doesn't list iron levels in their yearly analysis). I removed rusty portion of water heater in early March of this year and took away brown salt block... though I never saw her lick it.
-Planning to get iron blood test on Monday along with x-rays.

Thank you- grasping at straws and hoping I can help her to be comfortable and stop any ongoing damage. 


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Makendra and Arrow
Denver Colorado, 2021
Arrow's Case History: https://ecir.groups.io/g/CaseHistory/files/Makendra%20and%20Arrow
Arrow's  Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=262625

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