Polycystic Ovary Syndrome and Laminitis


Julia Cunniffe
 

Hello Everyone,


I have just joined the group and not yet had chance to read thru the previous conversations, so I apologise if this information is already here.


I have a miniature Shetland with EMS who I have been managing for several years, and on the whole is well and happy. I hope to find more information on improving his management when i read thru the information on this group.


My current concern tho is my 10 year old Selle Francais Mare, Jazz, who I have recently been told has Laminitis. I am still not totally convinced by the diagnosis, and I'm afraid I don't have a lot of faith in my vets, who have little interest in metabolic issues. 


Jazz has had intermittent lameness for over a month now. It has varied from looking footy, to shouldery, but has consistently been the right fore. She is rather a challenging character, having been an orphan, and lives out on a track, with a 4 year old gelding, around the track of my 2 mini's. Atm the track is deep in mud, wet and slippery, but since the Laminitis diagnosis I have not felt able to allow them on the grass of the other field, which is how I would normally manage them at this time of year.


During the summer months Jazz has bulges over her eyes and swelling between her jaw. She had a very muscular crest this year having been doing a lot of Straightness Training, and on the whole looked quite large, not helped by her low slung belly, but does not generally have other fat pads. I have erred towards assuming she is likely to be predisposed to Metabolic problems and managed her on a low sugar diet, lots of hay, minimal grass when sugars likely to be high, low sugar feeds, and on the track. She has never had any episodes of laminitis previously, has had event-lines on her hooves corresponding to those of my previous gelding who also did not experience laminitis, and has always been barefoot.


Her lameness started towards the end of November. mainly in trot and most obvious on the hard, wet sand surface of the round pen or the road. I had always struggled to feel pulses, so do not know her 'normal' pulse, but am getting good at finding them now. The vet looked for signs of an abscess,but Jazz was very reactive to hoof-testers on both front feet, inconsistently according to the vet, although to me she appeared to react to everything...she is very sensitive to touch generally, doesn't like it, and can be very uncooperative. In the light of palpable pulses both fronts, and looking slightly sensitive on a tight circle on the road on both fronts (surface of gravel on tarmac ad horses have been on soft wet surface of field now some many weeks...so again I'm not altogether convinced) and being unable to spot anything else, they diagnosed Laminitis. At her most sore she has stood with her right sore out in front of her, but only on one day, has not been lying down excessively. I kept her in stable with tiny yard area for 48 hours but she then began rearing so i let her back out on the track which is very soft atm.


The track has almost negligible grass on it, yet her pulses remain variable from unpalpable, to strong, sometimes on all 4 feet(never strong behind but sometimes easy to feel). The only day I allowed them access to the old grass of the back field, on a low Laminitis risk day, she later had stronger pulses and looked a little more footy again, so I have kept them off it since. 


She is unrugged, and not carrying any excess weight, looks very slim for her. We have not been having much sunshine, or much frost. What grass we have has continued to grow due to unseasonably warm weather. My vets tell me they are not getting lots of new cases of Laminitis at the moment.


While talking to Sarah Braithwaite at Forageplus earlier this week, about getting some Hay, Grass and Soil Analysis done she mentioned the possibility of PCOS. I had wondered whether hormones may have been playing a part in her symptoms, as she appears to have been in season much more visibly this year, and much more frequently. She was previously in with a older gelding, but after losing him has been with a vibrant 4 year old since May. She has always been a very dramatic, sensitive moody horse. During riding she often, ever since backing bites at my right leg where it rests against her side, and has had on ongoing back issue(tender lower back and wasting around trapezious) for a few years which has almost, but not absolutely resolved with Straightness Training which has created a lot more muscle and better carriage. We have more recently begun working on calmness,  and releasing muscle tensions and doing more ground work with softness again with less riding, and it is since beginning this that the lameness has come to the fore.


I apologise if i have included too much information here, but tbh I am baffled by Jazzes condition atm. Part of me is thinking that she is releasing old tensions and pains from previous injury's(she had a right shoulder/neck injury in France before travelling to England age 4, and also had a fall and got stuck under the trailer partition, later presenting as if she had a right brachial plexus lesion a few years ago, but this resolved quickly and apparently fully with rest and bodywork). However,  if she does have Laminitis, obviously i need to try and find the root cause asap. I can't believe it can be purely sugar related in view of her lifestyle, and a hormonal link would make sense in view of other characteristics...so any advice on how to proceed from here would be enormously appreciated. 




Maggie
 

Hi Julia,

Welcome to the group!  You can never provide us with too much info, and you provided a nice summary of your mare's issues.  But in order to get the best help we ask that everyone fill out a case history on their horse.  To do that, you'll need to join one of our sister groups called ECHistory8.  It's a filing cabinet for storing case histories, and keeps all the CH's in one easily accessible place.  Here's a link to that group:  https://groups.yahoo.com/neo/groups/echistory8/info  It won't take long to get approved and then just follow the instructions for filling out a CH.  You can copy and paste a lot of the info that you have already provided in the free form "time line" section at the end of the CH form.

Meanwhile, I will explain our philosophy called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise, and point you in the right direction for some more reading.

Diagnosis:  Forgive me if I missed it, but I am not seeing any mention of lab work.  Is that right?  The first step in getting a good treatment plan underway is a good diagnosis.  To get that, we recommend these 4 tests:  ACTH, insulin, glucose, and leptin on a NON-fasting horse.  At the age of 10, Jazz is just at the cusp of the age that we recommend you do the ACTH to rule out (or in) PPID (Cushing's disease).  PPID is an enlargement or benign tumor in a part of the pituitary gland called the pars intermedia, not usually seen (though not unheard of) in horses under the age of 10.  It's treated with a medicine called pergolide.  IR is not a "disease", but a "metabolic type" of horse, normally, but not always, described as easy keepers with abnormal fat pads such as cresty necks, puffiness in the hollows of the eyes, excessive drinking and urinating, etc.  IR is treated with a low carb, low fat, mineral balanced diet.  A horse that has both PPID and IR would need both pergolide and a carefully managed diet for the rest of it's life.  Any horse can have just IR, just PPID, or both (or neither).  With regard to the labwork, the ACTH is to diagnose the PPID and the insulin and glucose for diagnosing IR.  The leptin helps to differentiate if the horse is IR at baseline or if an elevated insulin is being driven by a high ACTH.  Leptin is the hormone that says "stop eating", and insulin resistance and leptin resistance go hand in hand.  More information about leptin resistance can be found in the first file in this folder:  https://groups.yahoo.com/neo/groups/EquineCushings/files/Insulin%20Resistance/  The labwork does require special handling so please read more about that on our website here:  http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis 

Additionally, you are going to want to read Dr. Kellon's  ECIR 2013 Proceedings on Reproductive Abnormalities in Mares with Diet Resistant Insulin Resistance.  Look here:  http://ecirhorse.org/index.php/conference-proceedings-recordings/2013-proceedings-recordings-table-of-contents  Scroll down to the free PDF's and it's the 4th one up from the bottom of the page.  This will give you another diagnostic tool to consider.

Diet:   To provide a low carb, (less than 10% sugar+starch) low fat (4% or less), mineral balanced diet, we use grass hay, tested to be under 10% sugar + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E.  This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse.  Until you can get your hay tested and balanced, we recommend that you use the Emergency Diet.    It does involve soaking your hay for an hour in cold water or 30 minutes in hot water to remove ~30 of the sugar content.  Make sure you dump the soaking water where the horse(s) can't get to it.  Though not intended for long term use, the emergency diet addresses some of the most common deficiencies.  More details about the emergency diet can be found on our website here:  http://ecirhorse.org/index.php/ddt-overview/ddt-diet  Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing (first file in this folder):  https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/  Or since you are in the UK, you will probably want to continue to work with Sarah at Forageplus.

A very important part of the IR diet is what you DON'T feed. No pasture, no grain, no molasses containing products, no sugary treats including apples and carrots, no unsoaked hay with an either an unknown ESC+starch content or ESC+starch that is above 10%.  Plain white salt blocks only--the brown/red ones contain iron (and sometimes molasses) and unknown mineral amounts which interfere with mineral balancing.  As I read your note, I was really struck with the need to keep Jazz completely off the grass.  Many people struggle with this concept, but the fact is, many IR horse just cannot tolerate any grass at all.  

Trim:  A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot.  Though important for all horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis.  Here are the links to our website on a proper trim.  Here:  http://ecirhorse.org/index.php/ddt-overview/ddt-trim   and here: http://ecirhorse.org/index.php/laminitis/realigning-trim  You are welcome to post pictures of your mare's feet so our hoof guru can help you to determine if you have an optimal trim in place.  Here's a site that explains how to take good hoof photos:  http://www.all-natural-horse-care.com/good-hoof-photos.html   Please put any photos and/or xrays in the PHOTOS section of ECH8.  That's the group you join to fill out your CH.  The CH's are in the "files" section, pictures in the "photos" section.  

Exercise: This is the best IR buster there is, but only if the horse is comfortable and non-laminitic.  Once she is able to tolerate increased movement, we recommend hand walking in long straight lines with no tight turns, which puts increased stress on the new laminae as they grow in.  Boots and pads may be in order for comfort during the rehab period.

I hope you find some information in this that helps you, Julia.  There is TONS of great information on our website, in our files and also in the archived messages.  You can search for anything using the "search converstions" and "search files" boxes.  But don't hesitate to ask any further questions that you have!  Let us know when you have your case history done!  We ask all members to please sign each time you post with your name (first is fine), date of joining, and general location (which helps us to source products for you).  When you get your CH done, you will want to add a link to it in your signature as well so that we can find it faster and answer your questions faster!  See my signature below as an example.

Maggie, Chancey and Spiral in VA



Julia Cunniffe
 

Thanks Maggie, I have been managing my Shetland pony with IR for several years so most of this information I am already aware of and using for him. He lives with company on a scraped mud track, with soaked hay and the same very low sugar feeds etc that Jazz has. To manage Jazz and her companion also on a totally mud track will be a massive undertaking. The track they are currently on doesn't have much grassy area left, but is so incredibly slippery (we're having a very wet, warm winter here in the UK) with all the rain we've had I am terrified that they will injure themselves even more significantly.

Unfortunately, the picture that Jazz is presenting with is not all that consistent with Laminitis which is why I have not yet had any blood work done on her. My vets had suggested nerve blocks and Xrays, to see if it is just a single foot lameness, but as she will not allow even hoof testing, she would definitely not permit nerve blocks without sedation, which would I believe render them useless.

During the last week she has been moving around the field in total comfort, trotting, cantering, rearing and playful, with some herbal anti-inflammatory alternative to bute. She has walked out on a soft surface for 20 minute walks and voluntarily continued on the road, when she didn't have to. This has been with her living out on her very muddy track with little grass. 

Then last night she once again looked very much as if she has a right fore abscess again, and didn't want to move. So she is back in her stable( and tiny crew yard because she cannot cope with being shut in totally and to enable her to be able to see her companion properly). This morning she looks more to have bilateral discomfort, as she will not allow me to lift the right fore to pick it out, which I presume must be due to discomfort of the left fore.

Unfortunately my previous trimmer, who's vet husband has also been very supportive, has now gone down the 'self-trimming' route and therefore is not willing to support me with the trim, which I have continued with on my own. The trim i was using with them based was on the work of Jaime Jackson and Dr Bowker, had worked brilliantly for my pony when he had problems but I have been unable to find another professional that performs the same kind of trim.

I shall try and provide one of the case studies you request today, but am unfortunately really struggling with this emotionally as I feel I am letting Jazz down, and am struggling to pull myself together atm. Currently at my wits end knowing who to turn to for professional help as I feel my vets have no interest and minimal understanding of the problem, and my ex-trimming friends feel I need to just give her pain relief and let her keep moving!

I will consider the blood-works you have suggested and perhaps get them done this week, possibly with a right fore xray, hopefully to rule out abcess and/or rotation once and for all.  

Thank you for your support, it is really appreciated. I apologise if I come across as being negative and/or defensive, but as an overly sensitive person who has already practically had a nervous breakdown trying to sort out the ponies IR/Laminitic problems in the past...I am a bit of an emotional wreck again trying to work my way through this for Jazz. 

Best Wishes,

Julia
 



On Saturday, January 9, 2016 3:42 PM, "spiral1957@... [EquineCushings]" wrote:


 
Hi Julia,

Welcome to the group!  You can never provide us with too much info, and you provided a nice summary of your mare's issues.  But in order to get the best help we ask that everyone fill out a case history on their horse.  To do that, you'll need to join one of our sister groups called ECHistory8.  It's a filing cabinet for storing case histories, and keeps all the CH's in one easily accessible place.  Here's a link to that group:  https://groups.yahoo.com/neo/groups/echistory8/info  It won't take long to get approved and then just follow the instructions for filling out a CH.  You can copy and paste a lot of the info that you have already provided in the free form "time line" section at the end of the CH form.

Meanwhile, I will explain our philosophy called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise, and point you in the right direction for some more reading.

Diagnosis:  Forgive me if I missed it, but I am not seeing any mention of lab work.  Is that right?  The first step in getting a good treatment plan underway is a good diagnosis.  To get that, we recommend these 4 tests:  ACTH, insulin, glucose, and leptin on a NON-fasting horse.  At the age of 10, Jazz is just at the cusp of the age that we recommend you do the ACTH to rule out (or in) PPID (Cushing's disease).  PPID is an enlargement or benign tumor in a part of the pituitary gland called the pars intermedia, not usually seen (though not unheard of) in horses under the age of 10.  It's treated with a medicine called pergolide.  IR is not a "disease", but a "metabolic type" of horse, normally, but not always, described as easy keepers with abnormal fat pads such as cresty necks, puffiness in the hollows of the eyes, excessive drinking and urinating, etc.  IR is treated with a low carb, low fat, mineral balanced diet.  A horse that has both PPID and IR would need both pergolide and a carefully managed diet for the rest of it's life.  Any horse can have just IR, just PPID, or both (or neither).  With regard to the labwork, the ACTH is to diagnose the PPID and the insulin and glucose for diagnosing IR.  The leptin helps to differentiate if the horse is IR at baseline or if an elevated insulin is being driven by a high ACTH.  Leptin is the hormone that says "stop eating", and insulin resistance and leptin resistance go hand in hand.  More information about leptin resistance can be found in the first file in this folder:  https://groups.yahoo.com/neo/groups/EquineCushings/files/Insulin%20Resistance/  The labwork does require special handling so please read more about that on our website here:  http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis 

Additionally, you are going to want to read Dr. Kellon's  ECIR 2013 Proceedings on Reproductive Abnormalities in Mares with Diet Resistant Insulin Resistance.  Look here:  http://ecirhorse.org/index.php/conference-proceedings-recordings/2013-proceedings-recordings-table-of-contents  Scroll down to the free PDF's and it's the 4th one up from the bottom of the page.  This will give you another diagnostic tool to consider.

Diet:   To provide a low carb, (less than 10% sugar+starch) low fat (4% or less), mineral balanced diet, we use grass hay, tested to be under 10% sugar + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E.  This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse.  Until you can get your hay tested and balanced, we recommend that you use the Emergency Diet.    It does involve soaking your hay for an hour in cold water or 30 minutes in hot water to remove ~30 of the sugar content.  Make sure you dump the soaking water where the horse(s) can't get to it.  Though not intended for long term use, the emergency diet addresses some of the most common deficiencies.  More details about the emergency diet can be found on our website here:  http://ecirhorse.org/index.php/ddt-overview/ddt-diet  Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing (first file in this folder):  https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/  Or since you are in the UK, you will probably want to continue to work with Sarah at Forageplus.

A very important part of the IR diet is what you DON'T feed. No pasture, no grain, no molasses containing products, no sugary treats including apples and carrots, no unsoaked hay with an either an unknown ESC+starch content or ESC+starch that is above 10%.  Plain white salt blocks only--the brown/red ones contain iron (and sometimes molasses) and unknown mineral amounts which interfere with mineral balancing.  As I read your note, I was really struck with the need to keep Jazz completely off the grass.  Many people struggle with this concept, but the fact is, many IR horse just cannot tolerate any grass at all.  

Trim:  A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot.  Though important for all horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis.  Here are the links to our website on a proper trim.  Here:  http://ecirhorse.org/index.php/ddt-overview/ddt-trim   and here: http://ecirhorse.org/index.php/laminitis/realigning-trim  You are welcome to post pictures of your mare's feet so our hoof guru can help you to determine if you have an optimal trim in place.  Here's a site that explains how to take good hoof photos:  http://www.all-natural-horse-care.com/good-hoof-photos.html   Please put any photos and/or xrays in the PHOTOS section of ECH8.  That's the group you join to fill out your CH.  The CH's are in the "files" section, pictures in the "photos" section.  

Exercise: This is the best IR buster there is, but only if the horse is comfortable and non-laminitic.  Once she is able to tolerate increased movement, we recommend hand walking in long straight lines with no tight turns, which puts increased stress on the new laminae as they grow in.  Boots and pads may be in order for comfort during the rehab period.

I hope you find some information in this that helps you, Julia.  There is TONS of great information on our website, in our files and also in the archived messages.  You can search for anything using the "search converstions" and "search files" boxes.  But don't hesitate to ask any further questions that you have!  Let us know when you have your case history done!  We ask all members to please sign each time you post with your name (first is fine), date of joining, and general location (which helps us to source products for you).  When you get your CH done, you will want to add a link to it in your signature as well so that we can find it faster and answer your questions faster!  See my signature below as an example.

Maggie, Chancey and Spiral in VA





Lorna Cane
 



Hi Julia,

>>>I shall try and provide one of the case studies you request today, but am unfortunately really struggling with this emotionally as I feel I am letting Jazz down, and am struggling to pull myself together atm.

Many of us here know exactly what you are struggling with,and we're here to help.
And you are here, so you are definitely NOT letting Jazz down.

I just wanted to underline the importance of Maggie's suggestion to get a case history up for Jazz,even in the midst of your struggles.
It is the best way to get the details in front of the people who can help .We are great supporters of the fact that the devil is in the details.
Working on the case history will also shut off the nagging,blaming,destructive ranting of the brain,while it focuses on getting the case history filled out.

You may even find as you fill out the details that something you hadn't noticed before jumps out at you,and could be part of the puzzle.

Another way to help the volunteers help you is to sign your posts with your name (Thanks for that),your location,and your joining date.When you get the case history done,add its link to your signature,so that volunteers don't have to look for it.


I've deleted the old messages so that people reading Digest format don't have to scroll through all the old stuff to get to something new.





Maggie
 

Hi Julia,

I totally agree with Lorna on the importance of getting your case history done on Jazz.  One reason is that knowing exactly what you are feeding her can help us to help you evaluate all the feed sources.  SO MANY bagged feeds that are advertised as save for IR horses are definitely not!  Most are too high in sugar, starch, fat, iron--all things that can worsen IR.  

So, get your CH up!  And go out there and take some pictures of Jazz's feet!  Follow the instructions in the link I gave you.  Our hoof guru can do markups for you on the photos to help guide you with your trim.  Meanwhile, once you join ECH8, go the photos section and look at other albums and study the mark ups in those.  Lavinia has done many, many markups and you can see the success people have had following the guidelines.  You can at least get an idea of what an optimal trim should look like, and compare that to what Jazz's feet look like.  These things will give you something to do and concentrate on.  Many on this list have had to find new vets and/or farriers, or have started trimming their own horses when they couldn't find anyone to do it the way they wanted/needed.

The DDT/E works!  But it doesn't happen overnight, though the emergency diet can turn some horses around pretty quickly.  Some horses take longer than others or need tighter control of their diet.  They all have different levels of insulin resistance, so what your IR pony may tolerate may be too much for Jazz.  We want to help you help Jazz and we are here to support you.  Like Lorna said, many of us know exactly what you are struggling with!  I found this group after years of struggling with laminitis/founder in my pony.  But not one episode since I found this group and put the DDT/E's into practice.

 I totally empathize with the mud situation--it's like that here too!  Hang in there!  We know it's not easy.  The collective tears that the people in this group have shed over their horses could probably flood an ocean.

Maggie, Chancey and Spiral in VA
March 2011
EC moderator/Primary Response
https://groups.yahoo.com/neo/groups/ECHistory4/files/maggie%20in%20virginia/