Possible Laminitis - How to proceed?
I've been a member for several years reading posts now and then for general knowledge, and have implemented a few diet procedures as preventative medicine in my horses. I try to get tested hay (not always successful), I feed minerals (California Trace, I'm in southern Canada close to the Washington border), I primarily use beet pulp for the supplement carrier (I do the rinse soak rinse procedure for my beet pulp), I have my water, shelter and food spread out and I put hay out in multiple piles to encourage movement.
My 23 year old mare has had a sudden bout of diarrhea (she has never had diarrhea in the 17 years we've been together). Diarrhea began on Wednesday or possibly Tuesday night after the night feed. Still drinking and eating happily. Capillary refill was good, skin pinching didn't result in tenting, she was moving around, digital pulse didn't seem unusual (also compared this to my four year old mare), hooves seemed maybe a bit warm but similar to the other mare, had lots of gut noises.
Possible triggers include alfalfa cubes, I had added in Alfatec cubes for the past couple months as she seemed a bit ribby coming out of winter and had never shown any negative affects from alfalfa hay. I was giving roughly one cup soaked per day (it was included in roughly four cups soaked beet pulp, so it was also rinsed soaked and rinsed again).
I had also added Camelina oil about three weeks prior.
The hay was not new, but we are feeding off if large squares currently so it's possible this bale came out a more stressed section of field? The only other possible trigger was I was held up feeding morning mash/supplements and ended up having to give it in one meal Tuesday evening. This isn't something I normally do, but I have done it on occasion without issue.
Diarrhea improved on day three (yesterday) until she had soft but formed poos with some liquid diarrhea interspersed. But she was also noticeably sore and reluctant to move. Pain appears to be localized to the hind left hoof, a hoof that we've had reoccurring abscesses in for the past decade although it's been almost two years since the last one and I thought we'd finally resolved the issue.
Consulted with vet on the phone (nearest vet is three hours away). Was told to continue monitoring but doesn't appear to be critical emergency at this point. I cut out the alfalfa and camelina oil, soaked her hay, scrubbed and investigated her sore hoof, took heat readings with a heat radar gun of all four feet (there has been no significant differences between any feet and they were similar in temperature to the young mare, I have taken roughly ten readings now), and walked her around several times. Today she is less sore than yesterday, she is moving more and trotted out on lead albeit not happily.
Initially I did an ice soak on the affected hoof thinking it was likely laminitis after a bout of diarrhea, but its looking more like an abscess and just coincidence that it's occuring concurrent to the diarrhea? Offered bute but she barely ate any of it (she's a total pig but hates bute). Decided to cold hose again this morning, she won't stand in multiple buckets but I have soaker boots so I could try getting ice water in those, but without heat in the hooves is it necessary?
How should I continue? Vet will likely put me on the schedule for her trip to my region next week if she can fit me in. I have an appointment for routine care already July 9.
If this is laminitis what will the next few days look like? Should I still feed her supplements (minerals, salt, and some herbal stuff for joints)? Should I invest in diagnostic testing in July, I'm thinking of getting x-rays, but clearly there is a larger systemic issue going on and I thought there was a possibility of some type of metabolic issue with her which is why I've done a few things like RSR and trying to get appropriate hay and feeding minerals. She does have some rippling in her hoof wall suggesting metabolic issues but isn't growing faster in the heel then the toe.
Thank you for reading, it's the first major issue I've had with this lovely lady where I've been unsure how to proceed. Your time and insight is appreciated.
I'm preparing my case study for inclusion now, just working around having a six month old baby!
Emilee Moore - British Columbia, Canada - 2020
Welcome to the group (although you joined some time back, I understand that this is your first post). It sounds like you have been reading up on ECIR and have some of the recommendations in place so good on you for getting that headstart as an advocate for your horse. I think it's a good call stopping the alfalfa and soaking the hay. I will be setting out our welcome letter below with all the details and it's worth a read to see what more can be done, especially on the kind of testing you can do and how to go about it if you suspect she has metabolic issues. If the rippling is quite regular on her hoof, it may possible coincide with each new batch of hay?
Instead of camelina oil, you can give her 3oz of flaxseed meal (per 1000lb of horse) and it is part of the emergency diet (details linked below under the DIET section). Weigh it once in an appropriate sized cup or scoop and mark the level. An estimate might be about 3/4 cup.
I personally have found that alfalfa gave a few of our past horses diarrhea issues or possibly a bad batch of hay or bad portion of that hay so check your hay as well.
You can also get her some hoof boots with pads or duct tape hoof pads on (anti fatigue or eva form pads) to help her comfort rather than offering her bute (anyway she rejected the bute). I've found good success with cloud boots and their cloud pads from Easycare. Personally I like these boots to have on hand, not just for laminitis but for any sort of situation needing comfort (eg. abscess or thin soles).
I'm sure some of the other volunteers including Dr Kellon will weigh in on your other questions. But while you are preparing your case history, you might want to let us know here about exactly what and how much supplements you are currently giving, to hear whether or not any need to be stopped (of course also include them in your case history). Plain white table salt is ok (iodised or not). Herbal stuff, please be more specific as well as some are not suitable for IR (or suspected insulin resistance) horses eg. Yucca is a no. The sooner you have your case history ready with as much detail as you can, the better the advice you can get because you seem to have a mixture of concerns at the moment.
Here's the full reference/welcome letter and it is very useful so do bookmark it so you can easily refer back.
The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.
Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.
Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have.
Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.
PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now.
Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed.
DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
- low carb (less than 10% sugar+starch)
- low fat (4% or less)
- mineral balanced
We use grass hay, tested to be under 10% ESC + 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 soak your hay and use the emergency diet (scroll down for it). The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it.
What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only.
No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.
We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.
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 equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.
Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet.
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.
There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.
For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.
If you have any technical difficulties, please let us know so we can help you.
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ECIR Primary Response
Photos: https://ecir.groups.io/g/CaseHistory/album?id=9798
A couple things make me think your girl will benefit from diagnostic testing. Recurring abscesses combined with rippled hoof walls can both be a trim issue, but both can also be from elevated insulin. The rippled walls without thicker growth at the heels can still indicate low-grade chronic/ongoing laminitis. You say she is a bit ribby. That plus her age makes me thing an ACTH test for PPID is also in order. I would have your vet run the endocrine panel from University of Guelph (insulin, glucose, ACTH, T4, and leptin). You can ask to have leptin left off the panel if cost is an issue as it is the most expensive part of the test.
There are specific conditions that we recommend blood be drawn under: a non-fasted state with grass/hay available for at least 4 hours before the blood draw, blood drawn at home while the horse is calm and before any other procedures are performed (stress and exercise affects insulin and ACTH levels) and before sedation is given (some sedatives increase insulin, others decrease insulin) . Make sure your vet has the blood sampling instructions from Guelph and will keep the sample on ice until he/she can process it, freeze it overnight, and ship by overnight service to Guelph.
Our website has more information on diagnosis.
https://www.ecirhorse.org/DDT+E-diagnosis.php
Xrays would also be helpful in case her trim is part of the problem, and they will show if she has any coffin bone rotation.
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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
I'm inclined to agree on all counts. I've read the overviews for PPID and IR, and while she doesn't match either one on most symptom something has to be going on. I've been trimming her for the past five years (initially with in person guidance and now supported virtually), I brought the hoof back into alignment after a series of back to back abscesses and she was abscess free for two years. The reoccurring abscess started after a really unfortunate starvation period when I pasture boarded her away from where I lived for a year until I could bring her to me. Turned out she was bottom of the herd with insufficient pasture and only one round bale randomly provided. I got her out of there once I discovered her condition. She'd never EVER had an abscess prior to that terrible time, I had had her for ten years at that time, almost eighteen years now. I truly believe that her health was severely affected and I'm still dealing with it to this day.
On a related note, I requested the case history form for smartphones but haven't received an email back - perhaps I did it wrong? Still figuring out how to navigate the website. I only rarely can get onto the computer as I've got a seriously clingy six month old baby - I'm responding now while he nurses and naps on me!
Poor Mist is still sore today, we've continued with soaked hay (cold soaked in trash cans for an hour or so) and RSR beet pulp with just salt and California Trace added. I have boots on order for her, I tried duct taping a pad on but our place is super muddy at the moment and it came off pretty quick. Interestingly she isn't standing in the coolest or soft and supportive spots, she's chosen spots where the ground is the firmest. We're moving in the next few months, we bought a property with five acres for them (undeveloped raw land with random meadow growth). They're currently on about one acre of wooded muddy land so I'm not sure what to do if she's in crisis still. I planned on developing a track but it would still have some green growth on it. Having said that, even her current pen has grass growing in places and she doesn't eat it? But recently she stripped a few trees of bark and nibbled on rotten wood and I think that's connected to this diarrhea episode and (likely) this probable laminitis episode.
Goodness I'm overwhelmed just considering all this!
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Emilee Moore - British Columbia, Canada - 2020
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet
https://ecir.groups.io/g/CaseHistory/album?id=78891
What kind of tree was she eating? Was it toxic? I can see how that might cause diarrhea ...but why she ate it when you say there's grass in her paddock might indicate something else going on. I would see what your vet thinks.
Right now, continuing to soak hay and keep her off grass and concentrated feeds that are not IR-safe is all you really can do until you can test her blood and find out what you are dealing with. If she's IR she will likely need to be kept off the meadows in your new place; a woodland paddock is perfect for her then, so maybe you can create one there. If she's PPID, she will benefit from medication and might be fine on a little pasture. If she's both, then diet control and medication will be needed.
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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
The case history form won't work for me, I'll get my laptop out one night this week when my husband is home to take over caring for our baby. No big deal, I've been making notes to myself as I remember things to include.
Touched base with the vet on Monday, she recommended bute for the lameness, since the diarrhea had settled down, but it caused the diarrhea to flare up today so no more of that. I've got boots on their way and rigged up a foam pad duct taped/vet wrapped on. Mist hates bute anyway so I wasn't keen to feed it, but of course want to help her with the pain. If she worsens we'll try a different medication.
After discussing her pain presentation we're inclined to think it's an abscess causing the lameness, however we agreed it would be best to continue soaking her hay until we know more after her appointment. As such, I did an Epsom salt soak this afternoon and pretty confident I could feel the soft and squishy spot the abscess is brewing to vent out above the heel bulb (chronic route for it to vent).
My new hay supply will have an analysis done and I've contacted Mad Barn to see about getting a custom blend. I've also cut out any herbal supplements and am just feeding California Trace and salt for the time being, and I'm going into town tomorrow to get vitamin e and flax seed to add in as per the emergency diet.
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Emilee Moore - British Columbia, Canada - 2020
I replied to another post yesterday that I finally found a really well made boot for my horse, Soft Ride, with the dual colored gel insert for laminitic horses. My guy has done well with these. Follow their instructions which are online and then call them with the measurements and they will tell you which size to order. They are really nice to deal with.
Has the vet thought about Equioxx for the pain? This can be used for a much longer time than other pain relievers in what I know.
Keep up apprised.
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Kim R, Lafayette, CA 2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee
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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album