Thoughts on laminitis episode for Canadian mare


Pat
 

I've had Willow less than two years. She is a very easy keeper. I am still learning how to manage her best. I've had her on full board for all except the first four months. Her feet were good when I got her and former owners only shod her for competitions. So I removed front shoes this July - she had them for a year. She was in pain because of soft sole so I got her some boots, which she wears most of the time. (I remove and clean, etc)

So for two months she has been a bit better then a bit worse then a bit better etc. in terms of soreness. She has only had light exercise - groundwork and walking. Sometimes with boots and sometimes without. She had access to grass during this time. There seemed to be steady improvement as her walls grew in and her sole toughened up.

In late August, she was left out on grass for up to six hours while I was away and was in very bad shape when I got back. Farrier did a trim and then she was terribly sore (would not walk without boots) and four days later she saw the vet. The vet says laminitis but I think she said mild .... (I was in a bit of shock and didn't ask as many questions as I should have.) The individual who told me she was left our for six hours on the grass has now changed her story to 2-3 hours. This person is convinced that the reason Willow is suffering is because I took the shoes off. And that this has caused the laminitis. Even though she has nothing but slow walks and a few trot circles 3 x per week since the shoes came off.

I am moving her to a barn at the end of September where another mare's weight is carefully managed and she is fed 3 flakes over three feedings a day of tested hay (although owner does not have test sheet). I can test the hay when I get there.  I have read info about balancing minerals and will do so once I get her to the new place.

I guess I am trying to figure out 1) how much soreness is from removing the shoes and how much from laminitis, 2) what willow's prognosis may be and 3) how much she should be exercised right now (if at all) and over the next year. I am trying to get a follow-up call from the vet but have been unsuccessful so far. The farrier I have was highly recommended. I think she is trying to build up the heels a bit. But its very difficult to know who is "right" in this industry.

Thanks very much,

--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Kirsten Rasmussen
 

Hi Pat,

Welcome to the group! 

Sorry to hear Willow is sore.  She is a beautiful mare!  I read through your Case History and I have a couple comments.  First, the Dr. Reeds (you don't say which one) and the red salt block are high in iron and iron worsens insulin resistance.  I suggest plain white salt (loose or a block) and stopping the Dr. Reeds for now.  I can tell you from personal experience that Dr. Reeds does not add much of value to your supplement program and that a real mineral supplement matched to your hay will be a huge help in healthy hoof growth.  There are details below in your welcome letter with links on testing hay and getting your minerals balanced to your hay so that deficiencies are corrected.  Heiro is not harmful, but it is expensive snake oil...been there, done that, too!  There is no evidence to suggest that it works, regardless of what their website says!  What works are the dietary changes we recommend here and on our website.

Second, if she is sore, do not exercise her.  If she is walking well in her boots (with pads if you have them), then some hand walking is probably fine.  
As for exercise long-term, we recommend waiting until the hoof wall has regrown with a healthy connection at least half way down the hoof wall.  If you can get her laminitis under control now through dietary changes, that will be about 6 months from now.

It sounds to me like your trimmer is on the right track by removing the walls, IF they were flaring and not supporting her weight anyways, but we can't know that or advise on the trim without seeing hoof photos.  When the walls are removed, however, if the horse is tender then boots with soft pads are definitely needed.  It sounds like you are doing that already, but I just want to emphasize that it is important and they should be on 23/7 until she is more comfortable without them.  We have very detailed instructions on taking hoof photos correctly that I recommend you review before you take them and post them (see the link in the Trim section below).  Sometimes, long after shoes are removed, pain can show up in the hoof if there was pathology present when shod for long periods of time, but it doesn't sound like that is your situation and I think you are right that the grass triggered this.

If you can change her diet and management enough to get her insulin under control then her prognosis is good.  Your farrier is right  -  no more grass (this can be revisited later when she has recovered and is back in full work, but it will always be very limited, if at all).  If people are unable to make the changes that are needed for their particular horse (some are more sensitive to dietary sugars than others), laminitis typically recurs over and over, sometimes getting worse each time as the bones in the hoof are damaged over time, and the horse often ends up being more of a pasture ornament or eventually put to sleep if they have a bad founder.  I say that not to scare you but to emphasize that managing diet and exercising a sound horse are the best things you can do to prevent this from happening again, especially as she gets older and IR can get harder to control.  Our first recommendation is to get a diagnosis so you know what you are dealing with (how high is her insulin now, and is her ACTH also abnormally elevated for the time of year), so read through the diagnosis section and consider having your vet come out again for a blood pull.  Otherwise, if you don't know what you are dealing with, making changes can be harder because you'll always wonder if its necessary.  For me, seeing my horse's elevated insulin on a dry paddock with soaked hay made it clear to me that he could no longer go to his summer pasture...before I saw his blood results I thought we could still make it work, after I realized his situation was serious enough that I had to make major changes.

The following is the standard welcome letter all new members get, it is packed with information so read through and click on the links for the things that are relevant to your situation.  
Ask questions if you can't find the answers, we are here to help!


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 etiquettewhat 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 and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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.

EXERCISEThe 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. 

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Rhonda Turley
 

I too have a wonderful Canadian gelding.  This group was a lifesaver for him. He foundered during the covid shutdown.. Canadians are known as easy keepers.  I have many Canadian owners/breeders on my facebook page if you would like to talk to others.  My gelding is now sound and back in light work.  Follow the directions provided here for best results.
--
Rhonda Turley
Brampton, Ontario
April 2020
Scooter and Rhonda     


Sherry Morse
 

Hi Pat,

While Willow is very cute there is definitely a bit too much of her to love.  If her current weight is 1200 her ideal is probably closer to 1100 (or less).  Based on that she should be eating no more than 22 pounds TOTAL per day - including hay and concentrates.  You can read the diet section of the website for information on this - https://www.ecirhorse.org/DDT+E-diet.php.

You have her current intake listed as 25 - 30 pounds of hay a day and she appears to still be out on grass for some period of time as well. At this point, until she's lost weight and her feet issues are resolved, the best thing you can do for her is get her into a dry lot or she needs to wear a completely closed muzzle when she is turned out and obviously this should only be for very short periods of time as she'll need to be able to drink which won't be possible with the closed muzzle.  Then her hay needs to be weighed and she needs to be limited to the 22 pounds a day so she can start to safely lose weight.  If the hay isn't tested please follow the information in the emergency diet and make sure it's soaked before being fed to her. 

Information on the bloodwork that you need to request from the vet is in the welcome email Kirsten already provided but I think it's a very good guess that she's IR and getting her diet and trim in order will go a long way to helping her feel better.  Until she's had time to adjust to the new trim I would not be forcing her to do any exercise and there's nothing wrong with leaving her in boots so she's comfortable enough to move around on her own.





Pat
 

Actually I have dropped her to 3 flakes per day of timothy and she has been entirely prevented from going on grass for two weeks. I may not have put that into the history....

I'm adjusting supplements as suggested above.

She's on full board 35 mins away, so unfortunately I cannot soak her hay. 

She is moving to a barn that has tested hay sometime in the next 2 weeks.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

Maybe I should move her sooner? Her planned stall not available but a small one is available now.

--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Sherry Morse
 

Hi Pat,

Do you know how much the 3 flakes weigh?  At this point we're really more concerned with the weight than the number of flakes.




Kirsten Rasmussen
 

If her pain is being driven by laminitis from elevated insulin, the sooner her diet is controlled the better she will feel.  I don't want to rush a move if you're not ready because 2 weeks is not long to wait, but if her current hay has not been tested and the barn can't soak it and she's still in her laminitic flare up, then she might improve sooner on a more controlled diet.  Ultimately it's your decision to weigh the pros and cons.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Pat
 

I took photos of her front feet and posted it to the Pat and Willow album.
https://ecir.groups.io/g/CaseHistory/album?id=253325


--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

#file-notice
#photo-notice

I took photos of her front feet and posted it to the Pat and Willow album.
https://ecir.groups.io/g/CaseHistory/album?id=253325
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

I weighed them tonight - 7.5 pounds each.

So she is now getting 22.5 pounds per day.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

Sorry meant to add, on the photos I have been using keratex on the lower half of the outside, i think a line shows there.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Sherry Morse
 

Hi Pat,

Is she still out on pasture without a closed muzzle as well?  While it may not sound like much that half a pound a day plus however much grass she's eating can be very detrimental to her losing weight and recovering from her laminitis.  These horses really do need to be micromanaged to a large degree, particularly when starting on the road to recovery. I know it may sound like we're being nitpicky, it really is important to be very aware of how much food she's eating.

As far as the hoof pictures, I will defer to Lavinia on recommendations, but it would be helpful to know when these were taken in relation to when she was last trimmed.  Do you have any x-rays you can share?  She appears to have rather thin soles which could be contributing to her soreness - if she's more comfortable in boots she should be wearing them as much as possible.



Pat
 

No grass at all for 3 weeks, since I returned from vacation on August 28 and found her so sore.

She was trimmed on August 28.

The vet - who is known for being good with metabolic issues - did not recommend testing or x-rays.  The vet was puzzled by the trim (she saw Willow about four days after). I think my farrier is trimming her with a goal of reshaping the hoof. Next trim scheduled for Oct 8.  I will be seeing the vet before then.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

She has been wearing boots most of the time since I took her shoes off July 1. She was very sore after removing shoes.

Before I went on vacation, she seemed a lot better. I had the boots off for a couple of days, she was moving ok at a trot in the outdoor arena.

While I was away she was out on grass for quite a long time I believe. I was told 6 hours because someone forgot to shut the gate. Now they say something else - 2-3 hours.

But she was really sore when I got back and has been wearing boots all the time since then. I am only out 3x per week and the boots are removed then and cleaned, then put back on.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Lavinia Fiscaletti
 

Hi Pat,

Agree with Sherry that she should be wearing her boots most of the time as long as she is sore - so good that is happening. Liberally dusting her soles/frogs/collateral grooves with an athlete's foot powder each time you change her boots will help keep her feet drier and help prevent any greeblies from taking hold in that dark, moist environment.

You didn't cause laminitis by taking off her shoes. Although she may have needed boots for a time to allow her feet to toughen up for being barefoot, that is a normal transition step. The trim needs to get the toes back more, RF more than the LF. The chipping along the perimeter walls is a combination of some excess wall length, toe too long horizontally and the need to have the diet provide a better balance of necessary minerals so she has all the building blocks she needs to grow strong feet. Her heels are underrun, again worse on the RF than LF. That's going to take finessing them back into place while maintaining the vertical height. There doesn't appear to be wall flaring, so that's a good thing. Her soles appear fairly flat, with little collateral groove depth near the apex of the frog. This generally points to thin soles, which would contribute to her being tender without boots.

All of the mechanical elements are quite fixable once the trim and diet are appropriate. How soon you get the diet and trim optimized will determine how long she needs to refrain from formal exercise.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Lavinia Fiscaletti
 
Edited

Testing will give you a definitive diagnosis, tell you where you stand and give you a base to compare with later on. Depending on her age, which isn't in her case history, PPID may be part of the issue. If it is, then she will definitely need medication, as well as a controlled diet and good trim, to get and keep her sound.

Horses' feet are not designed to provide support totally on the walls. The walls should provide no more than 10-15% of the total weight bearing. Your farrier was correct to remove the excess wall length so the entire bottom of the foot would be engaged in supporting the horse. To get the trim fixed, she really should be on a tighter trim schedule than 6 week intervals, as the toe regrowth and heel crushing under will just continue to outpace the trim cycle.

Given the information you have already provided regarding the barn's management practices (feeding her more than you tell them and than she needs, not taking the time to get her muzzled properly, turning her out onto grass more than she should be), I'd be inclined to believe she was left out for the 6 hours rather than the amended 2-3..

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Pat
 

Thank-you so much for the input.

I'll check in with the farrier on increasing the schedule.  She advised the foot powder and I started doing that this week.  I have amino trace plus arriving tomorrow. I also have her on the emergency diet now, having found all the ingredients.

Willow is 10 years old. I will update the case study.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Rhonda Turley
 

My Canadian gelding was put on biweekly farrier trims for April and May, then every 3 weeks farrier trims and just  changed  to every 5 weeks starting now..  This seems to have worked for him.  I also put him in Hoof Scoots for exercising only activity as this is more comfortable for him.  Being IR he needs regular exercise.
--
Rhonda Turley
Brampton, Ontario
April 2020
Scooter and Rhonda     


Pat
 

I will be moving my mare on Sept 26.  Any recommendations on how to reduce her stress?
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325