Coronary Band SOS


m.rogersthomson@...
 

A friend of mine recommended I get in touch with you and find your site for help with my horse Ben. We have been through a rough seven months and I am hoping to find some guidance on how to best proceed with getting him through it. The story goes like this:

26 November, 2020: A paddock accident. Ben tripped and fell, leaving him with a puncture wound in his knee. 
23 December, 2020: Surgery to flush his joint capsule for fear of  infection. 
30 December, 2020: Impaction Colic. Treated with drenches and fasting. 
3 January, 2021: Ben was found at 1:30am laying down, covered in hives, with projectile diarrhea. Put on an IV and quarantined. 
4, January, 2021: Diagnosed with non-infectious Colitis and prognosis poor. 
5 January, 2021: 3Lt Plasma transfusion
6 January, 2021: Vitals and demeanor improved but pulses began in his feet. His hoofs were iced, replenished every 3 hours. 
7 January, 2021: XRays taken of all four hooves to check for rotation and establish a baseline. No rotation present. 
15 January, 2021: Further XRays, no rotation, able to come off the IV and begin drinking/eating normally again. 
25 January, 2021: Further XRays, no rotation, Ben is able to return home
1 February, 2021: Wooroloo Bushfires force us to evacuate. Causing a 40 minute float ride at 11.30pm. 
5 February, 2021: Further XRays conducted, on the property we were evacuated to, show sinking of the pedal bone on his front left hoof. 
10 February, 2021: Perforation of the hoof sole on his front left. 
1 March, 2021: Minor perforation of the hoof sole on his front right. Seperation of the coronary band beginning.
7 March, 2021: Cannot stop the separation of the coronary band which extends through to the entire median side of the right hoof. 

Present day: The perforation of the sole is no longer causing issues but the coronary band problem is persisting. 

I am lucky to have an experienced farrier helping us through this but even she has never seen anything quite like what has happened, and is happening, to Ben. He is the sweetest, most kind, and warm horse who deserves to live a long and happy life and I will do whatever it takes for him to achieve that. We are together every day trying to manage this but I am just concerned the coronary band issue is persisting and as a result the median side of the right hoof is not growing. 

I can send images, documentation from the vets, blood test results, more XRays, anything you need and anything that might help. 

This is a desperate cry to help him in any way possible and I do hope this email finds itself to you. Thank you for your time reading our story and I am looking forward to hearing from you if you feel you are able to assist us remotely. 

Initial images of the damage at its worst in Mid-March: 



 
Current images in June:
--
Molly RT, in AUS, 2021


Eleanor Kellon, VMD
 

You will be getting a formal welcome message with instructions on how to organize your materials for us but on the surface it doesn't sound like this is a metabolic laminitis. Nutrition is very important especially in his stressed state. I would put you in touch with Carol Layton for that https://balancedequine.com.au/ . Does your hoof care professional feel comfortable dealing with the situation? Do you have any options for specialist consultation?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hello Molly,

Welcome to the group!

As Dr. Kellon noted, this does not sound like a metabolic issue and as such would be addressed on the Horsekeeping group (https://ecir.groups.io/g/Horsekeeping) unless this horse is also either IR or PPID.  If he is not IR/PPID please do join the Horsekeeping group and post there as that helps keep this main group focused on the IR and PPID horses. 

I do see that you joined the Case History group and posted an album (https://ecir.groups.io/g/CaseHistory/album?id=266376) as well as a CH (https://ecir.groups.io/g/CaseHistory/files/Molly%20and%20Ben).  If you could add those links to your signature for us that would be helpful.  To do that:

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window with your name and location

3) Put your cursor on the next line and paste the link to your Case History folder, hit return (which should make the link live) and put the link to your album on the next line.  Again you will need to make the link live - either by hitting return or adding a space after the link.

4) IMPORTANT: Scroll to the bottom and hit SAVE!

What follows is our standard group welcome although if Ben is not IR or PPID some of it may not be applicable for him.

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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.

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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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.