Rescue Horse with Severe Laminitis


 

Hello, my name is Paola and we have a horse rescue in Gran Canaria, Spain. Last Sunday August 29th we went to see a horse that was described to us as lame and malnourished, and with laminitis. I have found this group thanks to María Durán.

As soon as we saw the horse we called the vet and she came to take some x-rays. We have to repeat them next Tuesday as only one of them was visible. You can see it here:






Putting him to sleep is a very posible option but the horse has appetite and a very good attitude, so as long as he continues that way, we have decided to help him.

The trimmer is also coming next Tuesday to trim his hooves a and take measurements for the boots. He was eating a mix of beet pulp, oats, alfalfa and wheat. No forage at all. He is currently eating soaked meadow hay only + salt, and the vet has prescribed him HEMOVAS, GABAPENTINA and ASPIRINE. Anti-inflammatory (EQUZONA) only one day before the trim.


I have asked the vet to run some tests to rule out Cushings or EMS but she says it’s not necessary? Anyway she has acceded to run them but I would like to know your opinion.

Do you think the horse could have a quality life if treated? Do you know any cases like this that have improved? What would the next steps be? I trust my vet but I recognise that we all keep learning and she seems willing to “think out of the box” and not treat the laminitis as the “traditional” way.


Thank you so much in advance.





Nancy C
 

Hi Paola

You are going to get a full welcome with a lot of information shortly but I wanted to offer some observations and links to more info in the meanwhile.

80-90 percent of all laminitis is caused by high insulin from metabolic conditions like PPID and IR/EMS. The exception to this rule would be black walnut, feed room break-in, severe infection, and pregnancy. https://www.ecirhorse.org/laminitis.php

I would absolutely get the metabolic tests run so you know where you are.  If he is PPID, the insulin will not be controlled on diet alone.  You will need to treat him to lower his ACTH, most often with pergolide.

That said, diet is critical to controlling high insulin regardless of the cause. Soaked or known low ESC and Starch hay are very good. You are basically doing the emergency diet and ECIR generally adds magnesium and vitamin E.  You will hear more about this lataer, but in the meanwhile, try this link. https://www.ecirhorse.org/DDT+E-diet.php

It is very good your vet is willing to think of new measures. There are many here who can attest to improvement and quality of life for horses like this, including my own.

Look for a full welcome message that you should keep at hand to refer back to in the days ahead.

Thank you for rescuing this boy.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21. Next setting up for those who also might want to purchase. It takes time. Thanks for your patience.


Nancy C
 

Hi Paola

Just wanted to alert you that we see your Photos folder.  What a sweet face Condado has.
https://ecir.groups.io/g/CaseHistory/album?id=267828

He's got significant bone loss -- which you probably know -- and needs a very good trimmer to fix his outer capsule to what remains physiologically so that he can move about, hopefully pain-free and not continue to do damage.
https://www.ecirhorse.org/realigning-trim.php

It takes dedication but it has been done before.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21. Next setting up for those who also might want to purchase. It takes time. Thanks for your patience.


Cindy Q
 
Edited

Hello Paola

Welcome to the group! You are very kind and dedicated to be trying to help the rescue horses.

Please read our welcome letter below carefully - it is divided into sections on Diagnosis, Diet, Trim. Exercise is for later when horses are feeling better.

Nancy has already answered your question on whether to test and her thinking makes sense to me. Good start on the soaked hay and salt - she has given you the link for Emergency Diet in her message and it is also in the welcome letter below - it goes to our website and the details of the diet are about halfway down the pages. Please read the details on soaking and on what to feed.

In the meantime, I suggest getting some padding under his feet to see if it improves his comfort - eva foam, gym or yoga mats, old saddle pad?, some kinda rubber. If it is a denser material, you can also dig a shallow depression in the material under where you estimate the edge of P3 to be like a D shape around where the thumb tack was placed. If you can find anything a bit denser/more resilient than human yoga mats would be good but if human yoga mats work then go for it (just need to be replaced more frequently as they crush down quite fast). You can place the material under his front feet first and watch his reaction to see if he shows any sign of relief. If you find something he likes, then cut it up to a hoof pad shape and you can make a duct tape square with overlapping pieces of duct tape to duct tape it on. You may have to experiment a bit with different materials to see what gives comfort. I would start on this immediately and not wait till the trimmer comes next Tuesday. 

Is your trimmer experienced with laminitis rehab?

Here is the full letter, you can save this link and refer back to it again and again. I find the recommendations here are helpful for many horses with foot issues, not only those with laminitis.

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.

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 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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





Maria Duran
 

Hi all,

Just to say I´m here helping Paola in whatever I can with diet, diagnose and what is possible for me. I will pay close attention to this case just in case she needs help here in the group or with Condado´s recovery.

We are trying to get blood work done for ACTH, glucose, insulin, CBC, chemistry and piroplasmosis as it is very common here and his prior diet was very innadecuate but doesn´t justify IMO the BSC he is at unless he is diabetic, but find this very unlikely. 

He is in severe pain right now. Paola referes him improving a bit in posture after feeding only soaked hay, but I am worried there is more damage as the X-ray shows bone loss, so we would appreciate guidance in possible bone infection or loss of blood vessels sorrounding the coffin bone as part of his pain once the full set of X-rays are done tomorrow. Beet pulp and supplementation is coming.

Also would appreciate input on aspirin, gabapentin and hemovas. I am talking with Paola to substitute aspirin for jiaogulan once the trim is corrected and gabapentin for ALCar Dr. Kellon, if you believe there might be nerve damage.

I have two main worries with Condado, one is the possibility of a concomitant pathology like piroplasmosis and the other one is that the source of his current pain is not the trim or uncontrolled EMS alone. We will know more after the blood work and X-rays, but these are my concerns.

Paola here is the link for how to take a full set of good pics so that you can be helped in this group: https://ecir.groups.io/g/main/wiki/1472

This one is for how to set your signature and case history: https://ecir.groups.io/g/main/wiki/1191

To upload Condado´s pics: https://ecir.groups.io/g/main/wiki/1474

For general help navigating this site of with your case history or photo album: https://ecir.groups.io/g/main/wiki

Or just ask me and I will try to help you out.


--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album
_._,_._,_


Cindy Giovanetti
 

God bless you for rescuing that horse.

 

Cindy


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125