Michele and Odyssey - new laminitis diagnosis


codyandme_1999@...
 

Thank you all for the responses! Yes, I know we are at the start of his weight loss journey, I want to make sure it is safe as possible for him!  The Vet had wanted me to give him Platinum Performance Beta Lip-Ox for weight loss, but when I talked to them, they said if he was on stall rest and wasn't exercising they didn't recommend it because it would be ineffective.  That is when he had me give him the Thyro-L for weight loss.  So much information to absorb and figure out what is best for him! I have signed up for Dr. K's NRC Plus and Cushings and IR courses, so hopefully that will help me figure this all out.
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


Bobbie Day
 

Michelle agree that he definitely needs to lose some weight 😊
He is a cutie for sure, my little mare was just about this overweight too, I took many of Dr.K’s courses, balanced everything and omitted most everything that I was feeding her, she wasn’t a happy camper (at first) but at least we know (now) what we can do to help them, laminitis doesn’t have to be death sentence anymore.
And it’s wonderful that your wanting to help him, you just need “less” of him to love!
He’ll feel so much better when you get his diet sorted out.


--
Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


Sherry Morse
 

I would ask the vet what he hoped to gain by starting the Thyro-L in the first place.  If the answer was weight loss, I would taper him off sooner rather than later and actually measure what he's eating and make sure he's not eating more than he should be.

Looking at the pictures you posted he was obese in the summer and there's still too much of him to love.  I would guess he still needs to lose at least a 100lbs at this point and possibly more.



codyandme_1999@...
 

Martha,

Thank you! He isn't able to reach the hay on the other side, it looks close in the pictures, but it is about 3 feet from the stall.  I will definitely weigh the hay once the scale comes in so I know for sure what he is eating.  How long should he be on the Thyro-L? It was started on 8 Nov 2021.
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


codyandme_1999@...
 

Thank you Martha! I just called Equi-Analytical and they still have the sample and can run the #603 test without resubmitting the sample.
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


 
Edited

Hi again,
I looked at his body photos and, while he’s quite adorable, he still has too much weight on him.  Think about how he needs to support all of that extra weight on feet built for a smaller horse.  We’ve found that it’s pretty much impossible to lose weight on a diet that doesn’t restrict intake.  The Thyro-L will jump start his weight loss but that’s entirely a push in the right direction as he will adapt and quit losing.  We advocate using small hole hay nets for feeding hay and weighing it out (once your scale arrives).  The total feed (hay plus supplement carriers) should weigh either 1.5% of his current weight or 2% of his ideal weight, whichever is the larger amount.  If 900# is his ideal weight (and that seems high to me), you may find that he doesn’t lose enough and need to cut back a bit more.  It’s a slow, steady process.  I have a 14.2 h pony here, whose body score I would put at 4.5 and whose weight I estimate to be 750#.  


edited to add - I’d also keep an eye on the hay stall next to him.  My horses would finish their hay nets and begin snacking on the hay in the next stall, right through the grate.  My horse, Logo, used to share his feed with the horse next to him.  He would literally push it through the grate between them, cubes, hay, whatever.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


codyandme_1999@...
 

I wasn't sure if it would be useful, but I posted photos from about 2 months before his laminitis diagnosis.
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


codyandme_1999@...
 

I uploaded body condition photos.  Sorry about the front, he kept wanting to say hi, that was the best I could get without someone to hold him.  In the x-rays, I should have said he was due for a trim by the farrier the next day after the Vet took them.  The Vet trimmed the fronts before he cast the pads on his feet.  The back feet were trimmed on 18 Nov.
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


 

Michele, I would call Equi-Analytical to see if they still have your hay sample there to retest before sending more.  I’m not sure how long they keep them but it’s worth checking.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


codyandme_1999@...
 

Thank you all for responding!  I will start soaking the hay again and send in a new hay sample with the #603 test.  I will stop the Outlast and Alfalfa immediately and replace with Timothy.  The Vet put him on Thyro-L to jump start his weight loss, which is happening.  There is always hay in front of him, I don't restrict it at all, I'm estimating he is eating 15 lbs, I ordered a scale but it hasn't gotten here yet.

I will talk with the Vet about having the pads removed.  Once the pads are off, I'll get pictures of the feet.  I'm sure the Vet will take more rads at that time.  The Vet said the pads were to relieve the pressure from the deep flexor tendon on the coffin bone to prevent further rotation?

I'll try to get some pictures of body condition today. 

I really appreciate all of you taking your time to respond, it means a lot!
--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655


Lavinia Fiscaletti
 

Hi Michele,

So sorry that Odyssey is going thru this.

It would be helpful if you can get copies of all the blood work that has been done so far so you have the actual numbers, rather than just the vet's interpretation of them. That gives you something concrete to reference over time.

Looks like the hay analysis that was done is the #601 test, which uses NIR (a comparative analysis) rather than the #603 test, which uses wet chemistry methods to actually analyze the sample. NIR testing can be off by as much as 30% (higher or lower) than what the results show - which may mean that the hay is much higher in ESC+starch, and therefore not safe to feed unsoaked to an EMS/IR horse.

Thanks for adding the radiographs. It would have been better if the first set of rads had been done with the horse standing squarely, without any appliances in place, so that you could see exactly what was happening in the feet without any influence from the appliances.

I agree with you that the angle NANRIC Ultimate pads is much too aggressive. On the RF, the first rad shows a touch of bony column rotation; an extremely long toe that was causing capsular rotation; a bit of sinking; thin sole; ringbone; underrun heels. The second rad shows a shorter toe (tho not backed up enough) and increased bony column rotation due to the extreme angle of the pads raising the back of the foot too high. That increased rotation is putting more pressure on the thin sole by shifting Odyssey's weight onto the tip of the coffin bone and it is also creating more tearing forces on the lamina in the dorsal wall.

On the LF, in the first rad, he wasn't standing on the foot at the time the view was shot - look at the space between the bottom of the appliance and the top of the block. That means that the alignment of everything was altered as the leg wasn't weight bearing. It seems to show mild bony column rotation, which may or may not be accurate; a long toe with capsular rotation; a bit of sinking; some ringbone; underrun heels; thin sole. The second rad shows definite mild bony column rotation; thin sole; underrun heels; slight sinking; shorter toe but not backed up enough.

The padding is not helping the situation at all and Odyssey is telling you the same thing. I would recommend removing the pads asap and going to flat pads in boots. Something like the Easyboot Rx or the Soft Ride boots with the pads cut so they are level instead of being wedged would make the most sense.

As Sherry mentioned, if you could get photos of his feet without the appliances on, we could help evaluate the trim and provide guidelines for it going forward.

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


Sherry Morse
 

Hi Michele,

A couple of things jump out at me -

1 - Thyro-L can help jump start weight loss but it won't do anything to help control insulin.  We prefer to use portion control to help horses lose weight - either 1.5% of current weight or 2% of ideal weight - whichever is more.  Since you have a question mark next to Odyssey's ideal weight it sounds like you may not be sure what that is.  If you could post condition pictures of him we could help you evaluate if where he is now is where he should be or if he needs to lose more weight to be at his ideal. 

2 - If you want to stop the Thyro-L you'll need to wean him off of it slowly as he'll need to get his own thyroid working again.

3 - 8.5 ESC+starch could be ok as it's below our 10% recommendation but there are some horses that even that amount is too high.  We do not recommend alfalfa for IR horses here as it can make many of them footsore.  Outlast has both alfalfa and molasses in it and again is unsuitable for an IR horse.

3 - looking at his trim there's still room for improvement but getting pictures of his feet will help us evaluate that for you.



Bobbie Day
 

Michele, I meant to add that I am confused about why Odyssey is on Thyro-L if your concerned about weight loss? It is often prescribed for weight loss but hypothyroidism is extremely rare in equines and it's not recommended here or helpful. We recommend feeding either 1.5% of actual weight or 2% of ideal weight whichever is higher, it's just as important to not underfeed as it is to not overfeed. 

Bobbie and Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


Bobbie Day
 
Edited

Hi Michele, I'm sorry your having trouble with your boy but welcome, we're happy you found your way here! 
I'm going to try to answer some of your questions and I have attached our welcome letter below, there's a lot to take in so take your time and read through, let us know if you have questions, we're here to help!
1st - question regarding the pads being too aggressive, I am going to leave that one to our more experienced guru's, you can expect them to jump in and guide you with that one.
2nd - question your hay analysis we do recommend sugar and starch to be under 10% but if Odyssey is still having issues, it may still be too high for him, was he doing better when you were soaking and rinsing? We also highly recommend balancing to your particular hay it not only saves you a lot of money but that way he gets what he needs and nothing more, in the meantime please start the emergency diet below. The beet bulp is a great carrier but please be sure to rinse/soak/rinse (no molasses) before feeding. We do not recommend alfalfa for IR horses it can make some foot sore so it would be best if you could replace those feeds with either more BP or Triple Crown Naturals Timothy Balance cubes or Ontario Dehy Timothy Balance cubes, if they're not available in your area many members also use Nuzu Stabul One which you can get on Chewy if need be. I would absolutely stop the Platinum Performance your better off with a custom mix and the Tribute wholesome blends as it is not on our safe feeds list. 
3rd - Potassium, my thoughts are this is not a concern, from Dr. K " High intakes of potassium from the diet are the rule, and potassium is easily excreted by the kidneys". If your concerned about the potash however I would have the nitrates tested in this hay.
What follows is your official welcome letter, there is a lot of information to absorb so take your time and keep it handy for reference, remember we are here to help!


Hello 

Welcome to the group! 

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. 

Bobbie and Desi (over the rainbow bridge 7/21) 
ECIR Group Primary Response
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021



https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


codyandme_1999@...
 

On 8 Nov 2021 Odyssey was diagnosed with laminitis and on 16 Nov 2021 x-rays confirmed rotation.  8 Nov - Vet had me stop feeding Tribute Wholesome Blends balancer and to use Platinum Performance Wellness, Metabolic Support and Thyro-L and soaked hay (analysis in case history).  16 Nov - Vet said it was ok to add back in the Outlast and soaked beet pulp/alfalfa timoty cubes to make the supplements more palatable.  The Vet has him cast with NANRIC Ultimate pads with Advanced Cushion Support, which are visible in the x-rays.  When I got the hay analysis back I stopped soaking because the ESC+Starch were less than 10 (8.5) - Equi-Analytical analysis.

Questions:
- I'm concerned that the angle of the pads is too aggressive? After 3 weeks in them he is still really lame, if not worse.
- I had Mad Barn do an analysis of the hay (2021-12-07 MB MicheleCardenas-JustHay-1stCut2021) and current supplements (2021-12-07 MB MicheleCardenas-Odyssey_-_Current_Diet).  They recommended their AminoTrace+ (2021-12-07 MB MicheleCardenas-Odyssey_-_Optimal_Diet).  I think some of the nutrients with AminoTrace+ end up out of balance and I would be better off with just a copper/zinc/selenium supplement? or maybe Vermont Blend?
- With the potassium levels, should I not have Potash put on the hay field next year?
-
I still need to take pictures, but he has lost 80 pounds in a month, is this weight loss to fast?

I am so glad I found this forum.  Thank you all so much! I'm learning a lot and a lot more to learn to help my poor boy.

--
Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655