Sparkles, Trying to Make sense of this case ... Tick disease, IR, Laminitis


J
 

HI all. Sparkles is a senior, we think between 20 and 25.  American Shetland type mare. She is 10.1 hands and has steadily been around 380 pounds (we check throughout the year). I have seen her as low as 375 and high as 390. We use the tape and the formula (if I remember correctly I think she is a little less with formula). She has been with us since 2017. Prior to that was a backyard pony for a couple of years. I do not have much of a history prior to that other than she had been a carnival pony.
In the time she has been with us has been healthy over all. She has had 1 maybe 2 choke spells, she has seasonal allergies in the form of cough and swollen eyes (we think from pine pollen) she has had some colic issues. She has some minor dental issues.

 The first few months she was here, we attempted morning grass (knowing our new Morgan was metabolic I was in contact with our University forage professional) . We think grass triggered colic in both Sparkles and Morgan (they colicked same day .. though Sparkles has some very unusual symptoms). After that we quickly erected a run in shed along with a drylot and small track. The following spring expanded the track system and since our herd of four gets lots of daily exercise. SEE IMAGE OF OUR TRACK.  Because we have a very metabolic Morgan and a probably metabolic prone MFT, beside the track, I always look for a mature 1st cut hay. I normally test my hay but did not this past year because we got hay from 6 different fields.  I relied on my judgment re mature and so forth ... of course I regret not testing right away. My 3 mares, including Sparkles got soaked timothy twice a day. Sparkles no longer gets timothy. Our SB gelding gets soaked alfalfa and was getting Safer Choice. I would sometimes top the girls Timiothy off with a tiny bit of SC as a treat.
NOTE: Even though we use a track system, Sparkles can be quite crafty re putting her head through fence and not getting zapped. We try to keep her forelock and mane brained. We also throughout grass season kill grass with salt and vinegar along fence line. Still crafty Sparkles on occasion has gotten grass. She can crawl through a fence and under a fence. This year we will be reconfiguring all of our fence line and adding more to prevent any of the herd from getting any grass.

Toward the end of this past summer, Sparkles first showed signs of lameness. At first it was simply her not wanting to leave her stall in the morning, but once she got outside she was fine and was out on the track with the herd. She walked and ran just as much. This happened every so often. Toward the end of Oct, it became more consistent and more apparent she was uncomfortable. She was doing a lot of wt shifting and more reluctant to move. Some days downright refused to leave stall or move. Morgan X pony  is very classically metabolic and I have cared for her during laminitis ... Sparkles looked nothing like this. The only thing farrier saw at first was that her hooves were growing faster than her normal. Vet came out beginning of Nov. Did not feel pulses and Sparkles did not react to hoof testers. Vet was thinking possible tick disease so we started Doxy and sent bloods off to lab. Labs revealed Mod pos anaplasmosis and weak pos Lyme. Vet was not sure that Lyme was significant though said it could have been. After a week of being on Doxy Sparkles felt so much better. I put her out in one of the dry lots attached to the run in shelter for a week and then allowed her back on the track. She seemed better.

By the end of Dec she symptoms returned. She had days where she refused to leave her stall in the morning. She seemed more miserable than ever. I still could not feel pulses. Never had that lami stance (I know not all of them do). Vet came out she was able to feel pulses but not much reaction from testers. At this point vet is thinking lami and did a metabolic panel. Results showed she was severe IR with results at >200. I was quite surprised. I always considered Sparkles to be a slender pony (SEE PICTURES). steadily around 380 ... which I did not think was much for a pony that is 10.1. Never any cresty neck or fat pads. Always lots and lots of exercise. I began hay soaking right away. We soak in hot water for an hour. I started switching over to soaked beet pulp pellets. Vet recommended more bute. We did this for a while but then pony stopped eating. We are in Maine and had very frigid temps most of the winter (near 20 below zero). Hay would often freeze so I ended up needing to soak it and then dry it. Still, there were too many days she would not eat. As it was she was always terribly cold. I was worried not eating she would only get colder. I tried teff ... she ate this some. Eventually I found Triple Crown Safe Starch ... she ate this. By this point I continued to give soaked/dried hay, beet pulp, teff and TCSS ... For the cold, I was double blanketing her, put her in wool socks and duct tape boots with Cloud pads ... I tried various boots including Cloud, and Cavallo CLB ... finally we got Softrides which worked well. We also wrapped legs with fleece shipping boots. There were days with even these measures she continued to shiver. If we had a normal house type ... I think I would have brought her in the house!
Since DX of lami, farrier has been doing trims every 2 to 3 weeks.

It became very clear to us that the colder the temp the more discomfort she had ... The bute, the hay soaking and other measures did not seem to help much. What helped most was warmer days. We started Metformin.  Vet came back out in Feb to recheck insulin. She tested after 10 or so days of being on Metformin. Labs showed no changes re insulin! How can this be??? I tightened up diet again since we were getting more warmer days. At that point we just did soaked hay and soaked beet pulp. I do dress a little with alfalfa to get her to eat flax and supps.  Vermont blend, liquid Vit E and white iodized salt. I completely stopped the bute (I was never really sure it helped anyway).  I FINALLY got results of hay. RE ESC and Starch, I sent four samples (I tested the Triple crown as well) and all were less than 8. 

Thankfully Sparkles is on the other side of things and doing much better. I am puzzled that Sparkles continues to be high IR and that she was as sore as she was. Her feet did not look anywhere near as bad as my Morgan but her issues were so much more prolonged. Morgan recovered very quickly!


THE QUESTIONS: 
1. How could a pony who does not have the typical metabolic markers of being over wt, cresty, fatty etc AND be on a low sugar diet (hay less than 8 AND soaked) be so IR >200?         NOTE: ACTH was normal. Vet thinks we should do another test to look for possible Cushings. She does not seem to have typical markers for that either. She did have a slight delay in her shedding last year, but if you look at her June coat in my album, it still does not look that abnormal ... it is just slightly different than her norm. This year she is shedding much faster than her usual.

2. She is clearly sensitive to the cold. She started showing this last winter. Last year was the first year we blanketed her. This year we had to put two blankets on, wool socks boots pads and fleece shipping boots. Sometimes this was not enough. What is this cold sensitivity? Is it anything like Raynauds in humans? Is it possible the cold it self is the actual cause of these issues? When is something like Gabapentin used?

3. RE Tick diseases ... I know Lyme can cause and trigger all sorts of issues, but we are not sure if she actually had LD or not. Anaplasmosis was more clear. Does Anaplasmosis cause similar issues as Lyme? Since Sparkles responded so well to Doxy , I often wondered if we should have done another course.

4. When Sparkles has pads on, no matter if we are using duct tape or any of the many boots we tried, it seemed as though she was on her toes more. Her pads always ended up wedge shaped. You can actually see this in her XRAYS as she had her duct tape boots on her rears. I will also upload an pic of her pad. The pads do not start out wedge shaped. Any thoughts why this is? It is all fours.

5. She has been stalled most of the time in deep bedding since the end of Dec. Occasionally I would hand walk. Maybe 2 or 3 times (including today) I put in a small drylot for a little while. At what point is it safe to start letting out regularly? Beside our track, we have a couple of options to keep her in smaller areas and not with the herd.
--
Thanks all
Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


Jennifer Murphy
 

Hi Jen,

I just wanted to say that I love your track system! And Sparkles is adorable. :)

I'm no expert, but I remember when my mini mule first presented with issues and a farrier told me that he guaranteed 110% Flea didn't have PPID or laminitis simply by looking at him.  A month later when I had Flea tested he was most definitely PPID/IR! Sometimes what you see on the outside doesn't quite match what's going on inside.  Looking at pictures of Sparkles' hooves (and I am not really savvy about hoof knowledge), I would think they look pretty good, but in the rads it looks like she has an awful lot of heel.  I'm sure someone here with better knowledge of trimming will chime in, but I know when my little guy's heels were too high, he was not comfortable at all. 


--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


J
 

Thank you Jennifer for your reply. When Flea was DXd with PPID, did he have normal ACTH? At the time Sparkles showed she was IR, ACTH was normal (Tested in DEC). Vet is thinking we will try a different type of test. How common is it to have PPID and not have a pos ACTH or any of the usual physical markers (beside the IR and lami)?

RE the heel, yes. We all saw that and farrier trimmed based on the XRAY. Prior to XRAY farrier was trimming based on response of Sparkles and this worked very well. When she trimmed based on the XRAY and took off more heel, Sparkles was significantly more sore for about 4 or 5 days.

Did you happen to notice the pads in the XRAY images of the of the hinds and the picture of the blue pad? Her pads become wedge shaped. I would guess that indicates her heels (all four) are more sensitive. But taking off more heel caused more discomfort not less. Thoughts? 
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


 
Edited

Hi Jen,

My role here is to welcome you to the ECIR group as this is your first post.  I'm enclosing our group welcome letter with lots of important information and links to ever more.  And what you read there will undoubtedly result in more questions which we're here to answer.

Sparkle's ACTH is above normal.  The ranges you see are not meant to describe normalcy.  We like to see the ACTH mid way in the range, or high teens to low 20's, year round.  It may be that her ACTH during the rise is much higher.  Coat changes are not the first to happen with PPID but they're often the first ones we notice.  In my case, Logo had issues with skin infections and ulcers which I could not control until he began pergolide.  Your vet may be describing the TRH stim test which picks up earlier cases.  The blood is drawn before and after hormone stimulation and shows and exaggerated elevation when PPID is involved.  That test is only done for diagnoses.

My experience with tick borne diseases includes both Lyme and Anaplasmosis.  The anaplasmosis presented with a sudden high fever, which my emergency vet was able to diagnose over the phone as "tick fever", which locally seems to mean anaplasmosis.  We treated with Oxytet and then doxy.  The Lyme disease symptoms were more subtle but can include lamenesses and laminitis.

There's lots more here to address and I'll come back later to check to see what responses you've received and maybe add more.  In the meantime, there's lots of reading material here to occupy you.


And now for the ECIR Group Welcome letter.

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. 

--
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


 
 


Eleanor Kellon, VMD
 

On Wed, Mar 23, 2022 at 08:44 PM, J wrote:
1. How could a pony who does not have the typical metabolic markers of being over wt, cresty, fatty etc AND be on a low sugar diet (hay less than 8 AND soaked) be so IR >200?         NOTE: ACTH was normal. Vet thinks we should do another test to look for possible Cushings. She does not seem to have typical markers for that either. She did have a slight delay in her shedding last year, but if you look at her June coat in my album, it still does not look that abnormal ... it is just slightly different than her norm. This year she is shedding much faster than her usual.
Only about 50% of IR animals fit the overweight profile. I agree with doing a TRH stimulation.

2. She is clearly sensitive to the cold. She started showing this last winter. Last year was the first year we blanketed her. This year we had to put two blankets on, wool socks boots pads and fleece shipping boots. Sometimes this was not enough. What is this cold sensitivity? Is it anything like Raynauds in humans? Is it possible the cold it self is the actual cause of these issues? When is something like Gabapentin used?
High insulin causes vasoconstriction and cold on top of that only makes it worse. Cold can also make insulin readings erratic but it can't be the sole cause here. Gabapentin is used when nothing else is left but it doesn't seem to do much of anything. Try Laminox https://uckele.com/laminox-3lbs.html 1/2 scoop twice a day and use coupon code ECIR for 5% off.

3. RE Tick diseases ... I know Lyme can cause and trigger all sorts of issues, but we are not sure if she actually had LD or not. Anaplasmosis was more clear. Does Anaplasmosis cause similar issues as Lyme? Since Sparkles responded so well to Doxy , I often wondered if we should have done another course.

I'm not aware of Anaplasmosis causing laminitis. All chronic illness comes with some IR but not to this degree. I'd repeat the testing to see what's going on. Maybe you were lucky and caught Lyme early.
4. When Sparkles has pads on, no matter if we are using duct tape or any of the many boots we tried, it seemed as though she was on her toes more. Her pads always ended up wedge shaped. You can actually see this in her XRAYS as she had her duct tape boots on her rears. I will also upload an pic of her pad. The pads do not start out wedge shaped. Any thoughts why this is? It is all fours.
It's because her heels are too high. The palmar angle - angle the coffin bone makes with the ground - should be no more than 5 degrees. Her toes should be backed up a bit too but don't disturb the sole in the front half of the foot.
5. She has been stalled most of the time in deep bedding since the end of Dec. Occasionally I would hand walk. Maybe 2 or 3 times (including today) I put in a small drylot for a little while. At what point is it safe to start letting out regularly? Beside our track, we have a couple of options to keep her in smaller areas and not with the herd.
You can put her out for as long as you like as long as she can't get any grass (winter or not).

 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

The classical signs of PPID- coat, muscle wasting, increased urination - are all late signs. Early signs include tendon/ligament issues, unexplained laminitis often in the fall, late in life first episode of laminitis, development of allergies.  These early cases often only test positive in the fall, or if you do a TRH stimulation.

The only way the horse has to relieve pain in the hoof is to raise the heel. It doesn't matter whether the pain is heel or toe. Raising the heel unloads the foot. To put it another way, the horse can't raise only the toe. If her heels have been high for a significant time, her hind foot needs time to get back in shape for weightbearing. It needs to be done though because the high heel is tipping the sharp edge of her coffin bone onto the sensitive corium below it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


J
 

 Thank you Martha.
Interesting re above normal ... Yes the test vet suggests is the stim test. We were thinking about doing in June ... do you think we should do this sooner?  I have been reading through the pages on the ECIR site since Jan and more now. Very appreciative of the info here and the help to all. 
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


Kirsten Rasmussen
 

Hi Jen,

Early PPID is certainly a possibility.  Its possible that the reason Sparkles responded more slowly to dietary changes than your Morgan because the dietary changes don't treat the PPID so they don't really recover until the seasonal rise has ended and then you are dealing with the damage to the hooves, which can extend the recovery period even further.  But each equine is an individual and they don't all respond the same way, regardless.

The TRH stim test should be done outside of the seasonal rise.  The seasonal rise starts with the summer solstice, peaks with the fall equinox, then officially ends by the winter solstice, although the rise comes on slowly so effects on ACTH normally don't occur until August.  There is no reason not to do the TRH Stim test now or early this spring.  We do recommend retesting baseline ACTH (not TRH Stim) in late summer to see if ACTH is climbing too fast and medication dosages need to be increased to control ACTH through the fall rise.  Once diagnosed with PPID, these horses do best if ACTH is kept in the normal range throughout the seasonal rise, and normal for these horses is in the high teens to low 20s.

Another way to diagnose early PPID in horses with normal ACTH is to test baseline (not TRH Stim) ACTH at the peak of the rise; it will be abnormal then.  My horse had all the physical signs of PPID but normal ACTH, except at the peak of the seasonal rise.

It sounds like you are doing a lot to help your metabolichorses, and I love your track system, too.  If you can put up some additional electric strings lower down, or a physical barrier like 4" mesh livestock fencing, that should stop Sparkles from getting through the fence to eat.  I added a lower electric line 6" above the ground and a physical barrier when I noticed my horse was still able to get grass from under the bottom electric string, which was 12" above the ground.  They will do almost anything for that grass!

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


J
 

Thank you, Dr Kellon for your reply.

"Only about 50% of IR animals fit the overweight profile. I agree with doing a TRH stimulation."

We planned to do the TRH test in June as that is when our herd has their annual. Should the TRH be done sooner than that .... or are we headed into a "safer" period?

"High insulin causes vasoconstriction and cold on top of that only makes it worse. Cold can also make insulin readings erratic but it can't be the sole cause here. Gabapentin is used when nothing else is left but it doesn't seem to do much of anything. Try Laminox https://uckele.com/laminox-3lbs.html 1/2 scoop twice a day and use coupon code ECIR for 5% off."
Just looked at the Laminox ingredients. I see that there are some of ingredients used in the "mito cocktail" used in people. This is something I have been wondering about since I have been caring for these ponies. I will ask more about this another time. What percentage of horses w/ PPID and or IR respond well to Laminox? And is it ok if the horse is on something like Vermont Blend?

"I'm not aware of Anaplasmosis causing laminitis. All chronic illness comes with some IR but not to this degree. I'd repeat the testing to see what's going on. Maybe you were lucky and caught Lyme early."
Lyme test was repeated with the Metabolic panel in Dec and was the same ... a weak pos. I am from CT and have dealt with LD issues since the early 90s ... part of the "issues" were doctors (including infection disease from two different states) having varying opinions on tests and results and to treat or not treat. I don't know if a weak pos in a horse means anything or not. What are your thoughts on the fact Sparkles had significant improvement on Doxy ... enough so that she wanted to be back on the track with the herd but declined once the course of Doxy was done. I know Doxy has some anti-inflammatory properties ... but does it have that much? More effective than Bute ... or Banamine? Incidentally, I never thought bute was that effective ... I foolishly continued to give out of guilt and needing to do something. On days she was more uncomfortable I would give Banamine instead ... this seemed more helpful. I only tried this a handful of times though.

"It's because her heels are too high. The palmar angle - angle the coffin bone makes with the ground - should be no more than 5 degrees. Her toes should be backed up a bit too but don't disturb the sole in the front half of the foot."
Does it look like the toes were "disturbed" in the Feb pictures? We noticed heel was high after the rads and farrier trimmed more than she had been ... Sparkles was quite sore after this for about five days whereas previous trims Sparkles always felt better afterwards. Farrier is coming this afternoon.

You can put her out for as long as you like as long as she can't get any grass (winter or not).
RE putting her out. Boots or not boots? And speaking of boots, We had to try 3 different kinds before we found boots that fit her well which were the soft rides. We tried the clouds too. Both Clouds and SR came with wedged pads. Prior to that I was making pads including pads from Easycare which are not wedged. We wopted to continue making our own as we were not sure if the wedge would bother her. After realizing she is creating a wedge with pads I am wondering if she should be using the wedged pads that came with the Softrides as it might be more comfortable .... OR if we should continue using the flat pads as we can analyze how they are wearing?
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


Sherry Morse
 

Hi Jen,

Not Dr. Kellon but some quick answers for you:

1- TRH Stim - if you do it in early June you should get a good answer on whether you need to start pergolide or not.  Once we're past the solstice ACTH naturally starts creeping up but not to the extent that it will go up in the fall.  That just leaves you less time to try to get it down through medication prior to the full seasonal rise.

2 - Laminox should be fine to use with VT Blend.  Don't think there have ever been any studies on how effective it is but Dr. Kellon would know more on that.

3 - do you have actual numbers for Sparkle's "weak positive" test.  As you know, Lyme effects all horses differently - my gelding's titer was 9000 the first time I treated him and was 6000 to start the 2nd time.  He was definitely showing very subtle signs at 6000 but not as bad as the first time.  His ACTH was also elevated with the first round of Lyme but was normal after treatment.  

4 - if you feel the need to use a pain killer many of our members use Devil's Claw instead of NSAIDs (which both Bute and Banamine are).

5 - a full set of hoof pictures following the directions in the Wiki (https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help) would be helpful.  

6 - turnout in boots if that's what she needs to be comfortable.  She'll let you know what pads work for her and which ones don't.  She may prefer the flat pads to ones that have a set wedge to them and that's fine.




Lavinia Fiscaletti
 

Hi Jen,

If she is comfortable without boots, she can go bootless. If she isn't, then use boots.

She definitely shouldn't have wedge pads as those would make bony column rotation worse. The Cloud pads squish down into a flatter configuration, with material conforming to the contours of the bottom of the foot . The Soft Rides are not designed to conform but they have the elastomeric gel pads that provide a "springier" cushioning. If you use those, cut the frog support off and cut the pads so they are flat. Also, add aggressive bevels to the treads of any boots she wears at the toes and across the backs of the heels. You'll need to experiment with pads to see what makes her the most comfortable.

Really can't tell a lot from the pictures as there are no sole shots and no lateral that include the cannon bones. Please take and upload a full set of hoof photos per the Wiki description here:

https://ecir.groups.io/g/main/wiki/1472

Please leave them as individual photos rather than composites.

The fronts didn't need heel removed but the hinds definitely did. Making those changes, even when correctly done, could make her body a bit sore as it would change the way she was loading and carrying herself, causing her to use her self in ways she wasn't accustomed to - think of what happens when you start exercising.

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


Eleanor Kellon, VMD
 

Jen,

Did you do the Lyme Multiplex testing from Cornell? A positive is a positive - and there may even be infected individuals with a negative titer. It would be unusual for a horse to be diagnosed in the early stages so most are chronic infections and therefore likely incurable although a LOT more research is needed.  Doxy is not more antiinflammatory than phenylbutazone but endocrine related laminitis is not inflammatory anyway. If she was mine I'd be inclined to repeat the doxy to see what happens although her insulin is more than high enough to explain laminitis.

When heels are left high too long, the muscle-tendon unit begins to contract, making it uncomfortable to lower them. That's the only possible explanation for pain after lowering heels, plus the fact her frog and weight bearing/absorbing structures may be weak from the high heels. Gradually lowering them by taking a bit off every other day or so will make it easier.

She is wearing the pads that way because the high heels tip her weight onto the toe. That puts a lot of pressure on the solar blood supply and leads to bone loss.

Please post current hoof photos as described in the Wiki. Use flat pads. The high heel configuration is not good. If they need to come down some more, have some Sore No More or an Arnica cream like Arnica 35 on hand to rub into the muscles  and tendons on the back of the leg, from below the elbow to pastern.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lesley Fraser
 

Hi Jen

There are no tests yet that are sensitive enough to absolutely rule out Lyme Disease as a diagnosis (for humans or any other animals), so a negative result doesn't mean that Lyme infections are absent.  A test that shows a positive result of any kind isn’t something to ignore.  Lyme Disease can cause inflammation in the laminae, and I’d be repeating the doxy to try and eliminate infection from the picture.

Ticks can carry multiple infections, and you rarely get to find out the exact cocktail the one that attached itself was carrying. 

--
Lesley and over the bridge Omar,
11-2012,
Cambridge, UK

Omar - Case History


Eleanor Kellon, VMD
 


J
 

Thank you.
I think the LD test was from uConn. I will upload the results soon. Just looked at them again, Weak pos ELISA and Neg WB. Here is a copy/paste: Lyme ELISA Serum Weak POSITIVE @ 1:320, Lyme WESTERN BLOT Conf Serum Negative
I continue to wonder about the LD 1. because of how she responded to the Doxy, and 2 because I know how the LD bacteria can effect different things within the body ...I wonder if it has anything to do with the metabolic issues (I know she is a pony and at risk). I saw someone post yesterday something like they feel frustrated when they do not know what the next step is ... this is what I am feeling ... and I am also feeling I don't completely know the current steps or if they are adequate. I have read through lots of info and pages and have been doing tons of trial and error, but still feel as though I do not completely understand. How can she be on such a low sugar diet AND metformin and still no change in labs? Is this typical if PPID is in fact the underlying issue here?

Farrier was here today and said she thought her pulses felt pretty strong ... but says her gait look pretty good. 

Thank you re the heel. I do like the idea of taking off gradually. I slipped on ice hit my back then head on the concrete of barn and am working through a concussion and back injury so I dont think I myself can do this, but husband might be able to or the girl down the road who has been apprenticing with our farrier. Farrier is going to be away for 4 weeks.

One last thing re the hooves, since this pony has been with us, she has always had tall hooves. They are what farrier calls soup can feet. 

I will try to take and upload betters pictures by Monday. 
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


J
 

I just wanted to add, Sparkles really is feeling much better. She is eager to be back out with her herd. I think if someone did not know what she was going through, would look at her and think she was fine. It is me who is still uncomfortable ...
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


Eleanor Kellon, VMD
 
Edited

With the caveat that there's nothing typical about LD, I can tell you that the horses we have seen with LD laminitis did not have exceptionally high insulin and had pain way out of proportion to their insulin levels. Might be a  very different story if it's LD in horse that already has EMS but the response to doxy makes me think this issue is not only insulin related. That said, diet or diet and metformin don't work for every horse/pony.

The farrier apprentice sounds perfect! I hear you on the soup can feet. Ponies/minis do tend to grow this way if not trimmed properly.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001