Help please, recent and first laminitis


Laura
 
Edited

Hi wise members,


I have a 13 year old Lipi gelding who is experiencing his first (and hopefully last) laminitis.

I had thought I was doing everything right :(

Teddy has been off pasture since October of 2021. I have been balancing and testing my hay for at least 10 years. My current hay is less than 10% combined ESC & starch. teddy was first diagnosed as PPID in April of 2021 by a TRH stim test (post stim was 284, baseline ACTH was 17). My vet tested him because he has very frequent hoof abscesses (since he was 2 years old), and he has IBH. He was put on .5mg of Prqascend/pergolide at that time.  We retested his ACTH in September of 2021, and it was 59. His pergolide was increased to 1mg, but after 3weeks of inappetence, he was lowered back to .5mg.  I had difficulty finding a vet who would draw acth/insulin in my new home. I live in an equine "vet desert". Knowing that the seasonal rise was coming, I increased his pergolide to 1mg and finally had his  blood drawn for  drawn 3 weeks later on 8/12/2022. His ACTH was 43, and his insulin was 31.73. This blood draw was with hay and no "grain" meal. (he doesn't get grain, just his mineral balancing supplement in TC timothy balance cubes).

His workload has been variable due to my own health issues, and the weather. I did lunge him on 8/19/2022 and he was quite sound (and exuberant). On 8/20/2022 he experienced his first hind foot abscess (they have always been in the front feet). I applied an Animalintex poultice pad, and pus started to drain  the next morning. He looked much more comfortable. I continued with this routine, but noticed him becoming much more reluctant to move, this also happened on a day he got the hoof wrap/poultice pad off during the night. i assumed the abscess hole had closed up. I reapplied the wrap/dressing but he still was quite off. I then noticed he was stretching out, sore in front, and called my local small animal/equine vet on 8/25/2022. He confirmed that Teddy was quite sore, gave him 20cc IV banamine. I confined Teddy to a 12X12 stall with deep bedding. I started previcox the next day, and have been continuing since. I also increased his pergolide to 1.5mg. He looks much more comfortable, and back to normal in this deeply bedded stall. I did locate an equine vet who comes into this areq once a month, and they will be here to do xrays of his feet and examine him on the 31st.

My questions are: should I remain on this increased dose of 1.5mg of pergolide?  I panicked when I saw him sore in front :(
I'm hoping that taking the weight off his hind end had a lot to do with his front end soreness (not sure if I can call this laminitis??)
Should I keep him on the previcox ?

I am weighing his hay and he gets 17 pounds/day. He has started to refuse the TC timothy balance cubes, so I had just gotten some Stabul-1 in fenugreek flavor to mix his supplements in, and he loves it. I'll use about 3 cups per day for this.

This may be a bit disjointed and rambling, but I just can't believe it, I thought I was doing everything right.

Thanks

My
--
Laura in WI- 2022
https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Teddy


Sherry Morse
 

Hi Laura,

Without a case history we have more questions than answers.  Was Teddy trailered for testing last year?  13 is young for PPID, although it's not unheard of. It's more common for his breed to be IR as they're thrifty horses.  Regardless. if he is PPID you want to see his ACTH in the upper teens to low 20s year round.  59 in September or 49 in August is fine for a non-PPID horse but not one with PPID.  

An insulin of 31 is well below the level where laminitis results (that would be 80) although it's still abnormally high for a horse tested with just hay in front of them. 

Would you be able to post current trim pictures following the directions in the Wiki (https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help)

Be aware that NSAIDs will inhibit the clearing of abscesses and they will not work on metabolic laminitis as it's not an inflammatory condition.  They can be useful for the first week of soreness, but after that we recommend no longer using them. 

As Teddy's more comfortable on the increased dose of pergolide I would leave him on it until you can get his ACTH level checked again (ideally 3 weeks or longer on the new dose for an accurate reading).  If you have a local small animal vet who is willing to ship bloods for you and can draw them for you that might be another option instead of getting a horse vet out.

As a reminder we recommend horses should be fed no more than 2% of their ideal weight which includes hay and any concentrates.  Timothy Balance Cubes are fed at a 3:4 ratio to hay so Teddy's total intake should be less than what you would get for 2% if his diet was all hay.


 


Laura
 

Hi,

I did create a case file just before I wrote the email. I’m not the greatest computer guru, please can someone let me know if you see it?

I stopped the previcox today, after reading your advice Sherry  that it may delay the abscess, and not help endocrine laminitis.

Teddy was not trailered for the blood draws. I am able to draw his blood myself.

I will keep him on the 1.5mg of pergolide and retest in 3 weeks. 

My farrier is coming to roll his toes (he was just trimmed last Monday). I will post pics after that is done. 

Teddy is a typical “air fern “, his BCS is a 7.  He gets down to a 6 only when he’s working hard (6 hours a week).  His weight is 1525 last time I  was able to weigh him.

Thanks 

Laura 

--
Laura in WI- 2022
https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Teddy


Sherry Morse
 

Hi Laura,

You have an empty case history folder. If you have a file on your device you need to load it into the folder so we can see it. 

Photos of Teddy's body condition would also be useful.  A BCS of 7 usually implies a horse needs to lose at least 100lbs.  1575 would be closer to 275lbs or more to get down to what's usually an ideal weight for a Lipizzaner.





Eleanor Kellon, VMD
 

Laura,

You haven't done anything wrong, but something can still go wrong.  The timing of this is typical for seasonal ACTH rise, which may mean his pergolide dose was too low. It's difficult to manage a horse that is only positive by TRH stimulation. However, horses with EMS can also react to the seasonal rise with abscesses or laminitis. Another possibility here is that while your hay is below 10%, it's not low enough. That, or your hay is not homogeneous and your sampling was not truly representative.

How are you balancing your diet? I know you are a NRC Plus grad but what is your Fe:Cu ratio? Have you ever tested his iron status?

I agree with stopping Previcox - and starting hay soaking.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Laura
 

Thank you Dr Kellon and Sherry for your responses.

I will get body condition photos taken ASAP. Teddy is quite tall for a Lipizzan (16.2), but as you say, it is a very thrifty breed. He is for sure a typical EMS horse. A 100 pound weight loss would go a long way, but exercise is the only way I've been able to do this in the past. I have had a vet suggest thyroid supplementation to jump start weight loss, but we didn't start it. His thyroid labs were normal (and as I understand most horses are not hypothyroid?). Would thyroid supplementation  be something that you suggest ?

Dr. Kellon I'm not sure that I understand what acth to aim for in a horse that was diagnosed by TRH stim during the seasonal rise? I will have his blood done 3 weeks from the increase to 1.5mg.

I did use a hay probe to sample my hay. This batch of hay is very "dirty". I can see soil bits, and the water runs off very dark when I soak it. The iron level in my recent hay analysis was quite high (380ppm). I was using a 4:1 ratio of iron to copper in my previous calculations/supplement. I was considering resampling, rinsing or soaking, and resubmitting a sample. Either that, or asking Equi Analytical if they would consider rinsing the sample and reanalyzing it for me.

When the equine vet comes on the 31st, I will ask them to draw labs for iron. Am I correct in asking  for a ferritin and transferrin level??

I did put a halter on Teddy today and let him out of his padded stall. He walked quite sound in the paddock. I am hopeful that I nipped something in the bud. I put him back, and redressed his hind abscess (Animalintex etc). Should I wait until he has xrays on the 31st to let him walk around? He has been off previcox for 2 days. I assumed that if his feet were still sore, he would not voluntarily move around?

I tried to upload my case history file, and think I have done it correctly now.
--
Laura in WI- 2022
https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Teddy


Eleanor Kellon, VMD
 

You're doing fine here Laura! Relax.

Try feeding him 1.5% of his ideal body weight. I'm not a big fan of inducing abnormalities (hyperthyroidism!). Metabolisms vary but weight loss is still a matter of calories in versus calories out.

ACTH under 50 is not good enough. You want his seasonal ACTH in the lower 20s. Also important to realize that ACTH is not the only hormone that can cause insulin resistance but it's the only one that we're set up to test.

The iron testing has to go to KSU and sample handling is very specific - just like for ACTH https://www.ksvdl.org/laboratories/comparative-hematology/ . Your vet needs to read all that information and links. You need serum iron, transferrin and ferritin.

Animalintex is not a poultice. It does not "draw" like clay poultices do. What it does do it keep the tissues moist so that can help but not like a true poultice.

For the hay and balancing, go with whatever way you normally feed - dry, soaked, etc. If you are soaking, dry your sample before mailing.

As long as he is off pain relievers, you can turn him out.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."