New member - unusual case / emergency
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Emma & Tater
Hi all,
My beloved gelding is currently in the midst of his second laminitis attack in two months. While this is unfortunately not my first experience with founder, it is the first time I have dealt with it with a horse of my own (he is my first) and the first time I have dealt with it as an adult (last saw it in a cushings pony when I was 14).
My 8 year old andalusian x warmblood gelding showed absolutely no signs of IR, cushings, or laminitis for the entire 1.5 years I’ve owned him until 8/20/2022, when he came up dead lame on his right front. It had been a very wet week and he lives outside in a run, so I assumed abscess and treated as such until my vet came out to take x rays at my urging. To both of our complete shock, he had foundered on his right front with 4-5 degrees of rotation. Left front was perfect. His x rays from a year ago, taken for record keeping purposes only, were excellent other than thin soles. Prognosis was excellent. I replaced about 1 cup Purina Edge with triple crown senior gold so he would keep eating his supplements (absorbine flex max which he’s been on for a year) and added Mad Barn Omneity to build a better hoof. Did not remove alfalfa as vet was certain it was not metabolic, metabolic panel results supported this, and horse is prone to ulcers. Farrier trimmed to relieve poor angles, left shoes on. Horse was comfortable at the walk and returned to tack walking. X rays on 10/4 showed that gas pocket from founder was resolving and angles had improved, though soles were still thin.
All was well until horse turned up tender again on 10/19/22. Very sore on right front. Vet came out that day and said no founder on R front. Farrier came out next day, trimmed (horse was at 8 weeks despite nagging), and added full rubber pads in front. Horse seemed to be more uncomfortable and did not improve. Farrier came out Sunday and put horse back in rim pads. Horse’s mobility was down to a few steps. Farrier said horse was tender all around and that it was just the result of thin soles. Started horse on bute.
Vet finally came out again Tuesday 10/25, took x rays, confirmed horse is now foundered on BOTH fronts - still with minor rotation (5 degrees or less). Soles are paper thin. Farrier pulled fronts, horse is in cloud boots with pads - and still miserable. Vet stopped bute and started horse on previcox and recommended soaking in ice water as much as possible (“until you regret buying a horse”), hand walking when horse is semi mobile (he’s currently BARELY moving around, though he is taking enough steps to get into and out of his shed and lying down at night), and Bemer sessions (I can borrow one from a friend).
Now, my questions are: What in the heck is causing my horse to founder in one hoof only and then two months later, in both hooves?!
I am treating him as metabolic at vet’s recommendation - no supplements, no alfalfa- EXCEPT our hay situation is bad and the “hay” we have still has alfalfa mixed in. Should I try to buy some bales for him only? What do I even get? There may not be bales available so what are my options? Bagged forage?
Are heart bars really as bad as all that? The pads he was in seemed to make his feet hurt worse so I opted to leave him barefoot for now. He has been barefoot in the past - do I look for a barefoot trimmer? Anyone have recommendations in Colorado???
Other details: His feet were sturdy but very poorly trimmed when I got him - super underrun heels - so he has been shod all around for about a year, with rim pads on the fronts for a few months because of some bruising from earlier in the year. He has been sound as the day is long until all this happened. I have been putting fresh shavings in his run daily for him to lie in which does seem to help.
Any kind advice is welcome. Please be gentle, I am feeling terrible about this whole situation and just want my sweet boy to feel better ASAP. |
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Emma & Tater
I apologize if I am missing info or links - I am on my phone so am having trouble navigating. I will make everything more compliant when I get home this evening. I have uploaded the x-rays I have from 9/9 and 10/4 to the case file group, but do not have his x rays from yesterday yet. I also do not have his exact test result numbers but have sent another email to my vet requesting them.
-- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado |
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Trisha DePietro
Hi Emma. I am so sorry you find yourself here, but you are in the right place to help you sort out what's happening with Tater. Your first post signals me to send you a welcome letter. The information that follows will provide you with alot of information and some of that information may be new to you. I think you are very wise to treat your horse as if he is metabolic while you sort out whats happening to him.
1. Focus on the Emergency diet- the directions are in the information in the welcome letter. 2. As you are gathering the test results and putting your Case History together you can read further about diagnosis and trim. 3. Take a deep breath- we will help you figure out what's happening to Tater. 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 etiquette, what 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:
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. EXERCISE: The 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. Trisha DePietro Aug 2018 NH Dolly and Hope's Case Histories Dolly's Photos Hope's Photos Primary Responder |
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celestinefarm
Hi Emma,
Andalusians are also poster children for IR and many warmbloods are also. As your welcome letter answers some of the questions you asked, I would add to those answers the following. Timothy Balance Hay cubes are the only bagged forage available that is guaranteed to be below 10% sugar and starch and can substitute as a complete diet along with supplementing with salt, Vit E in the short term until you either can obtain safer hay or decide to go with the balance cubes. Triple Crown dealers can get them for you , they will be listed as TC Naturals balance cubes. Otherwise, they are called Ontario Dehy Timothy Balance Cubes and come if 50# bags. You can feed them dry, although I would recommend soaking them to your horse's liking. IMO, your horse did not founder in one hoof, then subsequently in the other. He became noticeably symptomatic in the hoof with poorer hoof form first, then finally the other hoof became symptomatic after it's better form could no longer resist the loss of laminar attachment due to the metabolic issues. ( laminitis and founder are overwhelmingly caused by metabolic issues of higher than normal insulin. ) HIs hind feet are also affected, but the hinds usually can handle more than the front feet since they are less weighted by the horse than the front and often don't show as much tenderness. Just in case you are unaware, Previcox is a NSAID, just like bute. We have had many people here shocked to learn that, as it seems it is something the vet's don't explain well. Getting a case history posted with your testing results, etc. will help the mods here give you more advice and direction. Let us know what your hay situation remains or whether you can find ODTB cubes, as someone will likely be from your area and can help source feedstuffs for you. -- Dawn Wagstaff and Tipperary Saline, MI 2003 Tipperary Case History |
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Emma & Tater
Thank you so much for your response, Dawn! I am going to look for cubes today. In my research on previcox, I did learn that it is an NSAID. Did you mention this because it is not preferred for laminitis? I saw something to that effect when I skimmed the basic info but have not fully digested the FAQ’s yet. -- |
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celestinefarm
Emma, Saline, MI 2003 Tipperary Case History |
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Welcome, Emma!
Not meaning to overwhelm you with too much information but you mentioned his thin soles. I would not be soaking his feet if his soles are very thin. As we can’t see the radiographs yet, our thoughts might well change. If it’s an abscess, it would be better to poultice the foot with Numotizine, rather than soaking. -- 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 |
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valerie puryear
Just a note of encouragement,Emma. If you follow the guideline here and stick with the emergency diet, you will see positve changes. It's a lot of work and worry, but we all know our horses are worth it! My vet says I went "hard core" on laminitis and managing diet, etc. but everything I have learned here not only worked, but has kept my horse sound and in work for 4 years! Take a deep breath and go for it! It can be done!
-- Valerie and Matera Aug 2018 Athens, GA, USA Case History Photo Album Ω |
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First of all, thank you all for your responses. I am overwhelmed (positively!) by your support.
A couple updates: I have uploaded a case history and hoof x-rays from 9/6/2022 (first episode) and 10/4/2022 (check-up) for you to review. I have not received the x-rays from 10/25/22 (second episode) from my vet but will post as soon as I have them. Also, I don't know if I shared this, but my farrier pulled his shoes and he is in cloud boots, which I think are softening his heel bulbs badly so I don't know what to do about that :( BUT the most important update, other than improving his diet: I reached out to Steve Foxworth, a well-known farrier in Colorado, to ask if he had recommendations for a laminitis founder assuming he would not be able to take me on. Well - he is hopefully coming out to see Tater TODAY, before he leaves for Nepal to trim elephants in the jungle for two weeks. He also knows and likes my vet, and my vet LOVES him. The roller coaster ride is at least throwing in some good loops... Martha - I don't know how to tag members but I took your advice to heart and did not soak him yesterday. Instead I put ice boots on his hooves for a while. I also was able to borrow a friend's Bemer blanket and boots at the recommendation of my vet, which he seemed to really enjoy - lots of licking and chewing in the short 10-15 minute session. Valerie - thank you for the note of encouragement. It is really challenging right now, especially since we really thought the first episode was mechanical in nature and everyone is shocked that it happened once - let alone TWICE. Dawn - wholeheartedly agree on needing to receive numbers, it's just not my vet's style... of course. I have been asking for them constantly since he first received the results but he hasn't sent them yet. I will keep uploading information as I have time. Currently trying to not get fired from my 9-5 while also making sure my baby is as comfortable as possible. -- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado Photo Album Case History |
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Some good things happening, Emma, well done. I hear you on the 9 to 5! Can I just add that it is really important to get those numbers from your vet as otherwise you don’t have a firm diagnosis plus you need a baseline to measure any future changes against. Sometimes I call the vets office and ask the receptionist to send me the results by email, or even read them out on the phone. Usually the lab emails results to the vet, so it should be the work of two seconds to forward that email to you.
-- Maxine and Indy (PPID) and Dangles (PPID) Canberra, Australia 2010 https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles
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Emma & Tater
Hi Maxine - yes I agree! Unfortunately he does not have a receptionist 🤦🏻♀️ Only an answering service. I’ll keep pestering him and ask for the lab name.
-- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado Photo Album Case History |
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Emma & Tater
Latest x-rays from 10/25/22 have been added to photo album.
-- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado Photo Album Case History |
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Thanks for adding the x-rays, Emma. I’m definitely not the radiograph expert here but what I see are thin soles, more so on the right than the left. Do you know what the vet measured when the rotation was calculated? He looks, as well as being a gorgeous horse, as though he could use a little more heel on the left foot and more sole all around, both trimming issues. Lavinia is our expert here and I would wait for her input before making decisions based on mine. 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 |
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Emma & Tater
Still working on labs - but some promising news today. My sweet boy finally got some real relief. First, the emergency diet is starting to work. There is far less heat in his hooves than before - I can’t remember if farrier said none or almost none. Second, we are now under the care of possibly the best farrier in the state. We discussed a thorough plan for rehabbing Tater’s feet but started with plain old styrofoam pads and the relief was instant. Tater is moving better than he has in a week. Numerous big releases - yawning, licking, chewing, even wet-dog shaking. I know we still need to nail down a cause but at least I can get some sleep tonight knowing that Tater isn’t in constant pain.
-- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado Photo Album Case History |
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Thanks Emma for the report. Immediate relief is not uncommon.
If you'd like to meet Dr Kellon and have her explain exactly this phenomenon, watch the ECIR group film on Diet and Drugs. https://www.ecirhorse.org/video.php There is also one on Diagnosis and one on who ECIR is. It is worth time invested just to meet Dr K. Thanks for making my night. -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2021-2022 HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993 |
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Great news Emma, good job! You're on the right track, hang in there. We've all been in your shoes. So glad Tater is starting to feel better, awesomeness!!!!
Joy -- Joy and Willie (EC/IR) Nevada County, CA - 2019 Case history: Willie's Case History Willie's photo album: Willie's Photos |
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Emma & Tater
All-
thoughts on soaking hay in cold weather? My BO says it will not work for him in his run because it will freeze overnight (temps are getting down to 35 F and there is frost on the ground) but it seems to be helping my guy and he ate it this morning in those temps after soaking the night before. Is it worth pushing back on BO? I did buy some timothy cubes and can switch to those (but I suspect I will meet resistance there with BO as well because that is extra work for staff). Also interested in what you all think of Tater’s current weight based on pictures in his album. -- Emma + Tater, no diagnosis yet joined 10/26/22 Colorado Photo Album Case History |
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Sherry Morse
Hi Emma, Many of our members live further north than you do and they soak their hay. You can soak hay for the day all at once if needed, particularly if it's cold it won't go bad before being fed. Based on your pictures Tater needs to lose at least 50lbs to be not so chubby. By the numbers if you think he's a 6 now he would need to lose closer to 100lbs or so but you'll have to use your judgement as you go on that.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Hi Emma,
Lots of us have had to soak hay in winter. My horses like the icicle hay. In fact I think it's a treat for them because there is a bit of a grass aroma to it. -- Lorna in Eastern Ontario 2002 |
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Bobbie Day
Emma, I live next door in Utah and I spent many years soaking hay. To our Canadian friends our temps are probably mild. I would soak and drain enough for two feedings then bring it into my garage where it would stay cold but not freeze. When it was warmer I’d leave a hay net hanging from my tree so it would drain well. By morning it was great. You could also use a hay bag and bring it inside after you’ve soaked it, just put something under it to catch the drips. I also did it in my bathtub more than once. It’s doable sometimes you just have to get creative. You can’t really appreciate everything you get out of your hay until you’ve soaked the sugar from it.
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