Hi everyone 
Yesterday my miniature horse Teddy was diagnosed with laminitis. X-rays show rotation in both front hooves. He previously had laminitis at some stage but this was before I got him. I have had him for 4 years. They is also an air pocket between the wall of the hoof which the vet said would increase as it travels upwards separating from the lamini. I think that is wht the vet said.. Also appears to be another air pocket on the other hoof but not confirmed.
The vet has padded (not sure what it is called it is a moulding paste dentist use) both his front hooves. He is to stay in his stable for 2 weeks and is on Bute 2 x a day for 14 days and then reduced to 1 x day for 7 days. Also on omoguard 1 x daily while on Bute. 

I have (today) brought speedibeet and linseed to start him on the emergency diet. He is on teff hay at the moment which I soak for an hour and then drain for 10 minutes before feeding. He is on Carol laytons best guess at the moment as this is what i had been using,until I can get some hoofxtra.
I also have vitamin e to give him along with his salt requirements.

I am feeding him 7 times in a 24 hour period. The vet thinks he is around 125 kilos (overweight).  I worked out that 1.5% would be 1.8 kilos which works out to 260grams per feed. 

I also asked the vet to test for cushings and insulin resistance, these results could be back tomorrow (Friday) or Monday. 

We have put down a deep layer of wood shaving to give him as much comfort as we can.

I am trying to do everything possible to help him through this. The vet mentioned that this could take 12 months and that it is always possible for the hoof to penetrate the soul and this freaked me out. The vet has my farriers number so they can discuss the trims he will need. 

Thank you for taking the time to read this.
Cathy

Hi Cathy,

Your first post here triggers this welcome letter.  It contains lots of information on finding your way around the ECIR group as as well as managing Teddy’s metabolic issues.  It looks like you’ve already done some reading and gotten Teddy off to a good start.  I’ll make a few comments and let others add to them.  Don’t hesitate to ask questions when they arise.

You will receive information on setting up a Case History folder to contain documents such as pdf files as well as setting up a photo album to contain any photos or radiographs you’d like to share.  We, of course,  would like to see all of that as soon as possible to help guide you.  Twelve months is the time it takes a new hoof to grow out but he shouldn’t be uncomfortable for most of that if you maintain a proper diet for him as well as an appropriate trim.  Since he’s a mini, you won’t be riding him, which we discourage for a longer period of time to limit the weight on the horse’s feet.

We discourage the use of bute after the first few days as metabolic laminitis is not an inflammatory event and thus bute isn’t helpful.  It may help for the aches and pains which develop when trying to accommodate sore feet but Devil’s Claw might serve your needs better and not be so detrimental toward healing.  Using omeprazole while using bute has been recently found to cause undesirable changes in the hind gut so I would definitely avoid that combination.  I understand why the vet prescribed the two of them but I would definitely avoid that combination but weaning off bute.

All beet pulp needs to be soaked and rinsed as the processing results in the addition of unwanted iron.  When you soak hay, be sure to rinse it to remove the soaking water.  The drain time doesn’t matter as long as the hay doesn’t ferment in the heat.

Are you using a small holed hay bag to feed him?  If you want to feed him that often, that’s great, but I don’t think it should be necessary, as long as the amount of feed he gets is appropriate.  The 1.5% should be of his total feed, not just the hay.  Good that you ask for those blood tests.  Those are just what we need.  Depending on the results, you may want to add glucose to the next testing round.

And, I feel as though I should mention that black walnut shavings are dangerous.  I try to stick to pine but I don’t know about the various shavings products available to you.

And now for the welcome I promised!

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:

• 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.

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. 

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Hi Cathy, 

Welcome!  It would be helpful to see a Case History once you get your blood testing results.  You should see a reduction in pain within 36-72 hours of starting the Emergency Diet.  If you don't, it's likely the cause of the laminitis has not been removed.  If this is metabolic laminitis, which is most likely, hoof penetration of the sole is extremely rare so please don't let that keep you up at night. 

For weight loss, to start you should feed 1.5% of current weight, or 2% of ideal weight, whichever is higher.  Usually 2% of ideal weight is...  The aim is to reach a BCS of 4.5/9, where you can just barely see the ribs.

Please also join the Case History sub-Group, create a photo album, and upload your xrays. 
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help

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

Snickers' Case History
Snickers' Photo Album

Hi Kirsten

Today 5/11 Teddy isn't showing any signs of pain. The vet had him on 2 x day bute but yesterday I only gave him one dose. Today I haven't given him any bute and I will just monitor him to see how he goes. I have ordered some devils claw for him to have instead of bute. The vet also had him on omoguard once a day while on bute but after joining this site and reading information and from Martha's reply I have stopped giving him this.
I don't know how much his ideal weight is. The vet said she thought he was around 125 kilos, 275 pounds, but the weight tape has him at 158 kilos, 348 pounds. Today I started feeding him at the 158 kilo rate of 1.5% so he is having 2.3kilos over a 24 hour period. Should I be feeding at the 2% rate. I don't want him to be starving.

I have filled in as much of the case history form I can,  just having trouble working out how to upload. my husband is the techy and he will be home on Monday. by then I should have Teddys blood test results and cushings result. I will also get copies of his x ray images. I will also take body shots so my husband can upload on Monday.
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Cathy in NSW,  2022