Buddy feet are getting more sore daily
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Its very easy for underrun heels to happen, and much harder to correct. Its a constant battle with my own horse. If a farrier only trims to the whiteline and never into it (some don't even trim to the white line), then most horses will develop underrun heels. Listen to Dr Bowker's podcast "Long Toe Woes" on the Humble Hoof if you get a chance. He says he trims into the whiteline EVERY trim.
Those pictures help a lot, thank you. See how the angle of the hoof wall near the coronet is steeper near the top than it is for most of the hoof? On your photo, project that steeper line to the ground and that will show you where his toes should ideally be. However, his heels are very underrun and I would not necessarily shorten them that far back on the first trim because that will leave him with very little hoof to stand on. We also don't know what it looks like internally and how much coffin bone sinking he has, which can change how we would normally trim. Going half the distance with the toes is reasonable for now, but the full distance would be your target over the next few months. Moving the toes back helps the heels to move back, too, and as they become less underrun the toe can come back farther, and so on. It doesn't happen overnight but you can see progress every month, especially if you buy a rasp and do a little shortening of the toes every week just to maintain what your farrier has done. The heels might also need some specific rasp swipes to help the process, but that's where requesting markups would come in and I would wait until you have new radiographs for that. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Kaylee Woodmansee, MI, 2022
Hello Kirsten and Martha, I have added two more front Lateral-A pictures to Buddys album. Please let me know if they aren’t quality enough and I’ll get some more (I was racing the setting sun). I have been feeling like his heels are under run for quite some time. My farrier went through the Michigan State Farrier program a few years ago and is always looking to learn, so I am really hoping he will be willing to work with me and the recommendations from this group. Our next trim is scheduled for 17Mar23. I will get on the schedule for some updated X-rays and I need to talk to Buddy’s vet about another option besides his recommended InsulinWise to get his insulin down. Kaylee Woodmansee, Dowling Michigan, 2022 https://ecir.groups.io/g/CaseHistory/files/KayleeWoodmansee%20and%20Buddy https://ecir.groups.io/g/CaseHistory/album?id=283978
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Thanks, Kaylee.
I see what you mean that your farrier tries to keep the toes back. The hinds look reasonably good, but despite your farrier's efforts neither of the fronts are in good shape and he shouldn't be ridden until they improve. Toes are too long, heels underrun (esp LF), and likely his soles are thin and he has broken-back HPAs (need xrays to confirm the last 2), all of which can be painful for movement because of the stress on soft tissues at the back of the hoof. His LF looks to be the worst, actually, but that doesn't always mean they favor that hoof more. Your beautiful clean sole photos clearly show the sole, which grows forward on the hoof, is growing over or "smearing over" the whiteline at the toe. The sole should not look ovoid when the hoof walls look round. This means trimming back to where the sole is at the toe is not going to bring the toes back far enough, you need to trim horizontally back into the sole, too. Can you try trimming the hair as short as possible above the coronet on both fronts, just at the dorsal wall, and redo the 2 lateral photos? It appears to me there is a big difference in the angle of the hoof angle under that hair, and seeing it better will help determine how far back the toes should actually come. You can step back a bit and get the whole cannon bone in the photo. I agree with Martha that it's time for new radiographs, if its possible. Laterals of all 4 hooves are the most important views to get, but especially the 2 fronts. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Hi Kaylee,
The only X-rays I found in your album were taken several years ago. Looking at the recent photos of Buddy’s feet, I would suggest getting more radiographs and posting those so we can help guide the trim. The fact that the farrier keeps his toes pulled back makes me think radiographs might help. -- 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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Kaylee Woodmansee, MI, 2022
Thank you for the supporting study information on the InsulinWise product! I have uploaded past X-rays and current body and hoof pictures for Buddy on his Case history. I added the link below in my signature so you shouldn’t have any trouble finding them. Let me know if there seems to be an issue. My farrier doesn't take anything off his soles and keeps his toe pulled back. Buddy’s RF has been tender/sore since spring 2022
https://ecir.groups.io/g/CaseHistory/album?id=283978
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FYI: https://ecir.groups.io/g/main/files/Insulinwise/Review%20of%20InsulinWise%20Study.pdf
You can read the original study here: https://pubmed.ncbi.nlm.nih.gov/32303322/ When they say something was "significantly less/more", they mean statistically significant, not actually a big drop/increase in the marker. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Hi Kaylee, I'm glad Buddy is feeling a bit better.
Insulinwise's own research shows that only about 2/3 of horses responded and their insulin went down only a few points. Like from 65 to 55 uIU/ml. That's just not enough to justify the expense. It might help, a little bit, but there are more effective options. Metformin, for example, when it works (it also does not work for all horses) has much more dramatic reductions. Soaking hay also really makes a difference. If insulin is still 93 uIU/ml on soaked hay, then adding Metformin should help: 30 mg/kg, 2x a day. You increased pergolide AND started soaking hay on Nov 28? I can pretty much guarantee he started feeling better because of the hay soaking bringing his insulin down. If it's only his right front that is sore, you probably have a trim issue or unresolved abscesses. Getting hoof pictures up and any xrays you have is a good next step. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Sherry Morse
Hi Kaylee, I would respectfully suggest you may want to see if you can find another vet to work with who is a bit more up to date on the current medications for insulin reduction (Metformin being the main one of those) or perhaps you can ask for references on this research as it goes against even the Tufts group which most vets do follow. ECEIM consensus statement on equine metabolic syndrome - PMC (nih.gov) (Just as an FYI - the poor bioavailability in horses was first noted in 2009 and the link above is from 2019 so it's not like this is a new development). Insulinwise has a money back guarantee - that's the best thing we can say about it. They do a VERY good job marketing their product to vets, but that doesn't mean it's any good. Without seeing pictures I would not recommend trying to do any exercise with Buddy beyond what he's comfortable doing on his own until you get his trim addressed and his insulin in a better place.
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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Kaylee Woodmansee, MI, 2022
Thank you all for your previous help! I added Buddy’s current blood work results to his Case file. His ACTH (17.8) seems to be ok but his insulin levels (93.97) are high. I had asked my vet about getting him on Metformin and he disagreed and gave me a recommendation for a product called InsulinWise. (Buddy has been on Metformin in 2018 by a different vet and it worked). I see there is some talk within the ECIR group on this InsulinWise product, and it does not seem to be very promising. The vet currently working with Buddy said that “Metformin usage is going down with more research. It is not absorbed well by horses, unlike other mammals. So I haven’t used it much lately”.
Buddy was on 1mg of Pergolide and I increased him to 1.5 mg on 28Nov22. Within 7 days his foot soreness was improving.
I have been soaking his hay since 28Nov22. He only gets a single tiny nibble (you can count the pellets) of triple crown lite with his Pergolide and that’s it. No other grains or supplements other than a selenium salt block.
Buddy is currently not sound enough for work. It makes his right front foot sore if he does to much. How else can I get his insulin levels down (if this is causing his foot tenderness)? I tested the same field of hay last year and it was not out of range. I started soaking it on 28Nov22 just because I had nothing to loose by doing it.
Getting feet and body pictures added to his case history is on my ‘todo’ list.
Kaylee Woodmansee, Dowling Michigan, 2022 https://ecir.groups.io/g/CaseHistory/files/KayleeWoodmansee%20and%20Buddy |
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Thanks for doing that Kaylee.
Although you don't have a PPID diagnosis, it sounds like that might be a factor in addition to Buddy likely having EMS. To get a PPID diagnosis you have to take him off the Prascend and do a TRH Stimulation test in the spring. I'd leave him on Prascend until 3 weeks before the test. You could try increasing it to 2 Prascend but we don't know if it's actually what he needs. Bloodwork for ACTH at the peak of the fall rise (late Sep) would help to determine that, as we now know how high it can go at the peak before it's considered abnormal. It would be helpful to know his current insulin and glucose numbers, but if he's in pain insulin is likely high and needs to come down. You can: - start soaking his hay - add Metformin again (30 mg/kg BID) - remove the TC Lite as its not guaranteed to be <10% ESC+starch. If pain is correlated to weather turning cold, warm him up with a blanket, boots and wool socks/leggings. We strongly recommend having your hay tested (603 Trainer package at Equi-Analytical is ideal) and supplementing him for what he actually needs. Once you have your hay results we have several people trained to calculate what will work best for that hay for a fee. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Kaylee Woodmansee, MI, 2022
Hi Cass,
Thank you for the help. I was able to upload his CH as a PDF document. -- Kaylee Woodmansee, Dowling Michigan, 2022 https://ecir.groups.io/g/CaseHistory/files/KayleeWoodmansee%20and%20Buddy |
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Hi, Kaylee.
Thanks for doing your case history. We need you to upload the document in the universal PDF format so that everyone, not just Apple users, can read it. Open your copy of the CH in Pages.app. If you're using a Mac computer, in the File menu, select Export To...Select PDF. After you upload the PDF, please delete the Pages.app version. If you're using an iPad or iPhone, open the CH and tap the More symbol (3 dots) and choose Export. Select PDF. More details from the Apple support article, which I found quickly using a google search. https://support.apple.com/en-us/HT202227 -- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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Bobbie Day
Kaylee, we want to officially welcome you to the group, your first email signals a welcome message which will include a lot of valuable information to help you manage Buddy.
So, please read it over at your earliest convenience, we're here to help you so take a breath. There are also blue hyperlinks, if you click on those it will give you even more information on the subject. I can't seem to open your file again so I will leave it to the other mods to give you advice on your situation, we have a wonderful team, so I am sure you'll be hearing from everyone soon. I do want to point out that the group's focus is based on the DDT/T philosophy. Which stands for Diagnosis, Diet, Trim, and Exercise. But we only recommend the latter IF the horse is comfortable, NEVER force movement for a horse that is experiencing pain. Hopefully, you have the diagnosis in your CH, and when you are able, please provide any x-rays, pictures, etc. Again, welcome and let us know if you need any additional help. Hello Welcome to the group! The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time. Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck. Orienting information, such as how the different ECIR sections relate to each other, message 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. Utah, Nov 2018 ECIR Group Primary Response https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie https://ecir.groups.io/g/CaseHistory/album?id=271156 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi https://ecir.groups.io/g/CaseHistory/album?id=78821 |
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Kaylee,
You uploaded a .pages file, so Apple users can open it but not the rest of us. Can you reload the CH as a pdf please? -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Bobbie Day
I can open it Kaylee.
-- Bobbie and Maggie Desi (over the rainbow bridge 7/21) Utah, Nov 2018 ECIR Group Primary Response https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie https://ecir.groups.io/g/CaseHistory/album?id=271156 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi https://ecir.groups.io/g/CaseHistory/album?id=78821 |
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I can't see it on my android PC, if that says anything.
-- Lorna in Eastern Ontario 2002 |
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Kaylee Woodmansee, MI, 2022
I believe I have added the link to my case history folder. Is it not saved as a PDF? I uploaded it from my IPhone and it was saved prior as a pdf. Thanks! -- |
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Sherry Morse
Please add the link to your Case History folder to your signature: https://ecir.groups.io/g/CaseHistory/files/KayleeWoodmansee%20and%20Buddy and it would be helpful if you could save the file as a PDF so all of us can look at it. Do you have current bloodwork? What is Buddy's current weight? What is his ideal weight? The odds are he is IR and not well controlled if you keep having laminitis episodes. Uploading current hoof photos and x-rays would be helpful as well.
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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Kaylee Woodmansee, MI, 2022
Hello, Please help me help him. -- |
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