Quest seemed better today and the vet said I could leave her stable door open and let her walk around if she wants. 

I put her cloud boots on front - when I've tried these in the stable the other week (when she was in agony) she hated them. I just put her normal flex boots (with soft pads) on back. 

She walked out fine but then just obsessed about trying to get to the hay stored in the empty stable (there was some in her actual stable) and while calm, she seemed a little stressed to me. She went in and out of her stable a few times, pausing and sniffing the concrete before stepping on it. 

I videoed her walking and have uploaded to YouTube - links below. Does she look okay to be walking around? If so, how often/how long should I let her out? The yard is secure and I can sit with her. 

I can't get her trimmed until the 2nd and will have the trimmer check the boot fitting. 


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Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Great, the others aren't terribly friendly but she'll stay out of their space when they ask. I'm hoping the ones who might groom with her will do that, but she didn't go see them today. It does make me think that maybe it hurt to go too far? 

She gestured to her hooves and shifted weight a bit afterwards which made me worry it did hurt her. I only realised afterwards she'd had bute in the morning (10 hours before) and I shouldn't let her walk if bute masks pain. 

I'm going to try no bute tomorrow morning. I know that's what you advise, and others whose judgement I also trust say the same. Its difficult when that runs counter to the vet though. And seeing her in agony, it's hard to not give her anything to relieve it. But she's not on as much pain now, she's been on too much bute for too long, and her gut is going to be a real mess. 

The vet doesn't want to start ertugliflozin until she's off bute but she doesn't want me to stop the bute yet. But I need to get the insulin down. 
--
Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Hi, Carly.
Glad to see Quest is a bit better. Free movement is fine but IMO the paved yard is not ideal footing for a footsore horse except for very short periods, not much longer than your videos, with free access to return to her stall. Cloud boots provide cushion, but they aren't likely to remove the pain of laminitis by themselves. Proper trim and mechanics (most frequently sole depth and better breakover) are also essential to pain reduction. Her movement is guarded, and she's favoring the LF. Is there an arena close to the yard, a place with softer footing where she can wander and roll?  I'm not suggesting you lead her any distance more than a few yards.

Check that the boots aren't rubbing her heels. You will see shiny areas where the boots rub before you see an actually wound. While the boots may "fit" according to the size of her hoof, because her toes are long, boots can still rub her heels. 

Pain is stressful, so I'm not surprised she looks a little stressed. If she likes to be groomed, frequent grooming while standing in deep shavings might bring her some comfort and distraction. She looks well-groomed already, so I suspect you're doing that.

Part of this rehabilitation process is waiting for the horse to heal itself. Focus on removing any inappropriate feeds that increase insulin, on the right mineral balanced diet, on Jiaogulan for vasodilation pain control, and on the proper trim. If you take hoof pictures taken to go along with the radiographs, you can request hoof mark-ups to show your trimmer. Details are in the Wiki.
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help
If you'd like to see what these look like, here's one example: https://ecir.groups.io/g/main/message/285302

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Hi Carly,
I just want to make sure that you know bute should be tapered off, especially since she’s been on it awhile.  Does a sachet contain a gram?  If so, she’s getting 2 grams daily?  I would cut her back to 1 gram for a few days and then give her 1g every other day for 3-4 days.  The idea is to stretch out the doses and decrease them alternately.  Here’s a another example of a taper which is slightly different.
--

Hi Martha,

Thanks for this - I wasn't sure how best to do it. She's been on two sachets (2g) twice a day, so 4g in total. This evening I just gave her 1g. Should I maybe have given 1.5? Or if I give another 1g in the morning (5am) that'd be 4g over 36 hours ..  then
Day 1-3 1.5 at 5pm, 1.5 at 5am, 1 at 5pm over 3 days (ie 4g over 36 hrs)

Day 4-6 1g twice a day for 3 days (4g every 48hrs)

Day 7 .75g twice a day (3g every 48 hrs)

Day 8 1g once a day (2g every 48 hours)
Day 9 .5g 

(The example is a little confusing as days 7 and 8 are 'every 48 hours' but just one day).

I don't know if that makes sense, it seems complicated ... 


An alternative is to give 1.5 in am, 1 at night for two days, then 1g am and pm for two days,  then 1g once a day? That's more abrupt though ...


--
Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Thank you Cass. Her RF has been the sorest/most heat, strongest pulse.  

Maybe should I wait until the trim next week? 

She chose not to move much after that video. About the length of the yard again there is a very soft sand school, but a rocky driveway in between. I feel its too far at the moment, but I'm hoping that's where she'll be able to spend time when she's better. Unfortunately I can't give hay in there though so can't use it for longer turnout.

I haven't groomed her with a brush as she doesn't like that at the moment but I do spend a lot of time scratching her, with her trying to tell me where to scratch. She uses her head to move me into the right position then I watch until I hit the right spot. I do it until my arms and fingers get too tired! It's the only thing I can do to bring her any joy at the moment which breaks my heart. I do just sit with her in her stable a lot. I just wish I was a horse, for her sake! 

I'll try to get hoof pictures tomorrow.  It's tricky as her bed is so deep her hooves are covered in shavings. 

On the phone today the vet said I'd have to put shoes or glue ons on her. I know I don't have to, but my vet is very anti barefoot. She keeps telling me to call my old farrier who is an excellent remedial farrier. He actually insisted on her being barefoot after another vet tried to tell me to shoe her. My problem with him was that he kept not turning up - three times he just didn't show, and then he'd not call or message. So I have an equine podiatrist now and she's great, Quest has been much more comfortable with her trims and she's really helping improve her hooves. I am just not sure how to handle the vet persisting with the idea that shoes are best ... 
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Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Thanks Sherry - thats what I was using as the basis for my suggested timeline.  She's currently on 4g a day and I was trying to figure out how it would work with am and pm feeds. However, I guess technically I should taper for twice as long - ie by day 8 I get to 2g and then I follow the timeline as set out - but that would be 16 days? And I can't start jiaogulan or ertugliflozin until she's off it all ... 

That example confuses me though as it has dosages over 48 hours that are only for 1 day? 
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Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Carly, most of us dealing with laminitis have received advice that didn’t help. Maybe my experience will illustrate the disadvantages of glue-on boots or shoes. Results were mixed.

My mare had thin soles and sinking in front and some rotation in one fore — with intractable pain. I could not make her comfortable in removable boots which she  grabbed with her teeth and turned sideways. I tried 6 different hoof pads and two boot sizes. I was desperate, reduced to duct tape Emergency boots over 3/8 inch thick industrial felt pads that had poor traction.

My trimmer/farrier applied glue-on boots in front, the Easyboot LoveChild Glue-on with pour-in pads. They solved the day to day problem of cushioning the soles and allowed her to walk with only occasional missteps. They also caused a new set of issues. Our trim interval was 4 weeks - how often my trimmer comes to this part of California. The front hooves grew like weeds without abrasion to wear the toes, soles or hoof walls. When the boots came off, we were confronted with the same trim problems we’d addressed two months earlier with a realigning trim— long toes run far forward, which shifted the weight of the heels far forward too. The glue-on boots, despite the use of antibacterial packing, harbored thrush. When the boots were removed, the quality of the new, deeper sole  was less than ideal, crumbly and powdery. One hoof exfoliated most of that new sole.

We pulled them after two trim cycles and resumed barefoot care every 4 weeks. By this time, she didn’t need boots for comfort to freely access her dry lot. It was a matter of giving the hooves the nutritional, mechanical and pharmaceutical support they needed to grow out. I rasp back the toes once between visits. It takes the patience of a real professional to leave the soles alone and primarily trim the hoof walls to maintain proper breakover and bony alignment. My mare’s soles were lumpy and unattractive but they worked to cushion the coffin bones.  You can see what they looked like in Cayuse’s photo album:  https://ecir.groups.io/g/CaseHistory/photo/7296/3543618  From acute laminitis to galloping in turnout with her companion took about 5 full months. 

If we’re an example of anything, it’s that we need to adjust our hoof care to the circumstances. There is no single magic formula. Glue-ons block access to the hooves to rasp the hoof walls when they over-grow.  A 3-week cycle would have worked better. 
-- 
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Cass - thank you for sharing your story. As a farrier working to rehab several horses at the moment, I’ve had this exact conversation with most of them re: glueing shoes versus leaving barefoot through this process.

There is no doubt in my mind that ‘micro trims’ focused on removing peripheral loading and keeping very short toes on a bi-weekly basis are far more effective and speedy than glueing on composite shoes if the horse is able to tolerate being barefoot and still land heel first in boots or barefoot in their turnout terrain.  

If you want to put this rehab into ‘rocket mode,’ add 4-6 inches of pea gravel in their feeding and loafing areas and you’ll speed the process of healing even more. It’s up to us to provide a low sugar/starch diet, minerals, reduced pharma (except for controlling PPID/IR or other medical issues), short (anti peripheral loading and long toes) trim cycles, turnout terrain and MOVEMENT (herd life!) to give them these supports. They can heal, we just have to get out of their way. 
--
Pamela Swartz - three PPID/IR (mostly) Arabians 25, 20, 15 yo

Quest's new boots arrived last weekend so I put them on her and opened her stable door.  I immediately regretted it as she went out but looked very uncomfortable and only did a few steps at a time with long stops in between. The pain was clear on her face. I let her do a lap of the yard then encouraged her back into her stable. That evening her pulses were up and hooves very hot and I felt awful as I expect it made everything worse for her. 

I think she's improved, pain wise, over the past week. She's still not great though. Her crest is still big and rock hard and she usually has pulses in front (1.5-2 out of 3 in my rating scale). We're on day 5 of ertugliflozin. 

She seems to have reduced appetite and is quite fed up. She tried to get out the stable door earlier, but I'm too scared to let her try again. 

When I talked to the vet she was really firm about the need for shoes - she said 'you've tried no shoes and it's not working so unless she gets better she will need shoes'. She also said that u less she gets better in a couple of weeks I need to consider her quality of life (basically, put her to sleep). It's made me a little scared of talking to her again! However I'm hoping for more xrays and blood tests towards end of this week. My concern is that if she's still sore she's going to say put shoes on her, or make me feel guilty for not putting her to sleep. 

Last time I talked to her she was back on paracetamol and higher bute though, but I've dropped it now. Was going to stop bute but were about to have freezing temps so I want to know if any pain is due to cold vs bute reduction. 


My question was going to be - did I make her worse letting her out last weekend? Ie if there is rotation would I have made more rotation? And is it right to keep her in until after xtays and mauve next trim? But I think I mainly needed to share. 

Thanks 

Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Carly, about  the new boots, are you certain they are the proper fit? Is there anything that needs to be done with the pads for her purposes?

--
Lorna in Eastern Ontario
2002

Carly,
I’m so sorry your vet isn’t willing to wait a couple of weeks to see if the new medication is working. That is very frustrating because your vet should know as well as any of us that horses have outstanding powers of healing but that those powers aren’t always instant. 

I know you’re aware of strong advice against  continuing an NSAID while Quest is taking a SGLT2 inhibitor. This can lead to the well-known complication of right dorsal colitis. The symptoms can be subtle and you don’t necessarily see any change in manure. 

Boots and pads aren’t instant magic for comfort. Each equine seems to want something a little different for comfort. Is Quest comfortable in the bedded stall without boots? Are the boots rubbing the heels? Are they changed and dried daily while Quest is standing in deep bedding in the stall? 

Boots do keep the hooves warmer by insulating the walls. Could that be what you’re feeling? Hot hooves aren’t a common symptom of endrocrinopathic laminitis. The damage to internal structures isn’t from inflammatory processes.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Hi Carly
I'm sorry to hear Quest isn't feeling comfortable at the moment.  I was wondering if you've been able to progress getting your hay tested - apologies if I've missed this in your case history.  Getting that done and then having minerals balanced specifically to its analysis by one of the trained ECIR volunteers is a key part of getting her diet tightened up.  Tapering her off bute is also something else to focus on, especially as she's currently taking a SGLT2 inhibitor.  As metabolic laminitis isn't an inflammatory event, the bute's unlikely to be benefiting her.  If you're worried about her reacting to colder weather, are you able to get hold of some wool socks to fit over her feet inside her boots (if there's enough room- she may need another pair of bigger sized boots to accommodate winter socks), and then use warm leg wraps too?  That should keep her feet and legs nice and cosy in her stable when temperatures drop.
I'm also sorry to hear that the vet seems to be somewhat impatient and very focused on shoes.  Keeping Quest's trim as good as it can be may need farrier visits far more frequently than 'normal', and using boots (once you've cracked which ones are the most comfortable for her, and whether she can tolerate pads/no pads in them) gives easy access to her feet on a regular basis.  It also lets you keep a close eye on hoof growth, especially once you start her on jiaogulan. 

Lesley and over the bridge Omar,
ECIR Group Primary Response,
11-2012, Highland, UK

Omar - Case History

I'm not certain they're exactly the right fit, no. She's very reluctant to lift her feet up so I can test/twist, have her walking etc. Like I normally would to test boot fit. They're potentially too big rather than small though. I have a thick eva pad in but thought I could put another in. My trimmer also fits boots so I thought if I waited until next trim I could ask her. Or see if I can book a fitting appointment separately - my concern is that walking out hurt her a lot so I am not sure it's wise to try now. 
--
Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

Hi Cass, 

I know, but I thought I'd wait a couple of days until we are past the freeze. Otherwise I won't know if it's bute or cold. 

Quest doesn't wear boots in her stable - she has thick shavings. These pack into her hoof. Under the shavings she has very thick soft EVA mats. She always moves the shavings by the door (she finds it easier to reverse than turn) so often stands on the bare mat there but seems okay with it. However she'll pick deep parts of her bed and she had been standing with hind feet on the banks of her bed. 

I've only put the boots on when I open the door to let her on the yard. Once a couple of weeks ago with cloud boots on front which were too small, and then last weekend with equine fusions and the clouds on hind feet. 

Boots may be slightly too big, but I can add pads and get them checked by my trimmer. Its hard to do when she's so reluctant to lift feet. I don't force her.

Her feet weren't hot from the boots (about 10-15 mins) - they were hot for several hours afterwards. If not related to insulin does this suggest some mechanical issue - ie rotation or sinking? 
--
Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

I have only recently found new hay likely to be lower sugar and starch, but financially its going to be tricky getting it tested, and then getting bespoke balancer (and getting her to eat the balancer) - I'm not sure I'll always be able to get the same hay either. I am eating into my small savings to get her boots, pay vet bills, extra bedding, feed, extra hay, supplements etc so hay balancing etc will have to come later.

I have some fleece wraps for her legs, but last time I put them on her she got very upset. I put very warm stable wraps on when I first noticed her pulses and took her off grass. She hated them and didn't lie down in them, then got acute laminitis pain. So I think she associates leg wraps with the pain. I don't know. But I wanted to see if she does get more uncomfortable in the cold before I do anything else. She has a rug on and deep shavings. 

I still need to update my case history, sorry. I  can't do it on my phone. She is on jiaogulan but I haven't really noticed pinker gums. 

Trimmer was going to come on 4 week cycle, but I do think they're growing quicker so I'll see if she thinks she'll need to be seen sooner. But it would make sense to wait until after xrays. 

I don't think my vet will be convinced by any argument for keeping her barefoot - she's very anti it. So it'll just be  matter of me having to say I disagree and choose not to listen to her advice. And I'm rubbish at that sort of thing 😒
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Carly 
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest
https://ecir.groups.io/g/CaseHistory/album?id=282557

It is tough,Carly. You don't have to respond, you have a lot on your plate. But have you tried putting an extra mat,or something, under the foot that will be taking the weight, whilst you lift the other ,trying to fit the boot as you see fit, before letting her stand on it ?

--
Lorna in Eastern Ontario
2002

Hi, Carly. I don’t think rotation or sinking causes heat in the hooves. Or at least it didn’t for my laminitic mare. Jiaogulan is supposed to enhance circulation, so it should make the hooves normally warm, but not hot. If you haven’t noticed pinker gums, you may need to increase the amount of Jiaogulan by a small amount- ½ teaspoon- until you do see pinker gums about an hour- 1.5 hrs after feeding it. The effective dose is quite variable between individuals. 

If I could wish one thing for anyone dealing with a laminitic horse, it would be a laminitis partner to use as a sounding board. It’s very hard to contradict the professionals we rely on. Speaking after 8 months rehabilitating a laminitic horse, I promise it gets easier after you start seeing your horse improving!
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos