9yo WB mare still in acute phase of laminitis-need advice please


MELISSA PALMER <melissappalmer@...>
 

Hi All,

Thanks in advance for any advice/help!

My 9yo dressage Oldenburg/warmblood mare was diagnosed with acute laminitis 5 weeks ago.  It was so bad that she was treated at the vet clinic for 4 weeks.  She is now back at home (I own my farm and care for her myself), on the emergency diet, complete stall rest and on A LOT of drugs.  Still on Banamine as she is so uncomfortable without it.  During her vet clinic stay she was on banamine plus Ketamine and Butforphanol.  She has both rotated and sank in both front feet.  The vet said she would support putting her down at any point based on her pain level and radiographs.  I opted to wait it out and see how she does.  I'm second guessing myself now as she is still so uncomfortable walking in her deeply bedded with soft shavings very fluffy stall.  She lays down for about 10-15 minutes every hour or so.  She is still eating well (her soaked grass hay @ 1.5% of her body weight and 1/8lb speedi beet soaked with her supplements added (vit E, Magnesium, CA Trace Plus and Metaboral).  She is also on 1/4tube per day gastroguard, 8 pills misoprostal twice daily and 1 tablet prascend daily.  I should also add that she has a muscle myopathy of some sort (PSSM-2 or MFM likely based on history of tying up 3 years ago), she is prone to ulcers, is a cribber and a hard keeper (never over weight).  My thought is that she will likely never be a competitive dressage horse again and likely never turned out in a field on grass again and I live in Virginia where the grass is VERY rich at least half of the year.  Is this a good life for a horse?  Did I do the right thing?  Her right front coffin bone is prolapsing the sole but has not come through as of yet.  I work full time and have 4 other horses at home and I ride so this is a ton of work and very time consuming and I'm only doing it if it's the right thing for my mare and she will be able to live out the rest of her life and actually enjoy it as a retired horse.  Thanks in advance for any advice!  PS-I can send radiographs if that is helpful and her vet report from the clinic? 

--
Melissa Palmer in Virginia 2021


Eleanor Kellon, VMD
 

Melissa,

Were her insulin, glucose and ACTH tested? If so, was it before the butorphanol? It would be very unusual for a 9 YO Oldenberg to have a metabolic laminitis.  Did she have any other abnormalities?  Has she been checked for Lyme?

Yes, the radiographs and report would be great.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


MELISSA PALMER <melissappalmer@...>
 

Hi Dr. Kellon,

I will post her vet report with all the testing as well as her radiographs.  I believe that she is IR and it could be related to her muscle myopathy.

Thanks so much!
--
Melissa Palmer in Virginia 2021


Cindy Q
 

Hello Melissa

Welcome to the group. I see Dr Kellon is already asking you some questions which you are working on.

I'm going to set out our full welcome letter below. I noted you said she is on the emergency diet, how long since you started this? Worth a read through the diet details below. There is also information on getting a wet chemistry hay test - with that information, you should be able to determine if she can go without soaking the hay. If she is under-condition currently, it would be ok to increase her soaked hay. The 1.5% to 2% of ideal body weight is a minimum.

Have you tried her boots and pads or even just pads duct taped on? Read this post for some information on hay testing and padding: 
https://ecir.groups.io/g/main/message/252205

As she's a warmblood (ie big), I would suggest Cloud boots and pads (from Easycare). Makeshift pads often do not last very long due to the weight of the horse crushing the padding down quite quickly (less than a day?) but I've had much better longevity with the cloud pads (they come in the boots or are sold separately) with big horses.

How is the look of her whiteline? Keep them clean and dry.

Here is our full welcome letter and a lot of the advice below, I have personally found is helpful for non-metabolic horses as well who have laminitis:

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 etiquettewhat 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.

EXERCISEThe 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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





Cindy Q
 

Also a reminder that Speedibeet should be rinsed soaked rinsed. As you not feeding a large amount, usually quite easy to manage if you have a colander or small weave plastic basket to drain into and rinse through. If you read the bag, it actually says to soak in at least 5x water vs the shreds. I know many people (here as well) like to put just that minimal amount to soak it to bloom it. There's a lot of surface iron on such products, including Speedibeet.


--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response