Bailey chronic RF lameness


Karen
 

I am in desperate need of some help/advise please.
I just submitted my case history on my 27 yr old appaloosa mare, Bailey. 
I have had her seen by four different vets in the past 90 days trying to resolve her RF hoof.  All the vets are at a loss as to what can be the problem. I have spent countless hours researching looking for help and her vet bills are creeping upwards. I'm assuming everyone can look and read her case file about the history on her hoof? Im also attempting to attach photos but I've yet to figure it out.

THis post is only concerning her chronic lameness but I will start another about how to get started on her diet and Cushing's.

Any help is greatly appreciated.

--
Karen Wellner
OKC


Lavinia Fiscaletti
 
Edited

Hi Karen,

So sorry that Bailey is having such a hard time of it.

I found Bailey's case history - here is the link to it:

https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW

I don't see any information in it regarding the hoof issue. Is there more information somewhere else?

Sorry, you can't attach photos here, you need to create an album in the Photos section of the Case History sub group, then upload the photos there. Here's the link to the Photos section:

https://ecir.groups.io/g/CaseHistory/photos

Once you have the photos uploaded, you can add the link to the album to your signature so we can find it easily.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Sherry Morse
 

Hi Karen,

Did you see your welcome message from last week?  https://ecir.groups.io/g/main/message/266899

Your case history folder link is https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW and it would be helpful if you could add this to your signature along with your year of joining.  (The information on how to do this is in your welcome message). 

As Lavinia already noted there's no information in the Case History about the lameness issue.  If you could start a photo album and post pictures of Bailey and her feet as well as any x-rays you have it would really help us.  Information on how to do that is here: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help




Maxine McArthur
 

Hi Karen
Thank you for creating a case history for Bailey. Could you please add the link to your signature? Just paste it into the signature box in the Subscription tab (in the left-hand column on this page), add a space so it is 'live', and scroll down to click Save. You can see my CH link in my signature as an example. 

This message is to send you our welcome for new members, which has a lot of useful information on Diagnosis, Diet, Trim and (when possible) Exercise. Please read it through carefully as it should answer some of your questions. 

I had a couple of questions about your case history: 
1. Re her diet--we don't recommend any Nutrena feeds, as they tend to be too high in starch and/or fat for our metabolic horses. There is a list of recommended feeds here in our Files section: Safe Bagged Feeds.pdf (groups.io).
There is more on diet in the welcome message below. We do recommend getting your hay tested and minerals balanced to the hay. 
2. She was diagnosed with PPID in June 2019, but you have her on 1.5 Prascend started in November 2020--or was the dose raised in Nov 2020? Has she been retested since 2019 to check if the dose is sufficient for her? 
3. Could you please add the actual results of her bloodwork to the case history? There are boxes for the ACTH, insulin, glucose and thyroid (if any) results. If you have done other bloodwork, that can be added to your case history folder (not the actual case history document), either as a pdf or document, or if you need to scan it, you can add it to your photo album. 

I couldn't see any information about her hoof problems in the case history either, but you can add comments in the 'Comments' section at the end of the case history, which makes it easier for people as then everything is in the same place. Once you get your photos uploaded, as Lavinia said, we can comment further on the hoof problems. There are links in the 'Trim' section below on getting the best hoof photos/xrays and creating an album.

Here is our welcome message--there are many useful links as well, just click on the blue text. You can also search the Messages and the Files for more information on specific topics. 

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 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. 



--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Maxine McArthur
 

Oops, sorry Sherry! We must have been typing at the same time. Karen, you have two welcome messages! Let us know if you're running into any problems with uploading of information.
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Karen
 

Thanks so much. I started soaking her hay today and put it in a hay net. I couldn't find any of the suggested feeds but I did mix half her safechoice and soaked beet pulp today as well. I'll slowly switch to straight beet pulp.  She wouldn't eat it of course. I bought the magnesium, vit e and salt. I'll put that in her feed tomorrow. THe feed store gave me a handout. Just wondering if I can put her on Triple Crown Senior Gold and one of their forage feeds?

I had my techy husband add my pictures and x-rays to a file. I do not have copies of the x-rays from 7/28 but there was no change from the x-rays dated 7/6. He also did a an ultrasound but didn't see anything unusual.

I updated my case file again. I lost all the info I put in yesterday. I will contact the vets who took her bloodwork and get those results tomorrow. Her original dosage of Prascend was 1 and vet upped it in Nov to 1 1/2. You can see in the photos the damage done to her RF hoof back in 1999. She's never been perfectly sound all the time on that hoof but this is the worst she's ever been. You can see the swelling she has in that leg now and she's lost some weight. I'm afraid she'll lose more now that I changed her diet. The stress is catching up with her. 

I switched her from 2 Equioxx to 1 scoop bute today as well. Vet has her on 15 SMT antibiotics tablets twice a day as well. This last vet at the hospital told me to bring her back this week if shes not better and she's not getting better. He had the farrier at the hospital file her hoof like the picture on the asphalt. He said we might see about other treatments and shoes this week. 

I'm trying desperately to relieve her pain. Thanks so much for any help.
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW


Sherry Morse
 

Hi Karen,

Housekeeping first - please add the link to your photo album (https://ecir.groups.io/g/CaseHistory/album?id=266692) to you signature. 

If you can source Triple Crown products you should be able to replace the Safe Choice with Triple Crown Timothy Balance Cubes if she won't eat beet pulp as a carrier for minerals.  You can also order samples of Stabul-1 (http://stabul1.com/) as that is a safe feed for an IR/PPID horse and can be wet a bit to allow the minerals to be mixed with it. 

Was the beet pulp rinsed/soaked/rinsed?

The Triple Crown Senior Gold is not an acceptable feed for an IR/PPID horse as it is 3x our recommended fat limit and is also higher in ESC+starch than we recommend.

When was the last time Bailey's ACTH was tested?  Has her insulin and glucose ever been tested?  If so, do you have those results?  If the Equioxx was not helping her pain switching to another NSAID (Bute) will probably not make any difference either.  If she is IR getting her diet fixed is the first part of helping her feel better and then getting her trim in order will help her as well.  NSAIDs will not help with a metabolic issue and we recommend weaning off of them and replacing them Devil's Claw which may help with pain she is experiencing.  You can read more about changing from NSAIDs to Devil's Claw here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Pain%20control,%20switching%20from%20Bute%20to%20Phyto-Quench.pdf and weaning off of NSAIDs here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf

Looking at the x-rays there's not a whole lot of sole on that right front and there are issues with the trim.  Those issues have probably existed for quite a while as it looks like there's a bit of ski-tip on the coffin bone on that foot.  The left front hoof also shows issues in the x-rays of that with a severely broken back pastern angle.  Hopefully Lavinia will have more comments on that for you sometime tomorrow.





I had my techy husband add my pictures and x-rays to a file. I do not have copies of the x-rays from 7/28 but there was no change from the x-rays dated 7/6. He also did a an ultrasound but didn't see anything unusual.

I switched her from 2 Equioxx to 1 scoop bute today as well. Vet has her on 15 SMT antibiotics tablets twice a day as well. This last vet at the hospital told me to bring her back this week if shes not better and she's not getting better. He had the farrier at the hospital file her hoof like the picture on the asphalt. He said we might see about other treatments and shoes this week. 

I'm trying desperately to relieve her pain. Thanks so much for any help.
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW


Lorna Cane
 

Hi Karen,

Another good carrier for minerals is soy hull pellets. They just need to be moistened, not R/S/R.
Most horses like these,IME.


--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Lavinia Fiscaletti
 

Hi Karen,

You mention that Bailey had damage done to her RF hoof back in 1999 - would you please explain what that was.

Thanks.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Karen
 

She got caught in barbed wire and cut off the outside heel bulb through her coronet band. You can see the scar in the pictures. Her hoof has always looked like the first picture. She's missing some of the hoof wall in the very back and now her hoof is now misshapen. The hoof that did grow back looks like that multi-layered hoof wall picture. On 7/21 I called some farriers that work at the local equine hospital to come evaluate her hoof. They cut that outside layered to see if they could find the abscess. Of course, they didn't but they did see the hoof wall that you can now see in the other pictures. It actually looks pretty healthy.  She has not showed a response to the hoof testers since April.  She has consistently shown a response on the scarred coronet band area. 

One vet said soft tissue damage and use soft shoes. One vet thinks her lameness on her RF is permanent nerve damage and suggested a neurectomy. The latest vet from the hospital said if no improvement then maybe shoes. None of them have mentioned the trim or the "tip" on her coffin bone. 
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW


Karen
 
Edited

Have you had the opportunity to look at Bailey's last FR pic that I put in her album? That's what the last vet had done to her hoof. He did not have anything done to her toe. I am currently trying to find a good farrier in my area.
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW
https://ecir.groups.io/g/CaseHistory/album?id=266692


Karen
 

I put in all of the hoof info starting back in 1999 and now I don't see it on my case history. I'm obviously having problems navigating this system.

I also have her ATCH and IR results from 11/3/2020
Her ATCH was 939 and  insulin was 17.46
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW
https://ecir.groups.io/g/CaseHistory/album?id=266692


Sherry Morse
 

Hi Karen,

Have you had her ACTH rechecked after starting on the Prascend?  If not, it should be rechecked, even though we are currently heading into the seasonal rise.  Uncontrolled ACTH can result in a loss of muscle and topline which is what I see looking at Bailey's body photo.

If you updated the case history document on your device but didn't upload that version to your folder that may be why we don't see the entire lameness history.




Karen
 

Testing 123
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW
https://ecir.groups.io/g/CaseHistory/album?id=266692


Sherry Morse
 

Karen,

I would suggest if you want to see answers to your post as they come in you either check directly on the website: https://ecir.groups.io/g/main/messages or change your user settings to "individual messages" instead of your current selection of "Full Featured Digest".  To do that you would need to go to your subscription page and make that change: https://ecir.groups.io/g/main/member/10516955

If you only want to see messages you sent you can use this link: https://ecir.groups.io/g/main/search?q=posterid:6288445 and then click on each message to see the full email chain associated with that message.




Lavinia Fiscaletti
 

Hi Karen,

I'm assuming that the rads dated July 6, 2021 were done before the vet had her foot trimmed - is that correct? Or was the trim before the rads were taken? 

The rads showed that her toe needed to be shortened to bring the breakover back more in line with where the bony column needed it to be. The photo from after the trim shows that the frog and heels were trimmed down, which was not what should have happened as that would result in a ground parallel or negative plane coffin bone orientation. It would likely make her sore.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Karen
 

Lavinia, you are correct. X-ray dated 7/6 was first. But the vet had the farrier rasp her heel like that on 7/28. After the blocks wore off she was worse than when we took her in. And she's still bad. 
--
Karen Wellner
OKC
2021
https://ecir.groups.io/g/CaseHistory/files/Bailey%20Case%20History%20KW
https://ecir.groups.io/g/CaseHistory/album?id=266692


Karen