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Connamera Sm .Horse Laminitis

B.J. Korol <hobhol@...>
 

Hi ,My 12 year old Small horse  Cricket developed Laminitis with 10degree coffin bone rotation 4 weeks ago . She has been on stall rest the first 2 weeks with Soft Ride boots but is now in stall without boots in thick shavings . She started out on 2 grams of Bute daily and is now completely off it and is getting Metformin and Metabarol daily . She had been on Metabarol since April since she had been diagnosed with Insulin resistance last year . She is walking much better now ,initially extremely uncomfortable ,the typical Laminitis walk . Her lab work showed normal ACTH but sugar level was  40 . I have been soaking her grass hay and limiting her intake to 3 feedings a day, which is not making her very happy ! I have a very small paddock area with very little grass and have been turning her out at 6AM with a muzzle ,I love her out for an hour and than back in her stall till next AM with a short walk in the PM for a little exercise and stall relief . My farrier has checked her once since initial attack and trimmed her toe slightly ,my vet is coming back this Thursday for re-exam and most likely more X-rays , the farrier will also be there and I am hoping we can do some corrective shoeing soon so I can get her back in a small amount of work to reduce her sugar levels . 
I 'm sending this history to you in hopes you would have any advice for me to follow to help with Cricket's rehabilitation .
Thank you 
-- BJKorol
BJ Korol

Candice
 

Hello BJ!

Welcome to the group! 

A quick answer until you can complete your case history so we can give you more adequate and custom advice for Cricket: the degree of rotation causes concern to me and if you have radiographs, please upload them. We can give you more precise advice with radiograph views, hoof photos, and a case history. She should be on the emergency diet asap and if you can get a hay analysis on your hay that would be best. Soaking hay only makes it safer NOT SAFE, especially since we are unsure of the numbers. It is best to turn out in the late evening and left out at night, since the starch/sugars in grass are lower during that time. Dr. Kellon and the others can correct me if I am wrong and also will add their input. Also, in regards to trimming, it is best to remove any extra leverage that can be causing Cricket more pain. Please post as soon as you can and let us know if you have any issues uploading. 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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. 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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. 

 

 

--

~ Candice 

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History: https://ecir.groups.io/g/CaseHistory/files/Candice%20and%20Shark

Shark's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71507 

 

Kirsten Rasmussen
 

Hi BJ,  I'll just add to your welcome letter that you can turn her out longer (in her padded boots) if you block off the hole in the muzzle so Cricket can't eat ANYTHING.  This will allow her more exercise or stall relief, safely.  Bring her in and remove the muzzle for her meals.  If she has 10 deg rotation I would make sure she doesn't get ANY green stuff, including weeds, because it's only going to slow the healing and possibly continue to trigger her laminitis until it's removed from her diet.

Also, you'll want to make sure her 3 meals are providing her with enough calories.  We recommend feeding hay weighing 2% of the horse's body weight (before soaking).  Unless the horse needs to lose weight, in which case feed either 2% of her ideal body weight, or 1.5% of her current body weight....whichever is greater.  This will allow for slow but safe weight loss.  Also read up on the emergency diet in your welcome letter, which in addition to soaked hay includes salt, ground flax, and vitamin E.

Candice's recommendation to have your hay tested is important, you need to know what you are feeding.  Make sure you pay a couple dollars more for the "wet chemistry" analysis as it is much more accurate.

Please do get your Case History posted with all your lab numbers in it, and her medication doses.

We are here to answer any questions you have after you've had a read through your welcome letter.

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

B.J. Korol <hobhol@...>
 

Thank you for your help , I will try to figure out how to put my care history on your site ,I have a very good Vet group I am working with in Charlottesville but would really like to learn as much as I can from you as a I can to assist in my mare's recovery . If I have trouble with the case history I will e-mail you for help . 
Thanks again 
--
BJ Korol Charlottesville Va. June 2020

coffincomplex@...
 

Hi BJ,

Sorry your mare is dealing with this. I wanted to also make sure she had been tested for HWSS, since that can definitely cause laminitis problems in Connies.

Best of luck and I hope she improves quickly.
--
Alanna
May 2018
South Bend, IN
Buster's case history: https://ecir.groups.io/g/CaseHistory/files/Alanna%20and%20Buster  .

Eleanor Kellon, VMD
 

HWSD (hoof wall separation disease) begins to manifest when the animal is a foal. When similar symptoms appear in adults, it is either white line disease or laminitis.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Eleanor Kellon, VMD
 

BJ,

Did you mean her insulin was 40? Glucose of 40 is very low and would most likely be the result of poor sample handling.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

coffincomplex@...
 

I've known 2 that had this issue, and both were diagnosed as adults. One was 5 and the other 7. They had hoof problems before that that weren't attributed to HWSS because it wasn't known then. There is a range of severity in presentations. 12 would be old for sure, but it may be possible that heterozygotes are hypomorphs, not normal. I don't think it's known yet.
--
Alanna
May 2018
South Bend, IN
Buster's case history: https://ecir.groups.io/g/CaseHistory/files/Alanna%20and%20Buster  .

Eleanor Kellon, VMD
 

All evidence to date shows heterozygotes (one disease gene copy only) are not affected, e.g. https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1005122 . Whether hypomorphic or amorphic, evidence to date is that the normal allele preserves a normal hoof wall in heterozygotes. It could be that heterozygotes are more sensitive to nutrition and trimming errors but those things can cause problems on their own too and in either case the answer is to correct them!
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

B.J. Korol <hobhol@...>
 

Sorry that was her insulin level ,I just got a copy of my mares labs and X-rays ,We just did another set of X-rays and her feet look great ,good foot growth and no coffin shifting . I am still keeping her on stall rest except for short time AM and Pm in a fairly dry area with a muzzle .We discussed putting shoes on her with Dr. Gunta and my farrier but I said I wanted to wait and would still use the Soft ride shoes till I see how she does with the turn out . If all goes well will put shoe on with wedge pad and soft padding under the frog .
I just got her first X-rays from vet today and I will send them on to you with her blood work as soon as I get todays downloaded from Blue Ridge Equine . 
Thank you for your interest ,
--
BJ Korol Charlottesville Va. June 2020

 

Hi, BJ. 
You can't attach X-rays or send anything directly to messages in groups.io as an attachment.

You received information about how to make a Case History from an ECIR volunteer. Most of your blood work values will fit in the CH form. For those things that don't, you can post a copy of your blood work in your CH folder as a pdf. If you can't make a pdf, then you can take a photo of the blood work results and place the photo in your Photo Album.

All the details are in the Wiki:

Case history help and how to join the case history subgroup: https://ecir.groups.io/g/main/wiki#Case-History-Help 

Photos, how to start a photo album for the X-rays, and how to correctly label the X-rays : https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help 

Let us know if you have questions or need help.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos