Topics

EMERGENCY


anne@...
 

My 17 year old gelding has been battling laminitis since May. His metabolic panel shows he’s IR and borderline Cushing. We immediately altered his diet and put him on Heiro. He’s been in clogs, stalled full time. He had to have a tenotomy a month ago to stop rotation. He was doing great until this week. His left foot is trying to slough hoof and there’s no new wall growth. Yesterday’s X-ray looked good. Showed new sole growth but venogram showed almost no blood flow. A small capillary feeds one side, heel has some blood flow and front and other side have hardly any. He’s currently taking 2 scoops of Bute morning and night, 14 antibiotic pills morning and night, Heiro in the morning and isoxoprene morning and night. We give him aloe juice and papaya to protect stomach from Bute. Our vet says there is nothing more we can do. He’s back in soft rides and in pain. Please help!!!  I need to find a way to heal coronet and prevent hoof from sloughing or find a way to grow hoof without proper blood flow. 


Anne from Michigan (12/19/20)


Sherry Morse
 

Hi Anne,

You'll get a full welcome message shortly, but to help you as quickly as possible we need to know exactly what his diet is at the moment as well as what his actual insulin, glucose and ACTH levels are.  Having pictures posted of his current trim as well having the x-rays will also help us help you.  If he is an IR/PPID horse Bute is contraindicated (details on this will be in your welcome letter).  Why is he on antibiotics and isox right now? 

We have several members in Michigan so if you let us know where you are we may be able to direct you to professionals who are familiar with our protocols and can help you help your boy.  The biggest thing is removing the triggers that are causing him pain and this will take time but can be done, even at this stage. 

For you, keep on breathing - we have had horses lose entire hooves and come back to soundness so don't give up on your boy yet.



Nancy Kitchen
 

Anne
You are where you need to be to get help for your boy..  I'm just a member but I want to say, just breathe and go thru the steps here. It can seem overwhelming but there are many here to help you thru those steps..  Hang in there, everyone here has been in your shoes and it's scary.  All the best.
--
Nancy K
Smoke and Tucky
November 2018, Southeast, MA

Smoke Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Smoke
Smoke Photo Album:    https://ecir.groups.io/g/CaseHistory/album?id=94122
Tucky Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Tuck 
Tucky Photo Album:


LJ Friedman
 

what is his insulin number, etc  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Eleanor Kellon, VMD
 

Anne,

I want to reiterate everything you have been told so far. We need a history, lab details, photos and radiographs to help you.

In the meantime, start the emergency diet and order Phyto-Quench so you can get him off the phenylbutazone https://uckele.com/phyto-quench-pellet.html . Photos ASAP, especially the LF.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cindy Q
 

Hello Anne

Dr Kellon has asked you to get Phytoquench and start the Emergency diet. The Emergency Diet is found at the bottom half of this page under the heading What is the Emergency Diet? : https://www.ecirhorse.com/DDT+E-diet.php

Below is our official welcome letter covering the ECIR protocol of Diagnosis, Diet, Trim + (when the horse is comfortable) Exercise.  It's a lot of information but please go through it and you can bookmark this post so you can keep referring back.
You will also find instructions on starting a case history (3rd paragraph) - more information is needed from you.

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. 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 - Sep 2017, Singapore
ECIR Primary Response





 

Hello Anne,
Have you considered taking your horse to MSU? Not sure if they would allow you to dictate/provide his diet while there? There is a farrier that has done difficult  laminitis cases for MSU. I don't know her name but met her at an Ada Hammer trimming clinic in MI. 

I also wanted to send you a link to a business that sells every kind of hoof pad material. https://www.happyhoofpads.com/index.php?route=product/category&path=60
I bought pad material from this vendor when my past horse developed laminitis. His boot came with wedge pads with a frog support but eventually I found that he was actually more comfortable in a thick NON WEDGE pad. The sellers pads are low priced. You do have to cut them to fit your horse's boots, not hard to do. 
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Eleanor Kellon, VMD
 

Hi Anne,

Another member was kind enough to forward to me October 30 radiographs and some LF hoof photos you had posted on FB.

You need a hands-on hoof consultation. I would take Bonnie's suggestion and if you can't actually take her there at least give them a call and get a recommendation for consultation on the photos, films and venograms. The foot is not trimmed according to clog instructions. There is considerable sinking but little to no bony rotation. A proper realigning trim could change perfusion to the foot but this is something that can't done from a distance.

We can help you with diet and supplements but the trim help  needs to be in person.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 


Eleanor Kellon, VMD
 


riggslippert@...
 

Hi Anne,

My IR  horse Cadet spent several days at MSU in 2019 for a non-IR related problem.  They did not have tested hay, but did soak hay for him to eat while hospitalized, and fed the meals I brought.  My PPID senior horse had abdominal surgery there in 2016 and was cured of small intestinal cancer.  I can confidently endorse your taking your horse there.  Good luck!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




anne@...
 

I will ask for a copy of his latest report.  I know the vet said he was within normal range on things now.  Currently, we are feeding him one large scoop of ration balancer, 2 scoops of senior feed with low sugar ( I think it is made by Tribute), 2 oz of hoof strengthener and 1/4 c aloe juice.  He was getting papaya but he is sick of it.  I have requested the venogram and x-rays.  Here is a picture of current trim.  He is in soft-rides.  I am putting medihoney and silver on a non-stick pad then wrapping with gauze and vet wrap as vet suggested.  We started a Bemer treatment tonight and starting red light tomorrow.  His current med routine is a scoop of Heiro, 2 scoops of Bute, 2 scoops of isoxsuprine HCI (to try to improve blood flow) and sulfamethoxazole and trimethoprim tablets (14) in the morning.  He gets the same routine minus the Heiro at night.  The tablets are to prevent an infection.  I will post Friday's x-ray and venogram as soon as I receive them,

Hmmm...cannot post a picture.


anne@...
 

Thank you!  I have had many people in other groups tell me I am being cruel to him by not putting him down.  I assure you I have no intention of cruelty.  HE is still fighting so I am fighting too.


anne@...
 

I have requested this.  I will post it when I have it,


Sherry Morse
 

Hi Anne,

A bit of housekeeping: Please take a minute to create a signature. You only have to do this one time and it will automatically appear with all future messages on the main forum. It helps us help you to better locate resources in your area as well as see what information and discussions you may or may not have seen since you joined.


1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window to type in your name, general location, and year of joining.

Example:

Sally Doe

TX 2020

NOTE: If/when you are adding a link to your Case History or photos, make sure you make it "live". Adding a space after your link or hitting enter on your keyboard will turn it blue.

3) Make sure you check the 2 boxes saying "Use Signature for Web Posting" and "Use Signature for Email Posting”.

4) IMPORTANT: Scroll to the bottom and hit SAVE!

All posts that you write or reply to, using either the web or your email software, will then have your signature automatically added at the end.

As far as pictures, this group does not accept attachments - you need to join the Case History subgroup: https://ecir.groups.io/g/CaseHistory and then create a photo album (named "Anne and xxx") and then put the pictures and x-rays there.  I assume you're using medihoney and silver to draw an abscess out?  If there are abscesses the Bute will slow down their resolution.

As far as your current diet and medications - most commercial ration balancers and senior feeds are not suitable for IR horses so knowing what your horse's current bloodwork is really is important. Hopefully you've read your welcome letter so you know that Bute is also contraindicated in cases of metabolic laminitis.  Isox has also been found to not be helpful in these cases.  You can read more on that here: https://ecir.groups.io/g/main/message/235390 and here: https://ecir.groups.io/g/main/message/198075.  A quick search of our archives shows that many members have tried Heiro and found it to be lacking (you'll notice that it's very clearly labeled to be used in addition to diet, exercise and proper hoof care - which is the same thing we advocate minus the supplement).

What sort of infection is your vet hoping to prevent with the SMZs?




Nancy Kitchen
 

Hi Anine - You will get the very best help here so as Marijke says - "Chase one rabbit at a time"
Listen to what Dr Kellon and this group have to say.  They will help you correct your horse's diet and get him on the road to recovery.  I know exactly what you mean when you say your horse is still fighting.  I had MANY people, vets included, that said to put him down.  When I looked into his eyes he said NO... so the battle continued...  if he wants to fight on then fight with him and for him...
These folks here will do the very best to help you do that for him...  all the best to you and your horse....
--
Nancy K
Smoke and Tucky
November 2018, Southeast, MA

Smoke Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Smoke
Smoke Photo Album:    https://ecir.groups.io/g/CaseHistory/album?id=94122
Tucky Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Tuck 
Tucky Photo Album:


Eleanor Kellon, VMD
 

Anne,

I'm going to go back to the DDT but in abbreviated form:

D: Diagnosis.

The laminitis is known but not the cause.  We need to see all your lab work.

D: Diet and Drugs

Go to the emergency diet for now. Your balancer and "low" sugar feed are not low enough in sugar and starch; senior feed too high in fat as well. Enter Heiro in the search box here.

Drugs -  bute has been mentioned already. Isoxsuprine doesn't work in healthy horses https://pubmed.ncbi.nlm.nih.gov/10338160/ and since the issue in laminitis is high endothelin-1, not high noradrenaline, it might not be of any help in laminitis either. https://pubmed.ncbi.nlm.nih.gov/12000527/ .

T: Trim

This is always critical but especially so in your case. In fact, to be honest it's an emergency.  The constriction of the soft tissues by the deformed hoof needs to be relieved. You need an expert.

As Dr. Phil likes to say, you need to objectively evaluate and ask "How's that working for ya?"

As Einstein brutally put it:  "Insanity: Doing the same thing over and over again and expecting different results"

This is NOT a criticism of you or your horse's care but you know some changes need to be made. We're here for you.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


anne@...
 

I have uploaded the photos and case history.  I am hoping I did it correctly.  i have ordered the phyto-quench pellets.


anne@...
 

I added the signature.  Sorry about that.  The vet just had me pick up more Bute and Isoxsuprine.  Should I refrain from using both?  I have ordered Phtyo-Quench and flax seed and magnesium.  They will not be here until Monday.  What can I do to help relieve the pain for him?  I should mention we are doing red light therapy and Bemer.  


anne@...
 

What can I do for pain/  If I quit Bute, I am afraid he will be in more agony.  I am getting him on the emergency diet.  Ordered everything needed.  I live in Michigan.  What farrier do you recommend?  My vet is supposed to be a laminitis professional and a farrier but I am open to anything to save him.
--
Anne Leighty

Freeport, Michigan