Laminitis


Yvette G
 

My mare, Molly, was diagnosed with Cushings 7/2020 and negative for EMS when she was having a laminitic episode.   I had her retested 2/2021 and she was negative for Cushings and positive for EMS.  I had some trimming issues, but that has been corrected as of April, 2021.  I found a trimmer who recommended this group.    Molly, is having another laminitic episode that began 8/27/21, the day after she was trimmed.  I did notice a couple of days before the trim that she seemed a bit off walking up hill so I don't believe it was due to the trim & Farrier said she did a very mild trim.   I have her in iCloud boots with a 12mm pad.   I was hand walking her a couple of times just for a few minutes, but t I just read an article that said confinement is best in the beginning.  She did not want to walk the other day.  She does have to move to get her hay and her water.  Not too far, but she has to move and she does.  Eating and drinking normally and no temperature.  Her feet are warm to the touch and I try to ice them a couple of times a day too.  I've been using Equine Light Therapy on her 2x a day for 15 minutes since 9/7/21.  The directions say 2x a day for the first 2 weeks and then 1x for up to a month if improvement.   My vet is coming out tomorrow to take xrays since it has been a year since her last xrays were taken.   Should I have her blood tested again for Cushings and EMS?  It seemed strange to me that she was positive for Cushings and negative for EMS this time last year and then in 2/2021 it was the reverse.   She does have Lyme as well.  

I have also been soaking her hay since this happened.  I just got a new batch of hay the day before the episode happened and the analysis just came back yesterday.  The combined ESC & starch is 3.9 so I'm wondering if I need to continue soaking it?  The aNDF is 54.8 and ADF is 35.4.  NFC is 15.9.  


Her current diet is 1/4 cup of Timothy pellets, 1 cup of ground flax, 1 cup of Omega E from Custom Equine Nutrition, salt & free choice salt and supplements 1x a day.  Her and her mini companion split one bale of hay a day in slow feed hay nets.  

Thank you for any suggestions! 
--
Yvette G in NY 2021


Trisha DePietro
 

Hi Molly. Here is our welcome letter that will highlight all the pieces of this puzzle. And it is a puzzle....BUT you are in the right place at the right time :)  please pay special attention to the blue links as they bring you deeper into more information about that particular topic. As far as your current hay...you should not need to soak it. As long as your ESC + starch numbers added together are less than 10% you should be fine and no need to soak. 

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. --
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Trisha DePietro
 

Sorry Yvette! I was thinking about Molly as I typed up the response...sorry about that !!!!! :)
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Trisha DePietro
 

Yvette- if Molly is not interested in walking about, I would just let her be. She will know when the time is right. In the beginning you want her to heal and the lamina are very sensitive in the hoof...so any additional walking may need to wait until she is way more comfortable. 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


 

Hi Yvette,
All this information should end up in your case history but I’m interested in knowing whether Molly is on pergolide as you don’t mention that.  You also state that she has Lyme but no mention of having treated her for that.  I know it’s tricky to decide what to put into an introductory post but those are some details I’d want to know next.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sherry Morse
 

Hi Yvette,

Do you have the actual test results for the various tests that have been done? Was Molly treated for Lyme?  If so, when was that and have you had her titers checked after treatment?  Is Molly currently on Prascend or Pergolide?  If she was on medication when she was tested in February she wouldn't be negative for PPID but her ACTH level might show that her PPPID was being controlled. 

As her current soreness started in the same time frame as the fall rise it sounds like her ACTH is not well controlled with Prascend (if she's on it) or she's in need of a dosage adjustment (if she is being medicated).  Having the vet pull blood now can be tricky but at least would give you some guidance on where she's at right now.

If you can post current trim pictures and any x-rays you have we'll be able to advise you on her trim.  If she's sore, as already mentioned, you should not be making her move.  If she's comfortable moving in her area to get hay and water that's fine but no forced exercise at this point. 

If she's IR and/or PPID you need to remove the triggers to help her feel better - that could mean changing her diet and/or medication - we'll be able help you sort that out once you have a case history done.



Kirsten Rasmussen
 

Hi Yvette,

A combined ESC and starch of 3.9% is unusually low.  Not impossible, but last year someone in this forum also reported such a low number (it was by NIR analysis) they had it retested and the new results by both wet chemistry and NIR analysis showed it was actually much higher.  If you think starting the new hay may have had a role in a laminitis episode, I would consider asking the lab to rerun the test to be sure and ask them to be sure to do it by wet chemistry.

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


Yvette G
 

Sorry for the delay in responding.  I didn't realize all of the digest emails I was receiving is where I should have been looking for responses. My apologies for not paying attention.  Molly is not currently on pergolide.  She was last year when she was first diagnosed 7/28/20. She was positive for Cushing and negative for EMS.  I was able to bring her home 11/20 and changed her diet.  I had her retested 2/21 and she was negative for Cushings and positive for EMS.  I thought I read somewhere that pergolide was not required for EMS.  I hope I didn't misinterpret that. 

I just had her retested again last week and she is now positive for Cushings and negative for EMS.  I don't have the formal report as of yet.  Just the verbal from my vet.  Is this normal to bounce back and forth?  

My head is spinning because everything my vet is recommending is almost the exact opposite of what I've learned here.  She put her on Equioxx for pain and inflammation.  I noticed a difference in Molly that afternoon.  She was moving great and began running around with her companion.  I called my vet and told her I was concerned.  She told me to try to put her in a smaller area.  The only area I have is my arena and there is grass growing around the edges and she obviously eats it so I chose not to put her in there.  She had already eaten some and I was concerned this could have been a possible trigger for this episode.  My vet said there wasn't enough grass to make a difference, but I disagreed and chose not to put her in there again.  My vet told me if she was having a severe case of laminitis no pain med would be enough to let her run around so that was a good sign.  Day 3 on 2 pills of Equioxx and she was now sore again and not moving so well.  My vets response was she needs to pace herself.    Molly is now only on 1 pill a day instead of 2.  She is moving okay, but I see the soreness again.  I'm concerned I've caused even more damage and should have confined her in her stall.  

My vet is also recommending corrective shoeing ASAP based on the dramatic changes in her xrays from last year.  My trimmer completely disagrees so we are sticking with a realignment trim.  Molly is extremely overweight at 1,243 lbs and has a cresty neck.   My vet said she feels her ideal weight is 900-1000lbs.  I think 1000-1100 lbs.  She is a Quarter Horse cross of some kind.  She is very stocky.  

My vet put her on ThyroVet Equine and Wiser Concepts InsulinWise to help her loose weight.   I feed her and her companion 1 bale of hay a day in 2 slow feed nets.  The bales are approximately 35-40lbs so this is pretty close to 20% of her ideal weight of 1,000lbs.   My vet wants me to feed her less hay because she hasn't lost any weight in a year.  I disagree with this too.  

I will work on her case history and get everything updated as soon as possible.  If this is too much in here, I apologize.  I just don't know what to do next.  
--
Yvette G in NY 2021


Yvette G
 

Sorry, I forgot to mention that I have only given her natural treatments for Lyme.  I put her on Tic-X and was able to get her levels to drop.  When she was diagnosed last August I took her off it.   I'm concerned what the Lyme treatments will do to her already compromised condition.  Her levels did increase as of the last test just a couple of days ago.  My vet said she is chronic.  Still waiting for the lab report.    
--
Yvette G in NY 2021


Eleanor Kellon, VMD
 

Hi Yvette ,

We need her case history, labs and radiographs to even begin to sort through this but I can tell you for sure you need to feed her less to get weight loss. That, or muzzle her to slow her down so she doesn't get more than her share.

I'm not saying for sure it's Lyme related but Lyme can cause a severe laminitis - among other things with neurological and joint disease being most common. There are no effective "natural" treatments. The treatment is antibiotics and they won't compromise her in any way.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Yvette, we recommend feeding an overweight horse 1.5% of her current weight or 2.0% of her ideal weight, whichever is the larger amount.  The larger amount for Molly is slightly less than 19# and the smaller is 18#.  She won’t lose weight if she’s eating more than this - hay, bucket food, pasture and snacks included.  What is the size and condition of the horse she’s sharing the bale with?  Ideally, you would separate them to feed them differently, or muzzle as Dr. Kellon suggest.

There seems to be a lot of information we’re missing here so best to fill out the case history form and post it for us to review so we can help you better.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sherry Morse
 

Hi Yvette,

We need to know actual test results to be able to comment better but horses do not "recover" from PPID.  The goal is to keep their ACTH level in the mid to lower end of the normal range.  It sounds like your mare was being controlled with medication and you took her off of it, is that correct?

As far as EMS - you can control that with diet and exercise but again, if you have a horse that tested IR/EMS and then when retested the insulin is in the normal range it doesn't mean the horse no longer is IR/EMS, it just means the condition is controlled.

Equioxx can definitely make a horse feel better if it is in pain but overdoing exercise can cause exactly the effect you're seeing, particularly on a horse with sore feet. Is she in boots?  We do not recommend shoes here as most horses do better with frequent trimming.  If you start a case history and create a photo album in the case history sub group so you can post pictures of the current trim as well as the x-rays we'll be able to comment more on what can be improved there.

As far as weight - obviously Molly needs to lose at least 143 - 200lbs.  To do that you want to feed her 1.5% of her current weight or 2% of her ideal weight - whichever is greater.  If you take 1000lbs to be her ideal weight for now she should be eating no more than 20lbs per day.  That includes hay as well as any concentrates.  If you are feeding her a 35 - 40lb bale of hay a day that's WAY more than she needs.  Your vet is correct that she needs less hay.  You need to weigh out what she's fed each day and make sure she's not eating any more than that 20lbs.  If she doesn't lose weight on the 20lbs per day you may need to cut her back more but given how much she's being overfed right now I think she probably will start to lose on a correct diet. 

Your mini should also be eating no more than 2% of his/her ideal weight per day which may be about 6lbs a day if the ideal is 300lbs so you may need to cut back on how much he/she is getting as well.

Thyro-L can help jump start weight loss but will not reduce insulin levels.  Insulinwise has been found by most members of the group to not do anything useful with regard to weight loss or insulin control. 


 


Yvette G
 

Thank you for the information.  I am working on separating them so I can better monitor how much they are eating.  They each have their own stall and can come in & out whenever they choose into one large paddock.  I do put them in their stalls for breakfast, but they share the hay nets.  Her companion is a mini and was overweight when I got her in November.  I just taped her and hopefully I did it wrong.  She weighs 468lbs and is 9 hands.  Obviously, I'm new to owning horses.  I was told they should have forage in front of them throughout the day, which is why I use the hay nets.  This is how it was done at the barn I bought and boarded Molly at before I brought her home in November, 2020.  Obviously, this life style does not work for her.   

I am working on the case history and hope to get as much as I can uploaded today.  Unfortunately, Molly has taken a turn for the worse and is now on stall rest because she can barely walk.  She's not happy and has started eating the stall door so I've been busy trying to keep her as comfortable & entertained as possible.  Thanks again for all the support.  
--
Yvette G in NY 2021


 

Hi Yvette,

it sounds like your thinking is taking a turn in the proper direction.  I think my first horses years ago were rotund.  I had acres of Vermont pasture and just turned them loose to ‘enjoy’ it.  One of the first things you need to collect for your barn set up is a suitable scale.  I use this one and it has worked well for me.  Although I think I’ve replaced it once, mine gets a lot of use, especially when I was caring for 8 horses here.

There are anti cribbing products you can smear on to slow down the wood chewing.  Cribox has worked well for me but I can’t remember the last time I had to use it.  I use a treat ball as entertainment, adding a few timothy balance cubes.  These balls aren’t the least expensive but they do seem to hold up well and the openings are correctly sized.  The balance cubes make a great feed as they are already mineral balanced but it’s important to note that their caloric value is greater than hay and you should serve 4 pounds of them instead of 5 pounds of hay.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Yvette G
 

Thank you Martha.  I already have the treat balls, but I don't have any place local that carries the cubes you recommended.  The only cubes I can find are Standlee Timothy/Alfalfa.  Any major issues if I use these instead?  I need something sooner rather than later since she is clearly not happy being stalled.   
--
Yvette G in NY 2021


 
Edited

Yvette, those aren’t on our approved feeds list because they aren’t guaranteed to be consistently below 10% sugar+starch.  However, you could do worse and I would probably use them temporarily out of desperation.  Muzzling her would be another option.  In the meantime, look around for a Triple Crown dealer.  They’re pretty much everywhere.  What part of NY are you in?  You can search online for TC dealers.
You can’t really expect her to be happy with your having just removed her greatest source of pleasure but she will adapt to the changes.

I should add that alfalfa can make some horses footsore.  If you have been giving her alfalfa all along, please remove it and see if that helps.  If you start these cubes and notice an adverse effect, please stop feed the cubes as well.  The TC ones we recommend do not contain alfalfa.  There are straight timothy cubes as well but they might be even higher in s/s than the mix.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


 

Hi Yvette,
I saw where you posted your case history with a better description of your location.  Searching the Triple Crown website for dealer locations, there are a few quite close and quite a few more if you’re willing to drive a bit.  It seems that Tractor Supply carries TC but there are others as well.  If they say they are TC dealers but don’t carry these cubes, ask them to stock them.  They sell really well where I am not far away.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 
 


Eleanor Kellon, VMD
 

Yvette,

Please read this https://wp.me/p2WBdh-VH .

486 pounds is what two minis should weigh.  This is what a mini should look like: https://lh3.googleusercontent.com/proxy/E-7DeWmhf_yOFWl-lGImCGu6XDaR9NnRboO3h5Y5H4nH9khHSvZY1le45mMu3eLEHnnjqIrJi2vKWibCSey0ayJ7Luz4MhdOstmlg7l1KFP5bjD3zL95YYvsgBuMy37EZo709_eF9JefApn7fG4
- a miniature horse.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Yvette,

I will be very blunt here - your mini is obese and is also a high risk breed for IR so needs to be on a diet ASAP.  A 9 hand mini should be about 275 - 300lbs depending on body type.  Were these horses mine they would be in a dry lot and separated when fed. 

If Molly's stall opens to a dry lot you can leave her door open and let her move as much as she wants (or doesn't).  The one thing you cannot do is feed her more because you think she should be eating 24/7.