Topics

Laminitis Triggers

ironic_acres@...
 

I have been a member of ecir.horse since 2013, with this horse. He has been controlled since that time. Last year, he was diagnosed with a 'neurological deficiency'. Lyme test came back negative, negative, negative (see Case History) and because of the inaccuracies in EPM testing, vet decided it would be best to treat for EPM. Ninety days generic Marquis (Marquis was out of production at the time of treatment) and he still failed a neurological so started on a regiment of DMSO/Toltz for 90 days. During treatment, he had a bout of laminitis that we attributed to protozoa die off. That hoof capsule has almost completely grown out (since December/January).  Fast forward to May, still neurological so vet recommends treatment for Lyme. Thirty days oral Doxycycline. About half way through treatment, he was having trouble getting up, walking and was very uncoordinated additionally he was presenting as acute laminitis. We finished all treatments, pulled blood values for ACTH and insulin (in case file). ACTH controlled, insulin high. Additionally vet started him on Thyro L as his fat pads have fat pads. 
It has been 30 days and he has lost some weight, but neck still cresty and sheath still swollen. He is on a roller coaster of lameness due to laminitis. There is no set pattern as I have kept track of good and bad days trying to find a trigger. Weather (humidity and temperature) has not show to be predictable, either has days out from Cabergoline dose. Yesterday he was almost sound, today he can't move. He is stalled during the day in deep shavings and out in a dry lot with his buddies at night (in Cloud boots). Our routine is obsessively consistent. 
My question is, what could possibly be the trigger? I am reluctant to put any more chemicals (treatments) into him and don't know the next steps. Money IS limited as the above treatments were well over $5,000 in the last six months. What are my next steps?
Thanks all!
--
Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω

Eleanor Kellon, VMD
 


First, I want you to understand we can't prescribe for your horse and without being able to actually see him and do hands-on evaluations we're very limited. That said, this is my impression from the information available.

I would stop testing him for things that have no convincing diagnosis - PPID, Lyme, EPM. No cabergoline. Focus on what you know is real - the
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Eleanor Kellon, VMD
 

Sorry - having trouble with my keyboard.

.....the
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Eleanor Kellon, VMD
 

…. the EMS.

 

Start soaking his hay. If your current hay has been balanced, continue that. If not, go with the emergency diet. Feed him 1.5% of current weight or 2% of ideal weigh, whichever is higher.

 

He may be profoundly insulin resistant and require medication to get him under control. I would start with metformin 30 mg/kg twice a day. If that doesn't work, go to Invokana. Also consider Jiaogulan or LaminOX for hoof support.

 

The possible neurological disease concerns me but I also wonder if this may actually be pain from laminitis. If you don't have hoof radiographs I would definitely get them and post hoof pictures for review. Getting him the hoof care he needs on the trim and boots end of things could make a big difference


--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

ironic_acres@...
 

Thank you. I understand that you cannot diagnose via this group. Your advice is very difficult to hear as I have been trying to follow the advice of my vet based on his interaction and observations of my horse and his history. So if I understand you correctly, stop treating for neurological symptoms unless we can identify a specific  diagnosis? Additionally stop Cabergoline? He was started on this due to the Stim Test a year and a half ago that was run twice with the same results. At first we thought the blood might have been mixed up, but second blood test showed same results. I am willing to stop it, but nervous considering the time of year. Should I stop Cabergoline and retest ACTH and insulin/glucose in 30 days?
Thank you.
--
Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω

ironic_acres@...
 

Sorry Dr. Kellon, I responded before the rest of your message came up. I still have the above questions, but I will start soaking his hay and track results. Additionally I will get the Metformin. Should I tapper off the Thryo L first or keep that as it is? He is on Jiagulon, but I can up his dose easily. Again, Thank you for your input.
--
Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω

Amy Veatch
 

Hi Tracy,
The neurologic part of your post caught my attention.  When Princess had her acute laminitis episode last October, we found her down in the pasture and once we got her up she was staggering and off-balance to the extent that me and the vet (at first) thought she had possibly consumed a neurotoxin.  Turns out it was endocrinopathic laminitis and that her neurologic-appearing movement was not unusual, which makes sense if you think about it--pain in all 4 feet and a LOT of body pain from bracing that went along with it, so no wonder she was staggering and unsteady.  It resolved very quickly on the emergency diet, right along with her hoof pain. Just tossing that out there. :-)
--
Amy & Princess (12 year old KY Mtn Saddle mare) & Max (6 year old mini gelding) - both PPID/IR
Southeast TN, Joined 2019

Max:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=134444&p=Name,,,20,1,0,0

Princess:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Pincess

https://ecir.groups.io/g/CaseHistory/album?id=96097

 


Amy Veatch
 

one more thing . . .
Because Princess seemed to feel better after moving around, Dr. K recommended I put her on jiaogulan and leave her out in a small enclosure full-time (to allow her to move and encourage the circulation in her feet).  The stall thing just wasn't working for her and once we moved her outside (I kept her alone but with buddies across a shared fence so nobody would push her around and force her to move more than she wanted to) and added the Jiaogulan, she improved very fast. 
--
Amy & Princess (12 year old KY Mtn Saddle mare) & Max (6 year old mini gelding) - both PPID/IR
Southeast TN, Joined 2019

Max:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=134444&p=Name,,,20,1,0,0

Princess:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Pincess

https://ecir.groups.io/g/CaseHistory/album?id=96097

 


 

Tracy, from what I understood Dr. Kellon to say, you should stop spending your money on testing for extraneous conditions.  I did not read that you should stop any treatments.  I may be the one who misunderstood so I would not make any changes before you clarify this.
--
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


 
 

Cheryl Oickle
 

Was he ever tested for West Nile?

--
Cheryl and Jewel
Oct 2018
Port Alberni BC Canada
https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel

https://ecir.groups.io/g/CaseHistory/album?id=81063

ironic_acres@...
 

I have seen it written here many times....the devil is in the details. In my narrative I left a few details out because they were either in my case file, or I did not think they were necessary. I apologize. Here are some more details, but I will still try to be concise.
Up until the end of June last year, Migo was ridden regularly. We had already gone on three, week long camping/ trail riding trips and two weekend horsemanship clinics. All was normal. Then at the end of June, he started having behavior problems that I attributed to his dominant nature. They hadn't been a problem in years, but originally, they felt the same...refusing to canter, cross-firing when he did, asking to not go up or down big hills (he did this in the first week of June no problem) and having a ton of thresholds. They progressed. Physically he started tripping, he couldn't step down from a trailer, but the most concerning part was he was conceding leadership to his herd mates. He also was getting ridiculously spooky.
I had my local vet come and do chiropractic and acupuncture treatment (he has an old SI injury and it felt the same). During his treatment he said that Migo reacted severely to both his EPM and Lyme pressure points.
I am not here to argue alternative care, however, I believe it is complementary. I was not willing to treat for either disease without more conformation. We did a Lyme test (which came back negative, negative, negative) and because I was not willing to do a spinal test, I took him to a larger vet hospital about an hour south to a lameness/neurological expert. A full lameness/neurological exam was preformed. This vet also knows this horse and worked with my local vet. It was decided that Migo had neurological deficiencies consistent with EPM. The three of us discussed next steps and decided 30 days of Marquis. It was on back order so had to get compounded from Rood and Riddle. After 30 days, there were mild improvements so an addition 30 days was recommended. I did a total of 90 days.
At that time I took him back to the larger vet hospital for a re-eval. He had some improvement, but still was neurological. Again, upon discussion we tried another treatment that targets the fairea protozoa. It is off label use, but felt I had few options. This treatment was more difficult physically for Migo. I do believe after 7 days he had a laminitis attack. Treated him as such and he seemed to bounce back fairly quickly. Fast forward 90 days. We are now in the beginning of March. He seems fine and I slowly start working him to build his hind end (all online or at liberty). By the end of March, he is laying down more and more. When he did get up, he would be stiff and walk like an uncoordinated kitten. I stop working him immediately.
Local vet has been doing regular acupuncture treatments to help manage pain. I somehow let him convince me to treat for Lyme. That is when we started doxycycline. Fifteen days into treatment and Migo is worse but this is also when I had to change hay. I was worried but happy when I thought my hay was too high in sugar because that would have explained the cycle of lame, almost dead sound, lame and I mixed new and old hay together to get them used to it. But a message posted here, showed me my mistake...but that left me with no trigger. 
I feel that last June, EPM was the culprit. I have no proof. In hindsight, the cycle of laminitis that started in March feels very endocrine driven...and he is as fat as a toad because he hasn't been working since last June, so it makes sense.  
I apologize for the novel, but I just don't want to miss something. He is still very unpredictable in his lameness level and I was not certain what could have triggered this since he was fine on this protocol for so long, but I guess they are all fine until they aren't...it takes the smallest event to tip the scale. 
I started soaking his hay this afternoon and feeding him his mineral bucket as always but I upped his jiagulon. Is there anything else I should be doing? He is in a deeply bedded stall or in Clouds so he can socialize with his herd in a dry lot. He moves great in his boots. I can't leave him out with them all the time since their hay is not soaked.

He has not been tested for West Nile, but he has been vaccinated. I don't know if that makes a difference or not. 
Thank you all for your responses.
Tracy and Migo
Ohio
February 2013

Case History
Migo's Photo Album 
Ω

Sherry Morse
 

Hi Tracy,

You have Migo's weight currently at 250lbs over his ideal and your CH says he's eating 15lbs of hay a day, but that was in 2010.  How much hay is he currently eating?  Is he still getting ODTBC as his mineral carrier?  Was he evaluated for kissing spine or other issues with his neck when he had the full lameness/neurological exam?  What does his current trim look like?  (Just as an FYI, your photo album no longer exists so some updated pictures as well as x-rays would be helpful).

If he's comfortable in the boots I would leave him in them. Go back to the basics of the emergency diet (which you already are) and see how things progress from there. 



 

Hi, Tracy. 
Is Migo lying down to sleep? A long shot... but when my sleep-deprived Paint (used to be called narcoleptic) starts falling asleep on her feet, especially if she isn't on level ground, she looks like she's having balance problems, crosses over in front, looks uncoordinated and neurologic. She also drops her head. It all means she's about to fall asleep on her feet. I doubt you'd miss that but thought I'd ask.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

ironic_acres@...
 

Sherry,
Those numbers are current. Migo should weigh approximately 1,000 pounds. He was at 1,250 but has already dropped weight since being on the Thyro L. He is now about 1,200. Based on his desired weight he gets 15 pounds of hay. I started soaking this week. Additionally he gets his 1 pound TCBC with his minerals balanced to hay analysis. This has been his diet since 2013 with small changes here and there. Surprisingly, he is not a big eater.
The lameness exam was pretty encompassing. He was cleared of Kissing Spine and complications with his SI joint injury. Hoofs and legs were clean.
His current trim is a work in progress as in March, when this round of 'things' started happening, he began laying down a lot of hoof. I mean, a lot. I could take off 1/2 a week and never get a head of the curve. His chestnuts, ergots, mane and tail have been on overdrive as well. He shed just fine and coat is normal, shiny as can be.
I am working on getting photos and xrays. Lynn (an expert picture taker here on ECIR) is going to help me. I want the photos to be on the same day as the xrays and am trying to get that scheduled.

Thank you,
Tracy and Migo
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Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω

ironic_acres@...
 

Thank you, Cass. I think he is laying down because he is stiff and sore. He has never been one to exert energy on any type of activity but this is different...he will get up eventually, but spends more than his normal time down. If he is up, he is mutual grooming a buddy, eating or drinking. Thanks for your experience. I am open to any ideas!
--
Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω

Lorna in Ontario
 

Hi Tracy,

Is his height correct,at 14.3hh ?

--

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

ironic_acres@...
 

He is probably closer to 14.2, but yes. He is a BLM Mustang with heavy draft influence...a Dang :) 
Tracy and Migo
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Tracy and Migo
Ohio, USA
February 2013

Case History
Migo's Photo Album 
Ω