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Looking for feedback on hoof progress


liisaacson
 

Hi All,

I have been managing a laminitis & rotation in my horse, Haven. We had several mis-diagnoses from August through December of last year, finally seeing the rotation on his rads in December. My vet says the bloodwork shows he is borderline IR, so I'm hoping it is OK for us to be here. 

We have had a set of rads done each month and his rotation continues, so I'm in a bit of a panic, feeling like I am missing something big. I had the February 2021 rads done at the tail end of a severe cold snap here in MN and have since moved him home to a heated barn & his comfort has improved. He is stalled most of the time and out in a small 20' x 20' paddock each afternoon when it is above freezing (since i really don't know the magic number in terms of temperature that is contributing to the winter laminitis flareup). He is still sore walking, but happy to wander at his amble pace.

I have the farrier coming back on March 5 and wondering if our approach is right (keep cutting back the toes, keep him in wide web shoes and pads).

His case history, bloodwork, rads and hay analysis have all been uploaded. 

I did have additional insulin & glucose bloodwork sent to Cornell on Tuesday morning and will post the results when they are available.

I first joined the list in 2015 when my old man, Courage, was diagnosed with Cushings, but we have not had to ask for any help as he is handling it very well with 1 Prascend daily.

Thanks in advance for the help!
--
Lisa and Haven
Independence, MN
2015

Haven's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Haven 

 

 

Haven's photos: https://ecir.groups.io/g/CaseHistory/album?id=261155 


Sherry Morse
 

Hi Lisa,

You'll be getting a full welcome shortly but would help us if you could add pictures of Haven's feet to the photo album when you have a moment.  At a glance his toes are too long in every set of x-rays so the first thing I would suggest is checking out the Wiki on getting photos taken for markups and once those are up post another note with the title "Lavinia Mark-ups Requested" or something like that so you can get on the list for Lavinia to provide recommendations for your farrier. 




Lavinia Fiscaletti
 

Hi Lisa,

Sorry that Haven is going thru all this. His blood work is definitely positive for EMS/IR, which is no surprise as he is a Morgan - poster children for IR. Likely, he has been IR all along but being in steady work was keeping things under control. Once He stopped working, he crossed the threshold and became symptomatic. His PPID test is negative. Really tightening up his diet is going to be key to resolving the underlying laminitis. Because endocrinopathic laminitis ins not an inflammatory condition, NSAIDs won't help. Putting him on the emergency diet until you can get his hay tested, then mineral balanced appropriately will help immediately. The winter laminitis issues are building on the base laminitis because the cold temps (anything below 50*F) can trigger vaso-constriction in susceptible individuals. Any time the temps dip into the 40s and below, blanketing him, putting wool socks on his feet inside of boots will help maintain blood flow to the hooves. Fleece-lined shipping boots are another option to keep the lower legs and feet warm. He can be allowed to wander at his leisure as long as he isn't on NSAIDs.

Thanks for uploading the series of rads. There is no bony column rotation present, but there is capsular rotation. Capsular rotation is a trim issue where the laminar connections are being strained by the lever forces being applied from too-long toes.The LF bony column alignment is really spot-on, while the RF has a broken back HPA. Heels are seriously underrun on the RF, which is being compounded by the shoes.There is some degree of sinking but it's hard to tell how much since the rads don't have the coronary band marked. His walls are medially taller on both feet. Both have side bone, with the medial side more advanced. Sole depth is adequate. The toes are getting progressively longer between trims/resets, which says that the trim interval is too long. It also points to the trim not taking the toes back far enough to set the breakover where it should be. We don't recommend shoes for laminitics as they tend to make it harder to do trims in a timely manner and are really only a band-aid to cover the actual issues.

Pictures of the feet would be helpful. Here's what is needed:

https://ecir.groups.io/g/main/wiki/1472

All of this appears to be fixable if the trim gets the mechanics tightened up and the underlying EMS/IR that is driving the laminitis is managed properly.

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


 

Hi Lisa,
As an ECIR member who just made her first post, you are receiving this official welcome from the ECIR group.  I’ll address a few things I noted on what you’ve already submitted (thank you very much!) and then finish with the ECIR group welcome letter which may be mostly familiar to you from your experience with Courage.  Please read it over, even with your previous success because, although PPID and IR have certain management similarities, there are things you may have overlooked because of their differences.

The guidelines still involve Diagnosis, Diet, Trim and Exercise (DDT/E).  You have your diagnosis with his insulin test.  

The hay looks to be adequately low in s/s but, as he’s overweight, it needs to be weighed out to accomplish an organized weight loss.  We recommend 2% of his desired weight or 1.5% of his present weight, whichever is larger, for his entire feed allotment, including hay, treats, and supplement carrier.  He should not be allowed grass.  You will want to ‘balance’ his hay rather than feeding him a ‘balancer’.  The idea is to provide for him what his hay does not, in correct ratios.  A commercial balancer is mostly carrier with supplements he may or may not need.  You will read more about that in the welcome materials.

Sherry has addressed his trim.  As she said hoof photos would be helpful to see if your trimmer has made progress toward the goal.

Drugs are another issue which is not one of the D’s in the acronym.  There is no anti inflammatory which will address the pain from laminitis, a non inflammatory process.  Any relief he gets from the bute is probably for muscular pain associated with assuming a stance less painful for his feet.  We recommend weaning horses off bute after a few days during the acute phase, according to the link here.  The only way to relieve the laminitis pain is to remove the triggers, generally high insulin and/or inappropriate trim.  Occasionally drugs such as metformin are used to attempt to decrease exceptionally high insulin, which is not Haven’s situation at this point.

And now for the welcome letter!

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. 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. 

 

--
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


 
 


liisaacson
 

Thank you!  I will try to get furry pix shortly and post them (apologies.. i didn't realize they were needed). 
I noticed the hay balancer experts file & will try and find someone to look at our hay analysis and make some recommendations.

Q: on shoes... The goes against my vet's recommendation, so i'm interested on this point.  I'm happy to pull them and try out these boots (seems like Clouds are the recommendation) but I'm concerned about pain and knowing which inserts/etc. Can this group help there? Is it always recommended that they go barefoot in these cases?  I did a little poking around last week and I do think his feet are round-ish enough that the Cloud sizing would likely work for him though I noted inventory was low at the time.  Are there other brands recommended?

Thank you so much!  I've had him since he was a baby & this is devastating (as you guys all know)

Lisa
--
Lisa and Haven
Independence, MN
2015

Haven's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Haven 

Haven's photos: https://ecir.groups.io/g/CaseHistory/album?id=261155 


 

Lisa, I’m not one of them but there is an incredible amount of knowledge and experience with boots among the group members.  You might post a separate thread with a question on boot choice and fitting before you decide which ones to purchase.  I’ve also seen mentioned a FB group which deals in used boots, which might be useful in sorting your way through them.
--
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


 
 


Gilly Edwards
 

Hi Lisa 

I have had great success with the softrides boots.  They also have a selection of inserts to suit the horses needs.
--
Gilly 
VA
2020


Sherry Morse
 

Hi Lisa,

There's a very good chance that Haven's feet will require several different size boots as he grows a correctly sized hoof.  If you're on Facebook there are a number of used hoof boots (Hoof Boot Exchange is a popular one) which would maybe help you with buying and selling as needed.  For rehab we do recommend either Clouds or Softrides. 




liisaacson
 

Hi All,

I'm trying to upload his furry photos and the hoof shots will not display. The file name show up in the dialog box but the image box displays as gray with a blue question mark. The body shots do display and I took them all with the same phone camera this morning. All images are jpegs. The hoof photos are smaller than the body ones. Any idea what I might be doing wrong?

--
Lisa and Haven
Independence, MN
2015

Haven's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Haven 

Haven's photos: https://ecir.groups.io/g/CaseHistory/album?id=261155 


Sherry Morse
 

Hi Lisa,

I don't have any words of wisdom because the images appear to have uploaded, but just as blanks.  I'm guessing you can see them without a problem on the phone though?  The only thing I can think of is that it might have something to do with the size of the images - the hoof images that are not actually there are all over 600kb (except the RF Dorsal - that one says it's 325kb) while the body picture is 225kb.  Is there an option to resize the hoof pictures to that same kb amount and see what that does?




 

Maybe, if they load up for you on one of your devices, take a screenshot and see if that will load.  The rads all appear to be screen shots and they load fine, except the one that was annotated which takes a long time to load for me.
--
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