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New Member - advice please

ailsa.gibson@...
 

Hi


I have a funny situation going on with one of our ponies.  She is only about 7 or 8 years old (not sure, a rescue), native irish cob type, about 12 hh.  We have had her 2.5 years with no illness of any type.  She does put on weight easily so we have been careful to limit her grass intake in summer.  She has never had laminitis before or any breathing problems.

About 3 weeks ago she developed a slight cough, and became a bit footsore, moving cautiously on rocky ground. I kept her muzzled during all time on grass after that.

About 2 weeks ago her breathing rate shot up, the cough happened every time she ate, she seemed to be becoming asthmatic, vet looked at her and prescribed ventipulmin, he was not concerned about lamintis. 

She didn't respond to the ventipulmin and a few days later ended up with a breathing rate of 72 per minute, and severe lethargy, unwilling to walk, so was put on antibiotics, steroids and pain killers as they thought she may have pleurosy or some kind of chest problem. Vet was still not concerned about laminitis as she had not signs of it in her stance, apart from not wanting to move. Her breathing rate quickly responded and dropped back to about 16 per min within a couple of days and she was trotting around again.  We then stopped the pain killers and steroids.

In the last few days her breathing has stayed ok, not quite normal but not massively elevated, however she is in pain from her feet.  Vet has x-rayed today and found slight rotation in one front, but the other looks ok.  However an abscess can be seen in the same place, on both front feet, at the toe, near the whiteline, kind of directly where the pedal bone is pointing too.  So vet now agrees there are some laminitic changes.  We've tried to access/drain the abscesses but no luck.  Farrier will try tomorrow.  

Blood has been sent off for IR testing and ACTH for Cushings (but she is quite young), should be back tomorrow.

She is confined to our field shelter with her feet poulticed and padded, and on a bed of shavings with normal hay. I'm going to soak tonight's hay for her shortly.  Not on any painkillers or other drugs.

I guess it is laminitis.  Hopefully the blood results will be clear if there is a cause from IR/PPID.   What I really wondered is whether people had experienced similar linked breathing issues?   The vet can't think what would cause both the breathing problem of last week, and laminitis.  We did discuss maybe the breathing was because of pain, but the vet thinks it was such a reaction that surely she wouldn't have been able to stand so well (there was no rocking back or lying down more than usual).

Any thoughts welcome.

I have xray images but not sure how to upload!

Thanks
--
Ailsa Gibson
UK
2019

Eleanor Kellon, VMD
 

It can take up to two weeks for insulin to return to normal after treatment with steroids so depending on timing here you may have to retest the insulin.

What are you seeing on her feet that you are calling an abscess?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

celestinefarm
 

Alisa,
Is your vet certain your pony did not ingest a poisonous plant in her pasture? I don't know what poisonous plants are a problem in the UK, but here in the USA, we have a list of them.  Some of the symptoms you describe also appear in poisoning cases. The rapid respiratory rate and subsequent laminitis....
Just another consideration.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Sherry Morse
 



ailsa.gibson@...
 

Thank you very much for all your replies!

I had also thought of poisoning, so interested that it came to your minds too.  We have been scouring our field and cannot find anything that could cause it, and our other horse is fine, but we will keep looking and thinking.

Vet receptionist says the results are back but she wants the vet to "interpret", so I have to wait until Sat morning in the UK.  Thanks for highlighting that the insulin results may be affected by the steroids.  They only stopped a few days before the blood sample.

I will do the Case History tomorrow.  I have just posted her x-rays here: https://ecir.groups.io/g/CaseHistory/album?id=95107
You can see a little dark area on both feet below the point of the pedal bone.  This is what the vet thought to be an abscess on both feet, but could not find any pus.   The farrier looked today and did not dig any more, he called it not an infection, but a pocket of gas/space caused by the laminitis.  He suggests just keeping a clean dry poultice on and letting it heal/grow out.  The pony isn't hopping lame, like horses with abscesses often are.  The farrier has trimmed her toes back.  I don't have any "after" x-rays.  She is perky today (keeps trying to escape the field shelter where I am temporarily stabling her!) but still very lame.  I am thoroughly soaking her hay and double netting it for now and will read up on your diet suggestions as I worry I'm taking the vits/minerals out of it.  She is used to ad lib hay alongside my big horse, so restricting things, soaking, feeding them differently will take some working out but can be done.

Thanks again, and I'll post what the blood results are tomorrow.  If they are normal I guess it suggests we are looking at some kind of poisoning.
--
Ailsa Gibson
UK
2019

X-rays: https://ecir.groups.io/g/CaseHistory/album?id=95107

Sherry Morse
 

Hi Ailsa,

I'm inclined to agree with the farrier as those do look like gas pockets, and she does have quite a bit of rotation in both feet.  I'd question if those were new changes though, although I'm far from an expert on feet.  If you can also take pictures of her hooves as outlined in the trim section of the welcome letter that will help us provide further trim recommendations (which can always help no matter what the cause of the laminitis).  


ailsa.gibson@...
 

Thanks, I'll add some hoof photos when I change the padding/bandage tomorrow.

I just thought of another question, sorry, re the blood results tomorrow - would the use of the steroids artificially lower, or raise, the insulin levels?  She was on prednisolone for 5 days until about 48 hrs before the sample.  Does that make the results pretty untrustworthy?

Thanks
--
Ailsa Gibson
UK
2019

X-rays:  https://ecir.groups.io/g/CaseHistory/album?id=95107

Lavinia Fiscaletti
 

Hi Alisa,

Thanks for putting up the radiographs.

There is definitely some slight bony column rotation in both feet, soles are pretty thin. There is some arthritis and a degree of sinking as well. I totally agree with the farrier that more digging around was not a good idea. Also good that he trimmed the toes back as they were definitely too far out ahead of where they should be. Also need to lower the heels a bit to address the rotation.

Although some of this may be new, some seems to be older damage as you can see event lines in the bottom 1/3 of the hoof wall.

Don't need to worry about losing vit/minerals with soaking in the short term.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR Hoof

ailsa.gibson@...
 

Hi

Thank you for all your advice and thoughts on the xrays earlier this week. 

I've been near enough following the emergency diet, and have kept her confined on a deep soft shavings bed, and the pony is a lot more comfortable already.   Her blood results are back and I have filled in a Case History file, it is in the signature.  She was totally clear of Cushings, but has a bit of a crazy glucose/insulin profile I think. The vets said EMS and to get weight off her.  I'd appreciate any opinions on it, I especially don't understand the output from the online IR calculator.  However, the blood sample was taken when she had only been off prednisolone (cortisone?) steroids for 48 hours so may be unreliable.

Her breathing is now fine and she is off all medication for that.  I increasingly think the breathing problem was her way of showing pain from laminitis now.  She has never had any breathing problems previously!  I do fear the steroids she was given for it may have tipped her into laminitis. But it's a bit of a chicken and egg situation, I can't tell what came first.

I have been reading lots of info, trying to plan for how to manage her better in future, and I've ended up with quite a few questions.  Hope it's ok to ask!:

0)  What do her blood results show, re IR / EMS?  Or are they worthless due to the steroids?  I can just proceed assuming EMS for now. 

1)  We have all our hay and haylage in storage for the year, I will get it tested.  Until I know its values I guess I keep soaking hay and feeding 2% of body weight. I'm about to buy some linseed/flax and I am also giving her the usual forage balancer minerals mix I have always used with my two horses.  Could anybody tell me if that looks ok to keep on with using? It has a full analysis/ingredients here: https://forageplus.co.uk/product/hoof-and-skin-health-winter-horse-feed-balancer/ 

2)  How long after she seems to be walking comfortably again dare I safely let her out alone in our dry lot/run?  She is already really bored, not used to be confined in the field shelter! And how do I tell when she is ok to go back out on the track (even if fully muzzled) for a while each day with my gelding?  (They are great friends, but can run around together a lot.)

3) I think read something on here about being wary of red/brown salt licks and iron.  She loves her salt lick which is a big quarried chunk of pink rock salt. Is that ok? 

4) You recommend non mollased sugar beet as a carrier for minerals etc and forage replacer.  I read on another site that as it tastes sweet it tricks the metabolism into thinking sugar is on its way, producing more insulin, making them hungrier and increasing leptin resistance. Is that ever a known problem? 

5)  If she is "just" an EMS case due to obesity (though there are far fatter horses all around us, without laminitis, which concerns me) is there a good chance that if I can get weight off her, then retest her blood, that she might have a normal profile again and be able to cope with a little grass each day in the long term, as long as I keep her slim?  Or do these problems tend to stick?


Thanks very much for any thoughts,

Ailsa



--
Ailsa Gibson
UK
2019

Case History:  https://ecir.groups.io/g/CaseHistory/files/Ailsa%20and%20Trixie
X-rays:  https://ecir.groups.io/g/CaseHistory/album?id=95107

Sherry Morse
 

Hi Alisa,

Hopefully Dr. Kellon will jump in to discuss the bloodwork results more completely but the results given indicate that while she is IR it's under control at the moment.  So with that in mind you're going to want to be mindful of her diet forever so she hopefully doesn't have another laminitic episode or slip into the 'uncompensated IR' range.  

You'll probably never really know about the steroids tipping her to laminitis but just keep in mind if her breathing was that elevated due to pain in her feet she was probably already having an issue so yes, definitely a chicken/egg sort of thing.

Since you don't have a current or ideal weight listed for Trixie just keep in mind that you want to feed her either 2% of her ideal weight or 1.5% of her current weight (whichever is greatest) to get her weight down.  Without knowing the hay values it's hard to say for sure about the balancer - knowing it's from Forage Plus it's probably a good general balancer, but one of our other members may know more about it.

If she's walking comfortably you can let her out again - we don't advocate forced exercise but if she's willing to move on her own it will help with a multitude of things if she is moving.  The same for letting her back out on the track - if she's comfortable in the dry lot and you think that the gelding won't harass her into moving more than she should be you can let her out with him again. Just be sure (of course) to monitor them to make sure he's not making her move than she wants to.

I'm not an expert on salt licks but that sounds like it's a Himalayan one? We don't recommend those either, just the plain salt variety.

If you use beet pulp we recommend rinsing it, soaking it and rinsing again (R/S/R) so the odds of it tasting sweet are slim to none (having inhaled a fair amount of it I don't think it tastes like anything but I'm not a horse).  That bit about 'it tastes sweet so it tricks the metabolism...' sounds like hogwash to me but one of the vets may be able to comment more on that.  Would love to know where you saw that too.

Getting the excess weight off (and then keeping it off) is the best way to control IR but it doesn't mean that she can then return to going out on grass with no worries.  More likely - given that she has evidence of previous laminitic episodes - she's going to need to be kept muzzled whenever she's not in the dry lot.

Hope that answers most of your questions and I'm sure others will chime in as well.

Eleanor Kellon, VMD
 

On Tue, Sep 10, 2019 at 07:11 PM, <ailsa.gibson@...> wrote:

0)  What do her blood results show, re IR / EMS?  Or are they worthless due to the steroids?  I can just proceed assuming EMS for now. 

Were these fasting blood tests? When had she eaten last? The adiponectin result confirms IR and insulin is elevated per the lab's ranges, but glucose is so low it's incompatible with life so the sample likely sat unspun at a warm temperature for quite a while. In any case, because of the recent steroid treatment she should be retested  In humans, prednisolone causes adiponectin to rise while in healthy dogs it has no effect. We don't know what it does in horses.



1)  We have all our hay and haylage in storage for the year, I will get it tested.  Until I know its values I guess I keep soaking hay and feeding 2% of body weight. I'm about to buy some linseed/flax and I am also giving her the usual forage balancer minerals mix I have always used with my two horses.  Could anybody tell me if that looks ok to keep on with using? It has a full analysis/ingredients here: https://forageplus.co.uk/product/hoof-and-skin-health-winter-horse-feed-balancer/ 

It's fine to use until you have a hay analysis. Feed her 2% of her correct body weight or 1.5% of current weight, whichever is larger.

2)  How long after she seems to be walking comfortably again dare I safely let her out alone in our dry lot/run?  She is already really bored, not used to be confined in the field shelter! And how do I tell when she is ok to go back out on the track (even if fully muzzled) for a while each day with my gelding?  (They are great friends, but can run around together a lot.)

Agree with Sherry.

3) I think read something on here about being wary of red/brown salt licks and iron.  She loves her salt lick which is a big quarried chunk of pink rock salt. Is that ok? 

It's your choice but be aware the colored "natural" salts are nothing more than dirty salt,  contaminated with all sort of other minerals, most of which are not healthful.

4) You recommend non mollased sugar beet as a carrier for minerals etc and forage replacer.  I read on another site that as it tastes sweet it tricks the metabolism into thinking sugar is on its way, producing more insulin, making them hungrier and increasing leptin resistance. Is that ever a known problem? 

Pure nonsense.

5)  If she is "just" an EMS case due to obesity (though there are far fatter horses all around us, without laminitis, which concerns me) is there a good chance that if I can get weight off her, then retest her blood, that she might have a normal profile again and be able to cope with a little grass each day in the long term, as long as I keep her slim?  Or do these problems tend to stick?

https://wp.me/p2WBdh-Iq . Obesity doesn't cause EMS. It's the other way around.

 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001