New to the group, new to laminitis


Wilmary
 

Hi everyone! 

I have a horse with rotation and sinking that arrived about 2 weeks ago. I have no other history. And currently on the emergency diet: 

 

18 lbs soaked 45mins to 1hr Bermuda hay

2 lbs Timothy pellets soaked

Cali trace plus

MadBarn Extra Cu and Zn (I was advised to do so with my other horse and made a crazy difference)

4-6oz TC golden ground flax 

2oz loose salt

GutX

 

He is a late teen/ early 20s paint gelding and underweight. 

 

He arrived Nov 8th (was seen by a vet in TX for X-rays on 10/20) and I got to work on his diet. He is extremely lame still, laying down less though and standing pretty square now but active weight shifting. Not sure how long he’s been on bute for if at all before arrival. Abscessed in both front feet. 

 

Vet came Nov 10 for initial exam started him on bute and said he needs to be on it for a LONG time which I’m not comfortable with. Will be waiting on vaccines due to current situation. Waiting to do blood work at this time since she wanted to give him time to adjust before we do anything else. Said we need to keep the inflammation down. I have no experience with founder but she mentioned he is no longer active due to no pulses and very slight heat. His feet were actively crumbling to the touch but have become pretty stable at this point. 

 

My questions are: 

 

Is there something I can do to replace the bute? I stopped the bute last week but he is pretty much struggling to move at all at this point and I’m struggling with doing nothing else. She did not recommend any other form of pain control long term but I would very much like options because I’m also worried about the strain he is putting on the rest of his body. 

 

We have a shortage of hay where I am so testing is difficult in my case as I pick up hay weekly due to limited, better quality hay options. 

How often should X-rays be taken to check for progress? 

Should I keep him confined? He is in a 18x18 stall now but can be moved to a 30x30 pen, I’m struggling to decide if movement should be limited or encouraged in his condition. 

 

What else do I need to be doing? 

 

Has been seen by 3 vets in total, all thought we can bring him back and be comfortable enough to ride someday in the very distant future. My spirits were shattered by a ECIR Facebook group dead set on him being put to sleep so I came here instead. I want to give him a chance and see if he responds.

 

Currently in cloud boots and pads 24/7 with 30 mins of drying and cleaning out daily. Was trimmed by hcp 11/12/21. Hoping to get her out this week or next at the latest. 

 

Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Trisha DePietro
 

Hi Wilmary. Welcome to the group. You have a lot of great questions and David is lucky to have you advocating for him. 

Pain control is a sticky point. You were right to take him off the bute. There are other options- first making sure his trim is ideal is really important. You can submit your photos and Lavinia, who is our hoof expert,  she can review them and make recommendations for your hoof care providers next trip in. Its good to stay on top of the trim, every 2 weeks or sooner depending on his response. Please see this link on how to do the photos and what is needed for the very best advice- 
  https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help  
The next  link talks about what "safe" feeds are for horses with PPID/IR I did not see the Mountain Sunrise on that list- that maybe something you want to replace with one of the feeds in the link.
https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/Safe%20Bagged%20Feeds.pdf-- 

Also, you can search in the search box at the top of your screen for more information with in the messages, files or WIKI areas.  AND within our welcome letter there are blue links that will take you to more specific information. There is a section on pain control as well....I see your vet diagnosed the PPID...but I didn't see any bloodwork posted...you might want to consider getting an ACTH level, insulin and glucose level to ensure that you are dealing with a true PPID case. Sometimes these horses also have Insulin Resistence too and that needs to be addressed as well. Getting a good diagnosis is part of the building blocks to returning health to your horse....If you have more questions- let us know. 
 

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


Nancy C
 
Edited

Hi Wilmary

Welcome.   You are in the right place to help your new guy. You are off to a good start with Trisha's welcome post.

I was concerned about this bit of info, as it is not usual for our Facebook Group to respond in this way. We have seen a lot of horses turn around when given a chance.

Was this another metabolic FB group?

Thanks for any info.


On Wed, Nov 24, 2021 at 02:29 PM, Wilmary wrote:
My spirits were shattered by a ECIR Facebook group dead set on him being put to sleep so I came here instead. I want to give him a chance and see if he responds.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

2021 NO Laminitis! Conference Video Recordings available to new subscribers 11.09.21
  www.nolaminitis.org



Wilmary
 

Hi Nancy, sorry I should clarify. It was not Dr. Kellon’s ECIR group but it is a Dr. Kellon and Pete Ramey based fb group which I love most of the time. The majority of the commenting parties to my post were owners not professionals but it still put a bit of a dent in my hope. 

Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Bobbie Day
 

Wilmary
I hope you don’t mind my two cents, although these other groups have very good intentions it is not something you will ever hear from Dr. K or Pete. He doesn’t run that site anymore or I’m sure he would have suggested that you join here and encourage not discourage. Pete has actually helped many here but he handed over that page awhile back because it just grew too much. My little mare had a very bad case and when he was there he actually did markups for me and never once suggested I put her down.
On this group you will get nothing but support, I’m sure I speak for everyone when I say that when or if that time comes it’s your and your horse’s decision not ours. We support each other and we will all help you every step of the way. There have been many, many severe cases here, and many successful rehabs but of course you have to commit to the protocols to give your horse the very best chance.
We’re here for you and we will never discourage!
Your not allowed to beat yourself up, just dig in your heels and get to work!
Your off to a great start, you found us 😊


--
Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


 

Good luck with everything you’re trying to accomplish! I have replaced bute with Absorbine “buteless bute” at the recommendation of a natural hoof care farrier. She told me that in her experience it was a valid substitute. I don’t know for sure since she also trimmed my horse’s sore club foot at the same time, but for whatever reason my horse is walking much better. This was an abscess rather than a laminitis situation but just wanted to share the bute info.
--
Susan H TX 2021


 

Hi Wilmary,
I’m glad you found your way here!  I read through your FB post and the comments it elicited.  I’m not sure what the take away from that would be - a good reminder of why, although I used to be very active on FB, I try to stay away now.  While I’m not the X-ray expert here, I feel I can safely say we’ve seen much worse.

Laminitic pain is not inflammatory so bute doesn’t do anything for that sort of pain.  It may help with associated stiff muscles and such but it’s not worth it with its associated risks.  It interferes with healing as well as with the mobilization of abscesses, which are likely to arise.  We recommend Devil’s Claw instead. I looked up the Absorbine product that Susan recommended.  It contains DC but also yucca, which we don’t recommend for a metabolic laminitis situation.  Uckele’s Phyto-Quench pellets contain DC but I understand they are on back order now.  I’ve seen other products containing DC recommended so perhaps doing a search on the messages here for “Devils Claw” or some iteration of that.  The most reliable way of controlling the pain is to eliminate its cause.

In the material Trisha sent, you will learn about DDT&E, something we refer to repeatedly.  The first D stands for diagnosis, which is where we need to start.  Until you have guidance from blood testing, it’s best to stick to the Emergency Diet (as I believe you are) with soaked hay or one with tested hay, below 10% ESC+starch.  You mentioned looking for the right vet before starting to test.  A good many of us are here because we never found that vet.  You obviously need one for testing and medication but no single vet is likely to have the depth of knowledge and experience with metabolic laminitis that this group has.  My experience has been that older, more experienced vets are perhaps more accepting of modifications to their protocol.  Be sure to have insulin, glucose and ACTH tested to get started.  And do what you can to obtain actual copies of the test results, as well as the vet’s interpretation.

Looking forward to seeing those additions to your case history!
--
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


 
 


Wilmary
 

Thank you all for the encouragement and support. I’m still looking to get a new vet here but I’ve had a hard time just getting through to anyone. I asked for acth test and insulin test to be done right away while she was here but was told to let him adjust for a month before we do anything. (Not sure of the reasoning behind it.) 

Theres a phytoquench without devils claw on valleyvet.com I’ve never ordered from them but it’s the only one I can find in stock. Is it just as good? Or are they not a legitimate site? Pricing seems off to me. 
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Sherry Morse
 

Hi Wilmary,

ACTH can be elevated by the stress of trailering as well as being in a new situation so waiting a few weeks to test isn't a bad idea.  The Phytoquench sold by Valley Vet is made by Uckele but you want the pelleted version with Devi's Claw for pain relief.




Wilmary
 

I figured it must’ve been something along those lines, thank you Sherry! 
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Wilmary
 

Quick update,

Moved him to a bigger area, everything is still close to him but he can move as he pleases. His sores from laying down are healing. Ordered phytoquench which will be back in stock December 1st. I’m really struggling not to give him bute, that’s all I want to do when I see him. Wondering if I should until it arrives since his pain isn’t from laminitis itself but the rotation and sinking? Low dose or stay strong?? 
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Sherry Morse
 

Hi Wilmary,

Here's the simple way to answer this question for yourself - was he any better on bute than he has been since he's been off it?  If the answer is no then it's a waste to give it to him.




Bobbie Day
 

Wilmary
Can you source some devils claw? When I was desperate and had to wait I actually went to the health food store and got the capsules and fed in with my supplements. I feed wet but there’s a lot of things you can use as a taste tempter.
Fenugreek, or my personal favorite as Dr.K suggested is Anise oil which you can get at the store. From my personal experience bute doesn’t help at all. The photo-quench absolutely helped us more than anything.
But I still added extra DC. When my little mare was off of PQ she had a lot of symptoms re-emerge. It really is a wonderful supplement that’s why it’s often sold out. I would stock up whenever I could.
It is hard to see them in pain, we’ve all been there.


--
Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


Wilmary
 

Sherry he is so MUCH more comfortable on bute, which is why is so difficult to not give it. But I understand it’s better for him to be off in the long run. 


Bobbie, Just human grade capsules devils claw? I found a few on Amazon I can order and be here Monday. How many capsules do you give? And how much anise oil? Thank you!  
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Eleanor Kellon, VMD
 

Another option for DC until the PQ pellets are back in stock is the Hemp Joint which is just DC plus broad spectrum hemp.

It looks like your trim is unloading/beveling the walls (?) which, together with boots and pads, is the most important thing for eventual comfort and reversing the sinking. However, this takes months and it's unreasonable to want him moving normally at this stage.

 If he has a dramatic positive response to the bute I would be highly suspicious of more abscess collections needing to drain. I would wean him off bute and on to DC, also starting Jiaogulan. Give that two weeks to work, starting the count down 3 days after last bute dose.

As for movement, don't force it but the 30 x 30 paddock should be fine.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bobbie Day
 

Wilmary
I gave my mare 15g of extra DC in addition to the PQ, Dr. K said you can safely double or triple that. The capsules I got have 480 mg so you would need 31 of these to equal 15,000 grams.
(1500mg =15g). The anise you can get at the store usually, maybe the DC as well.
Some members have had good results with PEA, but I believe that takes awhile to work.
As Dr. K suggested I have had great luck with Uckele’s hemp product too.
Good luck, hang in there it is hard to see, maybe get some j herb like Dr.K mentioned as well, abscesses can be terribly painful and gut wrenching, I actually thought my gelding had broken a leg it was so bad but since I have balanced his diets we have not had one more problem (thank god).


--
Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


Bobbie Day
 

I should mention though that I do buy it in bulk from Amazon, the capsules were just to get me through until my order came in. 
--
Bobbie and Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021


https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


Wilmary
 

Thank you Dr. Kellon, I think you answered the question I didn’t know I was asking but it would make much more sense if he is still working out an abscess with how lame he is.

The vet he saw in Texas put some sort of material all over the sole of both his feet that I’ve been trying to get off (you can see it in the photos). It’s black and really stuck on there, could it be possible it’s not allowing the abscesses to drain? 

I ordered the jiaogulan and Hemp joint support along with DC I found on Amazon! Thank you as well, Bobbie! 
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Eleanor Kellon, VMD
 

I'm not sure what the black material is. Possibilities are ichthammol or pine tar. Neither of them will seal off the sole to the point it couldn't drain but you won't be able to see any drainage.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Wilmary
 

Okay! Thank you all so much! 
--
Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201