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Newly diagnosed laminitis

Tanya Manser
 

Hi

My mare, Lilja, has laminitis. I have been giving her the emergency diet for 3 weeks. Bloods shows ACHT 15.2 pg/ml (<30 is normal). 

My vet is happy with the first two weeks progress, he removed the feet pads and doesn’t want to see Lilja again, unless there’s a problem. He said slowly reintroduce grass and begin exercise when Lilja is sound.

Lilja’s feet were routinely trimmed 3 days into laminitis, farrier is happy with feet, doesn’t think x-rays are necessary. He doesn’t want to see Lilja earlier than next routine trim. 

So, I am figuring things out for myself. Guidance would be very welcome as, in over 20 years of horse ownership, I have never had a laminitis case before!

QUESTION: Lilja was happily eating soaked bagged Timothy hay. That is now unavailable, so I bought a big bale of 2019 mixed grass hay. Pony will NOT eat it, is eating her straw bed instead. Can I soak/feed Timothy haylage instead please? Thanks.

I was a member before the move to groups.io but only just created profile files on this new platform.

Thanks, Tanya

--
Tanya Manser, UK, 2004.
Lilja - diagnosed laminitis 2020-05-01.
https://ecir.groups.io/g/CaseHistory/files/Lilja%20Case%20History

 

Hi Tanya,
Good you remembered us!  I’m going to treat your post as I would for a new member and include the standard welcome from the group, just in case things have changed since your last visit and you might find it helpful.  Thank you for getting your signature in place with a link to Lilja’s case history.

Where I live, haylage is prepared for dairy cows so I don’t have personal experience using it.  Searching Google, I found some concerns about botulism, which makes sense, but they weren’t universal so I searched the ECIR messages for ‘haylage’, which is something you can do as well.  There were lots of them.  It seems that people do feed haylage to horses, especially in the UK.  I read warnings that any nutritional testing is an average so not to count on it’s being correct.  Soaking it seems ideal.  I’m sure you will get more comments here from those with haylage experience.  You posted a ‘guesstimated’ weight for Lilja, which seems on the high side for her height but I know Fjords are compact.  Would you describe her as a normal weight or fat?  More haylage than hay, by weight, must be fed to maintain her.

While poking around, I found this post from Anna in Sweden.  She had her straw tested and found it was high in sugar.  There may be a reason Lilja is eating it.  Can you use another type of bedding or have the straw tested to be sure it’s safe?   I’m wondering if you tried soaking the hay from your large bale?  Is it possible some moldiness has developed which might be rinsed off?  I also saw mention of something called ‘seed hay’ which is apparently like straw but not quite.  Rinsed, soaked and rinsed again beet pulp is another safe option.  

 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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


 
 

Sherry Morse
 

Hi Tanya,

Fjords are one of the breeds that are prone to developing IR.  I don't see that there was bloodwork done for either insulin or glucose and those are the two numbers you really need to know before you want to consider allowing Lilja access to grass again.  Assuming that the laminitis coincided with the spring grass coming in that's a red flag that she may be IR and shouldn't be allowed on grass at all, no matter what the vet said.  So while it's a good thing you caught the laminitis early and she's doing better already, I think you need to do some more homework before you can have a clear picture of what's going on with her.

As Martha already mentioned, the straw can be problematic for some horses so if you can change her bedding to something she can't eat that would be preferred at this point.



Tanya Manser
 

Thanks Martha. 

Thank you - I’d done my ECIR homework first 😎

 

Yes - the big bale hay was rinsed, soaked an hour, rinsed. I even tried an overnight soak. She has ignored it since Saturday (3 fresh portions per day, put on floor for easy eating). 


Haylage is commonly fed here in the UK. Silage is bad news - botulism; haylage is made here specifically for horses. 


I have the typical analysis for one brand of horse haylage HERE. The Timothy is lowest in calories/sugar. But of course it’s fermented so pH changes, amino acids etc so I don’t know the implications of that with respect to laminitis.

re her weight, I would have said 340kg, but on googling Fjord weight, it says 400kg upwards. She is a body condition score 7. Weightape 458kg, calculated weight 470kg. I will add some photos from yesterday to her profile - ALTHOUGH I am aware they aren’t “correct” pictures, they were for me rather than ECIR. I will take correct pictures tomorrow. 


Did I miss anything? Thanks!!

--
Tanya Manser, UK, 2004.
Lilja - diagnosed laminitis 2020-05-01.
https://ecir.groups.io/g/CaseHistory/files/Lilja%20Case%20History

Tanya Manser
 

Thanks Sherry.

i asked my vet to run those bloods (armed with the “instructions” from this website, checking he was going straight back to the practice. 


My vet said ACTH was all that he needed as the insulin and glucose wouldn’t tell us anything we didn’t know!! (I disagree). I pushed for them again but he said they only ask for those tests when clients insist and he didn’t think the results were useful other than a paper exercise. (I disagree). So we went with ACTH which came back normal.

i DO think she is IR - hence posting in here rather than the non-IR section. She has abnormal fat deposits, bulge over eyes etc. I had her full brother (and dam). Full brother was confirmed PPID and on Prascend AGE 7!!!!! Sadly he’s over 🌈 bridge. 


So I need glucose/insulin done 👍

I’ll post some pictures now - not “correct” photos for the case folder, but were taken yesterday. I will take “correct” photos tomorrow.

Thanks.

--
Tanya Manser, UK, 2004.
Lilja - diagnosed laminitis 2020-05-01.
https://ecir.groups.io/g/CaseHistory/files/Lilja%20Case%20History

Tanya Manser
 

Photos from yesterday - “proper” photos to follow tomorrow https://ecir.groups.io/g/CaseHistory/album?id=247335&p=Name,,,20,1,0,0