Hi Becky,

I'll leave her feet to someone better versed than I.

Did you notice any clinical difference after beginning the pergolide last year?

Have you had insulin and glucose done ?I didn't see that in her CH,but may have missed it.

Is she still on pasture, what there is of it?

Have you balanced minerals to her hay from last year? I see that you have balanced since 2010,but just wondering about current hay.

Sorry for all the questions.Just trying to help you dig into some of the details which may be adding to hoof probs.

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

Hi Becky,

Thanks for putting up the hoof photos;

https://ecir.groups.io/g/CaseHistory/album?id=3922

Trim needs some changes to be optimal - toes are too long horizontally, looks like there is too much foot overall but this could be an illusion if there is sinking. Respectfully disagree with the trimmer that xrays are a waste of time - they would confirm that the trim is not as tight as it needs to be. Agree with you that the flat soles may be an indication that there has been some founder/sinking at some point. I can do some mark-ups for you but it will be a few days as there are several other people in line ahead of you and April.

If you have not had blood work done for IR I would suggest that being done. From the ACTH test that was done in Nov it does not look like she is PPID as the result was 34.5pg/ml. Many of her issues DO point toward her possibly being IR, however. IR and PPID are not the same thing, although many vets still seem to confuse the two issues. Blood work will clear this up for you.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Hi, 

Thanks for your replies ladies, will answer all below as I can. 

1) I haven't put her on pergolide, didn't think the results were high enough to warrant the drug. Thought to try her on agnus castus but don't think it should be fed with her Bosweillia so have asked the manufacturer of this to research ( same with the j-herb).

2) Haven't had her tested for IR, these are the first problems we have ever had, so I am confused what has triggered the IR to kick in. This has probably been asked but if she came back positive for IR,  I don't think there is anything in her management to alter. So, what benefit is the test? The only test available is the glucose / starvation test, which I know is not very accurate? I will not be able to get her to eat the glucose without syringing, & I am not prepared to starve her as I am still battling to keep her gut moving & she is still not drinking properly, so she is still getting some things which are likely throwing her sugar levels but her hydration is essential......She also gets very stressed with anything invasive....?

3) Yes I retest & rebalance forage / minerals every year. Because we use our field for hay I don't test the grass, mainly due to costs, so I do an annual re-evaluation. 

4) Yes she is on one of our summer paddocks - I can't keep her in as her hind leg & gut are getting get stiff / stopping working & I can't put her on the winter field which is mostly mud now, because she will likely slip & undo all the healing in her hind leg. So yes she has some grass, as she wanders about. 

5) I also disagree with my trimmer - I am getting her feet xrayed this week but I need to see if the osteopath recommends hock / stifle xray too & get them done together. Osteo is with us tomorrow. So, happy to wait for further thoughts on her feet until I have these. Thank you for putting me on the list. I will see if I can find a picture of her feet prior to the changes & upload it. 

Thank you for your help

https://ecir.groups.io/g/CaseHistory/album?id=3922

>>I haven't put her on pergolide

I misunderstood this from you CH,at the end of November.

·         Prescribed 1mg prascend daily for 6 months, then retest.

I do see now that you mentioned at beginning of February that you weren't comfortable doing that.

>> if she came back positive for IR,  I don't think there is anything in her management to alter.

You could find a way to keep her off pasture.That would help,if she's IR.

You might double check the minerals being fed, and their levels, to fine tune.

>>only test available is the glucose / starvation test

Surely there must be a simple blood  draw for glucose? No?

,

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

Hi, 

Thanks for your reply Lorna. 

Had x-rays today, showed long toes as thought, rotation & sinking, quite significant in the FR. Will upload when I get then hopefully tomorrow. No abnormalities to other bones I don't think (navicular etc). So they can be used for marking up by Lavinia or someone else, if possible. 

Oseteopath is concerned about the effects on the soft tissues higher up her FR. She can't move her leg properly & we think she is trying to compensate for the changes in the hooves. She is backing up well but struggling to walk forwards. 

Have asked trimmer for an appointment in the next week, if not have a recommendation for a farrier who also trims barefoot & is very open minded & getting good results, so feel positive about that if my trimmer doesn't help. 

Vet was ok as vets go but disagreed with what he was saying re her weight & her diet. Suggested I should look at heart bar shoes to help her. 

Can do a blood test for adiponectin, which is a simple blood draw & not a starvation test to look at IR. Recommended a THRH test too. 

questions

1) if I fill her collateral grooves with play-doh in the interim before the trim will that help / be ok? Vet suggested to cut pads & tape them to her feet to support the frogs / heels but will this tip her onto her toes if done before the trim is done? 

2) can anyone direct me to the resource, or somewhere which will help me understand about molecular weights? I am going to re-look at her diet - my supplements are correct to NRC but maybe out if I have misunderstood the molecular weights of the minerals in the supplements I am using?

3) thoughts on shoes by foot expert based on her x-rays would really help me please. I want to keep her barefoot as I understand the benefits of this but it needs to be the best thing for her to fix her feet.

Many thanks

 Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922

Hi Becky,

Need to see the xrays to be able to comment more thoroughly but you can tape styrofoam to her feet for support - it will crush down and form to the foot providing support in all the needed areas. Once it flattens some, you can add another layer on the bottom so you end up with a temporary "custom orthotic". Thick, soft pads (like those in the Easycare Clouds or the Soft Ride boots) are also good as long as you trim the orthotic flat instead of in a wedge shape. You need to provide support across the entire back half of the foot if there is rotation. If she isn't sensitive in the front half of the foot, then distributing weight across the entire sole/frog is desirable. Trim needs to be addressed pronto.

Best thing to fix her feet is going to be getting the trim correct - first and foremost. Without that, any added appliance is like adding a cast to a broken limb without setting the break first. Generally, we recommend no shoes, at least initially, as the time between trims will need to be short - 10 days to 2 weeks apart - in order to get and maintain an optimal hoof capsule. Shoes make that very difficult to do.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Hi Becky,

As you have already taken the NRC Plus course, you can always retake it (for free) at any time to sharpen your knowledge. Also, have you joined the NRC Plus Grads Group - another great place to get your questions regarding things like the molecular weights answered?

I spent some time reading thru April's case history (thank you for being as thorough as possible). Here's what pops out at me, along with a few more questions.

Looks like refocusing on the DDT's is in order.

DIAGNOSIS: As yet, you don't really have one so are flying blind. Although they are two distinct conditions, many vets still confuse IR and PPID. Recommend that you get simple insulin, glucose and adiponectin tested so you know what April's IR status is. These tests are reliable and DO NOT require fasting or administration of glucose. Although the glucose tolerance test is certainly valid, it is dangerous in a horse that is laminitic or on the brink of being laminitic and is unnecessary. You could do a TRH stim test but with the ACTH results you had in Nov that wouldn't be the first place I would be spending money right now. If she is primary IR, normal seasonal rise influences could easily have been the final push that sent her over the edge into full-blown laminitis. If you have any other test results - liver tests for photosensitivity - please add all of those into the case history as well.

Have you had her mouth/teeth thoroughly checked since she had the "anorexia" issues? One of the first things that comes to mind when a horse suddenly refuses to eat and drink their usual amount is a possible injury or broken tooth, esp in the winter when cold water could be very painful on a fractured tooth.

There are many red flags that April could be IR dating back to 2006. In 10/2006 you noted she was cresty, had bulges over her eyes, had sensitivity to touch. Also that her crest grows and she gets itchy and tight any time she isn't in work.

Also possible you are dealing with cold-induced laminitis as it sounds like there has been sub-clinical laminits going on for some time and this year things finally tipped over the edge into obvious laminitis. The walking stiffly on all surfaces is classic for sub-clinical laminitis.

DIET: You already test your hay and balance minerals to the results - great. Until you know for sure she isn't IR, stop all pasture access unless it's with a sealed muzzle on for exercise and companionship. Pasture is playing Russian Roulette right now. Feed under 10% s+s hay in small mesh hay nets, divided into 3-4 feedings per day. You want to feed 1.5%-2% of her ideal body weight in total feed per day. From the pix in her album, she has a cresty neck and appears to have a slight crease down her spine. Hip bones aren't visible, can you easily feel her ribs? BCS is more like a 5.5 - 6 than a 4 so she needs to lose some weight.

Stop the glucosamine, B vitamins (except biotin) as they are not recommended for IR horses. Stop the Goat's Rue - may lower blood sugar and has diuretic properties, both of which are not safe right now. Stop any fruits and vegetables as they may be unsafe for an IR horse. Why are you feeding echinacea?

If she is still on liver detox dried herbs - what are they specifically? Many are contraindicated in an IR horse.

For now, less is more. Need to stop throwing the proverbial "kitchen sink" at her and get the basics down first. Then can start adding things one at a time so you can judge whether they are helping or not.

TRIM: We've already touched on this and you're waiting for the xrays to be sent to you. Once you can get those up, I can do the mark-ups for you.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

HI Lavinia, 

Thanks for your email. Yes I am a member of the NRC grads. 

I will answer the above more throughly however I have a problem now; on his way back from my visit the vet crashed & the xray machine is broken, therefore they do not know when the images will be available. I have requested they do them again if they are not available tomorrow. I have been asking my trimmer since December what her hoof problems are & the images in my case study file are taken 2 weeks after her feet were trimmed (3 weeks ago now). I have found another person who is recommended but am unable to get an appointment. So, based on the photos & what I can remember about the images I saw on screen on friday can you advise on her feet please. Basically would you advise taking her toes back at the same time as her heels down, or just toes, or just heels? I want to help her as soon as possible. 

Hinds - no sinking, very slight hardly discernable rotation in one of them (can't remember which one) but excessively long toes. Should heels & toes be addressed? 

FL - minimal rotation & sinking, think it measured 13mm from coronary band to top of pedal bone. Long toes. 

FR - more rotation than the L, vet didn't measure the % / angle. Coronary band to top of bone was 20mm. Long toes. 

Can you advise please as I fear it may be days before I get her xrays now. 

Many thanks

 Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922

Hi Lavinia, 

1) I don't have her liver test results, will they be valid after 10 years or should I get done again?

2) Do I just ask the vet to take a blood sample & test for insulin, adiponectin & glucose? He did not offer me those options when talking about IR, only the adiponectin or starvation test. Agree on the PPID testing. 

3) Her mouth / teeth are fine yes. She didn't suddenly refuse eating / drinking, she gradually stopped & is eating ok now, but still not drinking enough. 

4) There are many red flags that April could be IR dating back to 2006. In 10/2006 you noted she was cresty, had bulges over her eyes, had sensitivity to touch. Also that her crest grows and she gets itchy and tight any time she isn't in work. The itchiness stops straight away after a good run, would this be common? 

Also possible you are dealing with cold-induced laminitis as it sounds like there has been sub-clinical laminits going on for some time and this year things finally tipped over the edge into obvious laminitis. The walking stiffly on all surfaces is classic for sub-clinical laminitis.

She has only walked stiffly since hurting her hind leg, she is fully sound on all surfaces prior to that. Would sub-clinical laminitis show - where? 

Could cold induced laminitis be a result of her catching a chill / standing on wet ground for a long time not moving much? 

Can colic tip them into laminitis if they are bordering on it? What about uneven loading on their feet due to injury? 

5) Until you know for sure she isn't IR, stop all pasture access unless it's with a sealed muzzle on for exercise and companionship.

Based on her feet info should I be keeping her in / immobile or not?

6) Hay is 8%, she will not eat it if it is soaked. I based her BCS on the descriptions in the file, I can feel all her bones. She was the shape she is on her spine even at 4yo, & when in her peak performance last year before injury. She's always had a crest yes, never goes down or gets hard. She is thin for her now, although maintaining the same weight but all her 'in work' muscle has gone now. Even though she is eating again she is not taking in even 1.5% of her current weight.   

5) The glucosamine was for her injuries, I have run out now. B vitamins - I find all the horses get paler gums in the winter, the B vitamin supplement improves this, But I will stop for her. Have stopped all herbs in preparation for the J-herb. She gets no fresh fruit & veg now she is eating again, although to get her to eat I had to feed over Christmas to keep her gut moving. Echinacea - not fed routinely but I feed for general health support when in high work, & fed initially she was poorly for stress. 

6) Liver detox, stopped now but it was dried clivers, dandelion, burdock, nettle, liquorice & I think milkthistle.

7) There has not been any heat, pulse or sensitivity to touch in her feet (other than discomfort walking) would this be common, as I think this has thrown me a little in these circumstances?

Many thanks

 Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922

Got the xrays, they are uploaded. Apologies if notifying in the wrong place

 Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922

Thanks for the update, Becky. This is the correct place to be posting.

Will get the mark-ups for you.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

HI

Thank you Lavinia. 

I have added some more photos from last year, showing her beautiful feet before she was injured & everything snowballed. Also some better pics of her in general over last year. 

I have a new hoof professional coming tomorrow, he is a farrier but having had a long conversation with him I think he is really hot on the horse as a whole, not just the feet as many of them are, so feeling positive. 

She is really bright at the moment & is eating her new Jherb as I have introduced it over a few days so hopefully that will support her trim. I have pads & boots ready for her too. 

Thank you for all your help, 

 Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922

Hi Becky,

April is a lovely girl. Thanks for adding the earlier photos.

Unfortunately, they confirm that her trim has had issues that predate her injury and the current problems. Although the angles aren't the best, they still show that her toes were too long horizontally. This means that it was also likely her heels were running forward somewhat. Her crest was present (which you have mentioned), weight was more than optimal although she was definitely fitter.

What that means is that when overt laminitis hit, April's feet were already in a compromised state so more susceptible to greater damage.

Good to hear she is feeling better.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Thanks Lavinia, 

Interesting, and disappointing re her feet, I will maybe ask more on that.

A big ask I know but might you be able to do her mark ups before the new farrier comes to her tomorrow, so I can be sure to discuss the correct pathway with him please? For her fronts maybe?

Understand & no problem if not.

Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922 

Hi Becky,

I've added some mark-ups to April's album here:

https://ecir.groups.io/g/CaseHistory/album?id=3922&p=pcreated,,,20,2,0,0

The toes are too long in the horizontal plane on all four feet. There is also significant sinking on all four. Sole depth is barely adequate at the moment so NOTHING should come off the soles in the front half of any one of her feet. RF shows a slight amount of bony column rotation and there's some evidence of ringbone starting on both fronts as well as some sidebone.

LF DP xray: Lime circles showing the collateral ligaments starting to ossify = sidebone.

Composite of both fronts: Green lines follow the new angle of growth coming in under the coronary band toward the ground. The hoof wall that diverges form this is laminar wedge that is the hoof's attempt to "glue" the structures together in the face of forces that are causing them to tear apart and fail structurally. Blue are where toes need to be backed to and then beveled under to set the breakover up correctly. Yellow lines are the degree of sinking: (1) is the coronary band, (2) is the extensor process. These lines should be very close together. The distance between them denotes the amount of distal descent (sinking). Orange circles are fuzzy areas on P2 that appear to be areas of rinbone beginning. On the RF, the pink line is how the bony column should be stacked up. Purple line is where it actually is - bulging slightly forward. This is a broken forward HPA (hoof-pastern axis), denotes some bony column rotation. Purple arrow is where the heels need to be lowered a bit to allow the bony column to relax back into the proper alignment. The brown line is where to lower the heels only. The whited-out areas on the toes are what needs to be removed by nipping/rapsing from the front or top without removing any sole from underneath. Do not rasp the entire dorsal wall smooth in order to make it look "pretty as a picture" as that thins an area that is already compromised. Instead, deal with this as it grows down to ground level.

RF sole: Green line is about where the hoof capsule should be. Green arrows are all areas that need to have flaring brought inward and toes backed considerably to get control of the overgrown and laminar wedge material. Orange are the overgrown and outward-leaning bars. Be careful not to get too overzealous in taming them now as they are doing overtime support duty at present due to the sinking and flaring of the rest of the foot. Just start to carefully bring them inward along their leading edges, removing only material that is flaking or peeling off.

Composite of both hinds: Same as the fronts.

RH sole: Green line is about where the hoof capsule should be so toes are again quite far ahead of where they need to be. Heels should be even with the widest opart of the frog so will need to be gradually encouraged rearward while preserving all the height possible as the HPA is slightly broken back so no extra height available to work with. Yellow are the sprawling bars. Red is about where the true tip of the frog is - everything beyond that is dead material trapped within the stretched forward sole and going along for the ride.

Main goal this round should be to back up those toes considerably and bring the flaring inward. Boots and pads after for comfort as needed. Should plan to be on a short trimming cycle  - no more than 2 weeks between adjustment - until youhave the correct template in place. Then you can start to push the time interval between adjustments outward.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Hi, 

Thank you Lavinia, lots of info to take in & learn.

1) I have added some photos from this afternoon, just after her trim, the light was a little bright so they are not great. What are your thoughts?  I printed off her mark ups & the text, & farrier had a good look at the xrays. I liked that he did each foot separately, so they were all done how he thought they needed, not all the same. He left the fronts of the soles on & explained what he was doing, evaluated & went back to the foot if necessary. He looked at her whole leg & was trying the shape her hoof to that. Also discussed the causes of it. However, he did differently to the recommendations in a few ways & says 3 weeks for retrim. So is he the right guy for my horse? Having said that he farrier is the best I am going to get in my area, there are no other barefoot trimmers I am aware of & no other farriers come highly recommended by someone I trust.

2) Movement - should I let her move as she wants, or restrict movement to reduce further damage within the hoof capsule? She doesn't seem sore at all but I guess the next few days will show if she is.

3) I am more than angry & upset re the recommendations for her hoofs because she should not be in this position. I have been having her trim done regularly, for & years, by someone I thought was competent. She trained through here; http://www.equinesciencesacademy.com/ . - is this a reputable training academy? 

4) I don't know alot about ring / side bone. Has the inadequate trim likely caused this to begin developing?

5) I now have concerns about my other ponies, can I create case studies for them to have someone evaluate their trims or do I need to suspect a problem other than an inadequate trim?

6) Finally, if I want to learn more about trimming to help my ponies best where should I look? I have been recommended Pete Ramey's dvds / book; is this worth looking at? if people in this group trim their own horses where do they learn from please? 

Many thanks

Becky

https://ecir.groups.io/g/CaseHistory/album?id=3922 

Hi, Becky - not Lavinia, but tossing in my two cents worth, since I learned to trim my own horses.  The trim is much, much better, but you are not quite there yet. Very, very good that he didn't take any sole off the fronts. You can see that the sole has actually crept over the white line (ie, you can't see the white line at all at the fronts of the front feet). The very front of the toe can still be rasped back vertically from above, and you can do that yourself in between trims  - just put the hood on the hoof stand, put the rasp at 90 degrees to the ground, and rasp. Then have a cup of tea, then rasp some more.  The good news: the front is well-bevelled upwards to make the break-over come back, and the walls are nicely beveled as well. 

Just a note about the previous trim. If you read Dr. Bowker's presentations:  https://ecirhorse.org/proceedings-2015.php  , you will find that he has found that "peripheral loading", meaning the bulk of the weight of the horse is born on the walls, without the soles being involved, causes a variety of issues. Peripheral loading is caused by shoes (standard shoes - some of the newer ones like Eponas and some of the EasyShoes do have frog and sole support); peripheral loading is also caused by allowing the walls to be too far above sole plane, and not correctly beveled. April may have been "barefoot", but the previous trim had exactly the same effect as though she were wearing shoes.

Another note: when you take pictures, and also when the farrier comes out to trim, get a nylon stocking and cut the toe off to make a nylon tube. Slide this up over the hoof onto the leg, so that the feathers are contained in the tube, and one can then fully see the coronary band, and the angle of growth therefrom. Your new trimmer has done a fine job, but anything that helps (such as being able to really see the whole hoof) is always good.

Regarding training academies: the ESA looks absolutely fine, but they have no control over what the students do once they are out there in the field. The proof of the pudding is in the eating: if the trim is inadequate, it doesn't matter where the trimmer trained.  You can learn to train your eye to recognize good trims.

I watched all of Pete Ramey's DVD's - very helpful.  Another great resource is Paige Poss's Iron Free Hoof:  http://www.ironfreehoof.com/   This gives some great examples to help you train your eye. I have uploaded a picture of a hoof with nicely beveled walls into your photo album.  https://ecir.groups.io/g/CaseHistory/album?id=3922 

April can move as she chooses; just don't force her to move at the moment (no riding, eg).

Ring-bone and side-bone can have lots of causes. Side-bone seems to be very common in drafts and draft crosses. It is possible that the trim contributed to this, but beating yourself up is not allowed. Now that you know which direction to go, carry on in that direction.

You can photograph the other ponies' feet, and upload onto the photo section of EC Hoof. This site is for discussion of hooves of non-IR/PPID horses.

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

Hi Becky,

(1) Thanks for adding the latest photos. The farrier appears to have addressed a number of the problems that were there so that's a good thing. That he was evaluating each foot independently is also good. I don't think that the toes were brought back far enough but he did make a start. He also took the heels back - which is good - but may have been too much too soon, esp on the hinds, as there wasn't ANY height available there to work with (this from the xrays). How April fells about these changes over the next few days will give you a better idea how it went. I wouldn't advise waiting 3 weeks as the toes will get ahead of you in that time frame. You could always back the toes at the halfway mark, tho.

I think the frogs have been over trimmed for no real reason other than to make them look better. Would prefer to see only loose flaps removed rather than having the entire frog shaved so that all the calloused protection is gone.

(2) I would allow her to move as she wants, just not to the extent of roaring and racing at full speed around a large area.

(3) You are certainly not alone in your feelings of frustration about the situation. There are literally hundreds (if not thousands) of  other members here that have been thru similar scenarios. Personally, I went thru 9 different farriers before I started trimming myself because I just couldn't get done what my horses needed.

I know of the academy but can't say yay or nay. Just because someone trained at a particular place doesn't necessarily mean they are automatically good/bad. I have found that getting recommendations from people I trust and then seeing their actual work is more helpful.

(4) Side bone and ring bone have many contributing factors. Genetics and conformation play a role but trim is also a big one because it can magnify or minimize the other contributions.

(5) If the other ponies aren't IR/PPID then you can post pix on ECHoof (a sub-group of this main group) that is devoted entirely to all things hoof. You'll need to send the pix to me directly for upload, however. If the same person has been working on them, it is likely there are some things that need attention with them as well.

(6) Pete's work is a great start. You can read a lot of info on his site:

http://www.hoofrehab.com/

You can rent his DVD's (and many others) from Giddy-up Flix, the Netflix of horse-themed stuff:

http://www.giddyupflix.com/

Paige Poss is another excellent resource:

http://www.ironfreehoof.com/

Equine Lameness Prevention Organization has an informative website:

http://www.lamenessprevention.org/

Read, look at feet, ask questions - just like you would for any other subject.

HTH.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Hi Becky,

I wanted to respond to your #3: feeling betrayed by years of farrier work you thought you were having done properly (and promptly) in the best interests of your horses. I don't think you're alone on this one. I only joined this group in December and got markups from Lavinia (which I so very much appreciated): but, boy, was I horrified by the scope of what needed to be done. And when I asked my farrier to help implement the plan he went storming off down the driveway in a huff (literally).  Am I now worried about all my horses, including the non-IR ones? absolutely. This seems to be the hardest part of the whole process, and it's also the one that takes the longest to correct even when you have a professional in place who can and will do the work you need.

Kristen and Jasper

December 2016