Pony with rt front lameness


mel7198@...
 

HI, 
My name is Melanie and I have a 16 year old welsh pony April who presented with rt front lameness about a month ago. All her labs came back normal. We put front shoes on her and it made a huge difference but during a lesson she was little off at the trot.  The vet advised up to walk only for two weeks. X-rays were taken but were normal. We have been soaking her hay and changed her supplements as suggested by a nutritionist. She is turned out in a very eaten down paddock with a grazing muzzle. 
Thank you.
Melanie 
--
Melanie Lemoine VT 2021  
Case History
https://ecir.groups.io/g/CaseHistory/files/Melanie%20April


Trisha DePietro
 

Hi Melanie. What follows is our Welcome letter that highlights our protocol for IR/Cushings care. Was just wondering your Vet thought about Lyme Disease? Might be something to consider.  Is the grazing muzzle completely sealed or can she get some of that short stressed grass? We advise to seal the bottom holes of the muzzles because the sugar content of the stressed grasses in overgrazed pastures can be very high and contribute to soreness/inflammation. Good for you to soak the hay- you'll get more information and ideas from our welcome letter as you try to get on top of her problem. 

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. 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


Sherry Morse
 

Hi Melanie,

In looking at your Case History you managed to include a long email from your vet in it regarding April's feet. 

Good Morning All,

Here are some measured radiographs from April’s front feet. All images can be seen by clicking on View Images in the Asteris Link below

Josh - April has been sore in front and happened over a wk ago I saw her around that time and she was significantly better that day. We discussed possible post trim soreness as there was some hoof tester sensitivity (it wasn’t much), post vaccine rxn, sub solar bruising  and/or a possible laminitic episode. She came up quite sore again this wk and saw her Tues this time she was moderately lame w/ the rF and had increased pulses.

No evidence of any real P3 displacement.

There were moderate pulses in that foot only and more reactive w/ HT than before and essentially normal w/ LF.

So possibly she had a one sided laminitic episode, but that’s not common. In any case in boots and on meds. Not to worry Josh, not asking for shoes or pads, just wanted you to appreciate what you already know is there: a very thin distance below the toe of P3.

Mel - the Insulin and Glucose test were fine. The minimal elevation of Insulin beyond normal is not surprising in a non-fasted, stressed pony. Hope she is doing better.

Let me know if questions 


The link to the x-rays (https://keystone.asteris.com/#/share/BURLTNEQVET/share-request/86145410-0421-4000-1054-ffffff210428/share-recipient/96ba907e-4000-8814-1054-ffffff210428) shows that she has very little sole depth and this could certainly be contributing to the lameness you're seeing. IMO her insulin level and weight indicate that she should be treated as IR until you have a test that proves otherwise (after she's lost weight and no longer is lame).




 

Hi Melanie,

Welcome from another Vermonter!  I’ve looked through your case history and have a few comments.

You state in your first message that you are soaking April’s hay.  That’s perfect, except I don’t see any mention in her case history that you are feeding her hay.  We would consider her insulin elevated, even for a non fasting insulin test, which we recommend.  Given that and the fact that she is overweight, I would feed her weighed hay, which is soaked and rinsed.  Her hay should weigh 1.5% of her present weight or 2% of her ideal weight, whichever is the larger amount of hay.  This weight needs to include any added feeds that she gets.

Once you have the hay tested, you can decide whether continuing to soak is necessary and also which supplements would work best for the hay she is eating.  We can help with that, once we see the report.  Your nutritionist, if local, might help with hay testing.

You mentioned that she is in an ‘eaten down paddock’.  I thought I had one of those myself until I took the ponies out of there for another reason and found that it was eaten down because they’d been eating it down themselves.  Seems pretty obvious in hindsight.  Something to keep in mind as you strive to reduce her weight.
--
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


 
 


mel7198@...
 

I am hoping someone will look at Aprils x rays and give me their opinion. Thanks
Melanie
--
Melanie Lemoine VT 2021  
Case History
https://ecir.groups.io/g/CaseHistory/files/Melanie%20April


Sherry Morse
 

Hi Melanie,

Did you not see my message yesterday: https://ecir.groups.io/g/main/message/265467




mel7198@...
 

Thanks for the input. This is so new to me that there is a lot to filter thru. Does someone look at her x rays that I forwandered?  Would love to hear another prospective on them.  April is getting soaked hay and I will see if I can weigh her hay. Thank you.  I was hoping that  Dr. Kellon could look at the xrays for me and let me know what she thinks.  Do I need to email her directly. Am new to this website so not sure how it works. I
Melanie Lemoine VT 2021  
Case History
https://ecir.groups.io/g/CaseHistory/files/Melanie%20April


 

Hi Melanie,

I think a number of us have looked at April’s Xrays but I’m not sure either Dr. Kellon or Lavinia has.  The most remarkable observation is how thin the soles are, which was brought to your attention  by your vet, as well as by Sherry.  Have you watched your farrier trim her feet?  I know that’s not easy when you’re also holding the pony.  The first thing they often want to do is clean up the bottoms of the feet.  You can be proactive here by telling the farrier you don’t want any trimming done on the bottom of the foot.  I have enough experience with many of the local farriers (most likely even yours) to know that you may get some ‘side eye’ from that request but just do the best you can.

Lavinia will give you specific trimming instructions if you post with her name in the subject heading.  She would most likely appreciate hoof photos to compare to the Xrays.  If you feel you need Dr. Kellon’s help specifically, include her name as well.  We’re all here to take the load off her back so it may take her longer to comment.

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


 
 


mel7198@...
 

Thanks for the info. My farrier has already told me that he will not be trimming the bottom of her feet.  We are going to trot her on Monday after her having 2 weeks off. Hopefully she will be sound again and we can slowly bring her back. I will post an update after we see how she is. I am also getting a Lyme test done.   
--
Melanie Lemoine VT 2021  
Case History
https://ecir.groups.io/g/CaseHistory/files/Melanie%20April


Lavinia Fiscaletti
 

Hi Melanie,

Good news that the farrier won't be touching the soles - AT ALL. Testing for Lyme is also a good idea.

Generally, the trim is fairly tight. Her soles are thin, so at the moment there is nothing to trim on her feet at all. She needs protection from the ground to allow her soles to increase in depth and padded boots would be the preferred option right now, esp. if you plan to do any work with her.

Getting her insulin level down is needed, as it is definitely too high to be considered at a healthy level.Soaking the hay until it you can have it tested and then it tightly mineral balanced to match the analysis would be your best option.  Have you had her tested fro PPID? At her age, that is also another possibility that could be contributing.

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


mel7198@...
 

What type of boots would you suggest when she is being ridden? 
Thanks
Melanie
--
Melanie Lemoine VT 2021  
Case History
https://ecir.groups.io/g/CaseHistory/files/Melanie%20April


Lavinia Fiscaletti
 

Hi Melanie,

Whatever boots fit her best and she is most comfortable in. That is a very individual thing, so need to measure her feet thenresearch which boots fit those measurements the best.

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