Question - laminitis or too much trim?


Pat
 
Edited

My horse has sore feet immediately following a trim a week ago.  I am trying to figure out if it is laminitis or the trim. My horse had laminitis 21 months ago. She has been on the suggested diet for 19 months.  Tested hay, appropriate amount in weight, slow feed nets, 3x per day, amino trace plus, white salt. She is also fed Assure Guard Gold since 3 colic episodes in October 2021 and a small amount of flax and the j-herb.  She has lost 200 lbs, is at a perfect weight and is fit.  Since her laminitis episode in August 2020, her feet have steadily improved.  Up until this week, she could be ridden in the sand arena barefoot and down the rocky road, barefoot. Her paddock at this barn is small. She is ridden 4 times per week when the weather is good. This is Pacific Northwest - green grass and rainy days, mild weather.  When I am at the barn 2-3 times per week, I allow her to graze without a  muzzle for 15 mins.  The barn owner has been putting all horses out since Feb gradually increasing from 10 mins to 45. My horse wears a greenguard muzzle during that time. Her x-rays in the case study are from October 2020. When she had laminitis almost two years ago she was very overweight, fed too much non-tested hay, and left on grass without a muzzle for 6 hours. She had also just had her shoes removed two months prior. There was no rotation. X-rays and insulin test results are in my case study. This time she walks ok on her own in the sand arena and shows no soreness in her paddock or the barn. She is sore walking over the rocky road and two days after the trim, was sore being ridden in the arena.  But no where near as sore as the she was during the laminitis episode two years ago which showed no rotation. There are no bounding pulses. No heat in the feet. My coach thinks she is more sore on the right front than the left. I allow the grazing for companionship and because of her small paddock - to add movement to her day. There really aren't many barns in this area with dry lots large enough to support exercise. My farrier is skilled and was highly recommended to me by someone I respect. Her reputation is great.  She follows the TACT approach. My mare's feet have steadily improved in her care. The last two times my mare was sore though was when the farrier said she removed a bunch of shedding frog material. She also scrapes off old sole. But the last two times my mare was sore were also in late August and now in May (spring and fall). I'm going to get a new set of x-rays this week, have been meaning to anyway. I am trying to decide - is it the grass? Or is it the trim? Thanks for your thoughts.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Maxine McArthur
 

Hi Pat
Willow's last insulin test seems to have been in 2020, going by your case history, so it's probably time for another one. That will also give you an answer. High insulin --> no grazing. If she needs to go out you could use a blocked muzzle, but someone will need to bring her in for hay after 4-6 hours in that case. 

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Lavinia Fiscaletti
 

HI Pat,

You've done a lot of good things to get your girl into an overall better place. Now you need to fine tune things so that they are optimal instead of just "better".

Allowing grazing for an IR horse is playing Russian Roulette with her health. A Greenguard muzzle is not suitable to keep an IR horse safe if turned out on grass as it won't prevent her from eating the grass. It doesn't sound as if you've had the hay actually mineral balanced - which means her diet isn't as tight as it could be. Whether the Amino Trace Plus is a good fit for her hay or not is an unknown. Do you have a copy of the current hay analysis that you could share?

The timing of the soreness makes it suspicious for the trim being at least part of the problem. Trimming off frog from a barefoot horse is generally unnecessary, except for isolated ragged spots. Scraping off sole is also not needed as a barefoot horse will shed exfoliating sole on its own. August and May lameness incidents in an EMS/IR horse also coincide with times when insulin tends to spike due to ACTH increases heading into the fall (August) and spring grass growth.  It could be that the trim pushed her over the edge if she had some sole removed while she was also spiking insulin due to the increased grazing time - perfect storm of problems occurring at once. Being more sore on one foot can point to a possible abscess that may have been mobilized due to the trim. It would be really helpful to see a full set of current hoof pix so we can see what is happening with her trim as the last ones were from over a year ago. Here's the link to what photos would help:

https://ecir.groups.io/g/main/wiki/1472

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


Pat
 
Edited

Thank-you Maxine. I am arranging a vet appointment for a test and hoof x-rays.  Willow's test results fell within normal range last time from the vet's perspective - 14.  When I entered the numbers into the ECIR calculator it said she was food triggered insulin resistant.  Can you help me understand what Willow's test results mean for my horse's management? When you say high insulin = no grazing, what is high insulin? Many horses on this site have test results far higher than Willow had. And if I want to see if the grass is triggering, do I need to actually make sure she has grass the day before the test?  Also can you remind he how long she should fast before the test?

Huge thanks!
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

Thank-you Lavinia,
As Maxine suggested, I am arranging another insulin test as well as X-rays. You can see my questions about Willow's previous test in my response to Maxine. I need some help understanding the previous test results.  I will get external shots of her feet today.
Cheers!
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Maxine McArthur
 

Hi Pat
There is a link to information on reading your insulin test results in your welcome message to the group here: https://ecir.groups.io/g/main/message/254531
That welcome message is always a good one to revisit if you hit a bump in the management road. 

There’s a whole page on our website about why lab reference ranges for insulin are not ‘normal’ : https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php
(And yes, we need to change the column on the case history form to not be “lab normals”! That’s a work in progress.)

In any case, was Willow fasted for that 2020 insulin test? As you will see in the links above, we recommend drawing blood non-fasting, when the horse is eating tested low sugar hay, no hard feed. If the horse runs out of food overnight, don’t test until four hours after the first hay of the day, as the first meal after an overnight break will lead to a bit of a glucose then insulin spike, which you want to avoid. 




--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Pat
 

That makes sense. Yes, last test was after overnight fasting.  So it sounds like I should arrange the test for the afternoon, just to make sure. They have just changed (this week) the feeding pattern at my boarding barn to try to ensure they have enough hay overnight but we're still not sure how much - if any - she has left in the morning. Then there is a morning feed, a feed around 2:00-4:00 and an evening feed. She is trying to make sure they don't go any longer than 3 hours without hay in front of them, although my horse is fast eater.  So if I arrange a test for around 4:00-5:00 PM, that would be about the time Willow has finished or is mostly through her mid-day hay. I'll read the guidelines you have provided. Thanks!
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Sherry Morse
 

Hi Pat,

If you had a result of 14 after an overnight fast Willow is most definitely IR as a fasted test result is expected to be about 4 - 5, not 14.  Being a quick eater is another sign that her IR is probably still not well controlled.  Is she being fed hay in a small holed hay net?  If not, she probably should be and I would stop any grazing at this time and make sure turnout is only with a completely closed muzzle so she can have social time but not risk her health with grass.



Pat
 
Edited

Thanks for your thoughts! Yes she has always been fed in small hole hay nets - as long as I have had her which is 3 years. She is actually a much calmer eater than she used to be now that she gets enough tested hay weighed to an appropriate amount each day. Her weight management before I bought her was lots of exercise as a trail horse and very light feeding of non-tested hay, so for a while she still worried a lot about starving.  She was still overweight during the first test (about 1.5 years ago), had only been on tested hay for two weeks. I am looking forward to seeing what the result is now that she is down 200 lbs and fit. I am having her put out in the arena for turnout now. I think she would be frustrated to be out in a pasture and spend her time there being unable to eat. I know she would keep trying to get grass. She might get the muzzle off which would be a disaster.  
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

I have uploaded hoof shots from yesterday. I forgot to do the sole shot, I don't know why, getting older and forgetful I guess.  I have been trying to use my hoof armour but it is not absorbing correctly (I know the instructions and am doing my best), so that is why there is a bit of flaky stuff on the sole, it is hoof armour plus talcum powder. I removed it where I could.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Pat
 

For context I should note we’ve had a terribly wet winter and spring.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Sherry Morse
 

Her trim is much better than it was last year which points to the issue being her diet not being tight enough and/or that she should not be eating ANY grass.  It would be really helpful if you could get a proper side shot of her to compare to where she was last August and also if you could update your case history with her current diet.  If she were mine she wouldn't be out on grass unless she was in a closed muzzle - we recommend the Tough 1 or Best Friends Small hole muzzles as those are the easiest to totally block.  




Pat
 

Updated case study loaded.  She will not go on grass at all, turnout will be in arena. Barn owner intends to build dry paddock turnout this summer.
Still waiting for appointment for x-rays and blood test.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


maed@...
 

Hi Pat,
you’ve made a lot of progress. And I think that it’s a good decision not to have her out on grass.  
With the feet and laminitis- sometimes you can see the laminitis with hoof rings - but I couldn’t really see them much in your pictures.  And you can also kind of tell in the way that a horse stands or if they have trouble turning.  But getting the X-rays and blood tests will tell you for sure.  
--
Mary E in Wi 2021
https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Eli/


Pat
 
Edited

One version (lateral) of x-rays uploaded.  Vet (not my usual vet but the barn owner's vet who is a lameness specialist) said no physical signs of laminitis. He said the problem is thin soles and the trim caused the sensitivity.  Two weeks after the trim, my horse is back to normal. She has also not had any grass though.

I received the insulin test results yesterday and I expect they will be of no value from re-reading your guidelines.  I will see if I can get my own vet to come and do a re-test.

The test was non-fasting, in the afternoon, with low nsc hay available before.  Just insulin, glucose was not reported on.  (I unfortunately could not attend the visit.)
Results are:

<14.4 pmol/L (note not mmol/L) reported as Low, with a reference range of 28-390.

Just the same, I would appreciate any comments on this result - is there any value to it and what is the unit conversion - and the x-rays.

Thanks,
Pat


--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Eleanor Kellon, VMD
 

I agree there is no evidence of laminitis and actually everything looks better than in 2020. The conversion factor for insulin is to divide by 6 so yes, this is low and not a concern.

Your horse would benefit from this trim https://hoofrehab.com/DistalDescent.htm and absolutely do NOT touch the sole.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Pat
 

Dr. Kellon thanks so much for your response and for ALL the work you and your team are doing.

What a relief for me to hear this news.  Because I do not have to arrange another test but even more because Willow has made it to a good place.

My barn owner has a Cushings pony who she wants to retire and her vet suggested an 'almost dry' lot with grass mowed down to nothing, just so he had something to pick at while out. She has other metabolic horses as well and plans to put them out for a few hours in the mornings. (This would only happen if the pastures were not muddy, we live in the Pacific NW.)  Would this work for my horse as well?  
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Eleanor Kellon, VMD
 

Mowing the grass very short is a stress that increases sugar and triggers regrowth which also increases sugar.  Bad idea. You need an area devoid of grass with a perimeter around it so they can't reach any over or under the fencing. With areas of high rainfall, a pea gravel layer over top is helpful. The other option is a paddock paradise system. Ask on our Horsekeeping group for details and do a search there.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Pat
 

That's what I thought. She is also planning a track-type area. I am familiar with those and keen on it. I will push for no grass at all. I don't know why her vet would have advised that.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325