Hello, this is my first post here. I have been on the FB group but I’m hoping I can get some reassurance here that I’m on the right path. I will try to be concise but thorough in my giving of my horse’s history until today. 

My boy Tucker is a 28 y/o Irish sport horse gelding I’ve had for 12 and a half years. He’s been treated with 1/2 pill Prascend daily since he was 20 when he tested barely elevated on his ACTH. He remained well-managed on that dose and was tested every spring and remained consistently controlled. We tested for IR when he was 23, I believe, and he was all good, so I did not test again. I now realize that obvious error. He has eaten Poulin e-tec low carb senior, the minimum amount for his weight of 5-6lbs daily, for 5 years along with 2 tbsp/day iodized salt. He’s notoriously picky and is suspicious of any change of diet, and refuses to touch if even a trace of medication or supplement is detected. He’s always been this way.

12/23/22 he presented extremely mild, subtle soreness up front. I only noticed because I’m a crazy horse person and also know him well. It was just a change in posture I struggle to describe. Tense, guarded. He has ALWAYS had a preference for standing with the LF out front, and the RF planted under him. He always ate off the ground this way, grazed this way, stop square or with LF ever so slightly forward at rest. But I noticed this day he was standing with it a little weirdly farther out while eating hay at chest level. I chalked it up to me being paranoid as I saw him move, turn, and walk normally. He was living out 24/7 in a 1.5-2 acre dry lot on a small hill, as he has the last 3 years (at this property). 

12/24/22 
Got a freeze overnight. He was very lame in the morning. Reluctant to turn. Seemed lame on both fronts. I immediately suspected he was foundering. Stalled him, wrapped his feet with magic cushion, and gave him extra bedding. Called the vet. Iced at her instruction and got bute for him. 

12/25/22 
Seemed a smidge better. It was Xmas day so I was away the second half of the day and my boyfriend monitored him and sent me video updates. Tucker remained the same as he had that morning. 

12/26/22 
I get home and he’s crippled lame. Called my vet out on emergency. Pulled blood for a Cornell EMS panel and tested strong positive for Lyme and anaplasmosis on an on-site SNAP test. Sent out a Lyme multiplex to Cornell too. Put Tucker in soft ride boots and continued 2g bute/day. My vet suspected the anaplasmosis and Lyme triggered an inflammatory event resulting in acute laminitis. He was also likely a tinderbox with untreated IR, in retrospect. Began refusing to lay down at this point.

12/27/22
Vet came out and took X-rays. They are in my case file (https://ecir.groups.io/g/CaseHistory/album?id=283825). They showed 5-6 degrees rotation in both fronts, thin soles, no sinking yet. Still super lame, sawhorse stance. Continued icing. Elevated HR (65ish bpm) and respiration, persistent sweating, pained expression and tight mouth. I excessively bedded him up with banked walls trying to encourage laying down, to no avail. 

12/28/22
Added 2x/day 20 pills Tylenol and 1cc acepromazine IM 1-2x daily. Continued signs of pain listed above, elevated HR, etc. Remained in soft ride boots. 

12/29/22
Same as 12/27 and 12/28

12/30/22 
Got bloods back in the afternoon. High ACTH, glucose, and thyroid dysfunction. Upped to a full pill pergolide daily and added 1g scoop/day thyrozine powder. Still has not laid down a single time since 12/26 that I could tell. Not a shaving on him. 

12/31-1/7 
We struggled through with some bad days and some ever so slightly better. He stayed in boots, we switched from soft rides to clouds. I started trying to get him off the low carb senior and onto the Poulin balancer. Then I found the ECIR group and website. 

He got his first realigning trim with a farrier recommended by my vet on 1/3. He showed immediate signs of relief and FINALLY began laying down again starting about an hour after the trim.

1/8/22 
We begin to transition from senior to double rinsed beet pulp mixed with triple crown Timothy balance cubes and VT blend with iodized salt.

1/10/22 
Added flax 

1/12/22
Added vit E

For the most part throughout all this time we had steady extremely slow progress. He began eating off the ground by choice again, he started moving a tiny bit more, his HR would occasionally dip down below 60. I weaned him down to 1g daily bute around 1/11-1/12. 

Second realigning trim done 1/27. 

Xrays and bloodwork re-taken 1/30. Bloods not back yet. Xrays showed some sinking, making soles thinner and bone closer to penetrating, but doesn’t appear to have any worse rotation. Gas pockets forming in the wall separation space. My vet mentioned resection, and she and my farrier are both wanting to do glue on shoes or clogs. I would prefer to keep him barefoot in boots and pads as this group advises. I’m talking with them about that currently and saying that if he is improving I am nervous to change something. Those new xrays are also in my case file.

His HR has finally dipped below 50 since the second trim. He lays down regularly and at more normal intervals and for more normal periods of time now. He has a small sand run out off his stall I made him that he moves around quite a bit. It isn’t very pretty to watch still, but he moves on his own accord a fair amount. 

Open to advice, thoughts on glue on shoes vs not, hoof resections, etc. Thank you in advance!!! 



--
Annie Fitzgerald, Massachusetts USA, 2023

Hi Annie. Welcome to the group. Your first post triggers a welcome letter for you that explains our protocol of Diagnosis, Diet, Trim and Exercise( only if they are pain free). 
We don't recommend shoes or clogs at this point because he needs his feet free to be trimmed frequently as this will provide him with pain relief and also will keep the mechanics of the hoof stable. Trims should be 2-3 weeks. You can get mark ups here from Lavinia which can guide your farrier and vet to trimming appropriately. I would not consider a hoof wall resection at this time. Take a look at the WIKI on this page and you will find directions on how to get good photos and good xrays. Our welcome letter will answer alot of the questions you have now and in the future, so keep it handy. 

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 etiquette, what 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.

EXERCISE: The 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
Primary Responder
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993     

Annie,
Its weird, I resonded to you I but do not see the post...   I wanted to make sure you had some response!  One of the moderators usually responds by now with the welcome letter and the basics for managing acute laminitis with IR.
I have read on this site that icing a laminitic hoof is not indicated.  Especially if it was brought on by the cold in addition to other factors.  Chronic high insulin reduces blood flow to the foot and being cold further reduces blood flow to the extremities.
Is your guy booted and wraped in front and back?  Backs can really be as bad as the fronts.  My girl did so much better once I got clouds on the back feet as well.  IME Boots that have a thick pad that really conforms to the bottom of the hoof is better than any shoe or clog.  I think I am correct in saying "NO" to hoof resections!  
You do not want to open foot up!  I thought my girl was going to penetrate but she thankfully did not. and the bacteria/fungus you let in is way worse than any you would let out!  Keep him warm and get rid of any alfalfa, grain or treats.  Soak hay if you feed hay....not sure what he is eating off the ground?

 Easycare makes an attachement for the bottom of their boots that can take the shape of a clog bottom.  it is a plastic wedge that screws onto the bottom of the boot and it is easy to put on and take off.  It can be shaved down to not have an incline and it makes the break over of the boot move much futher back and is plastic so offers no much friction to turing.  That is not as important as getting the sole supported and the hoof wall reduced in weight bearing tho.
As best you can get a case history up loaded and that will make it easier for the moderators to guide you.
Im sorry you and your boy are going through this.  Glad you found this site.  It has saved my mental health to have such great input from such experienced people!


--
Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Thank you Trisha! I have figured out how to start my case file. I have made an album with all xrays and edited my post above to link them. I am also going to figure out how to include it in my signature. Figuring out the site slowly but surely here. Thank you for confirming that I am right to resist shoes and a resection--I start to feel a bit crazy going against professional opinions. Looking forward to hearing more once moderators can take a look at his xrays.
--
Annie Fitzgerald, Massachusetts USA, 2023

Thank you for the reply Lesley! I am interested to hear about the clog attachments for the boots you mentioned! I will look into those. He is in cloud boots and pads up front, not behind. Perhaps I should try behind too. I don't even have xrays of his hinds. My vet didn't even mention it. I have told my farrier that keeping him barefoot right now is what I would feel most comfortable with and hopefully she is receptive to that...otherwise I will look elsewhere as I have only used her twice at the recommendation of my vet anyway. I'm far more attached to my horse than to her!! He is still steadily getting tiny bits better so I am hoping despite the scary xrays...we might come out the other side of this if I listen to him and trust my instinct that I know him best.
--
Annie Fitzgerald, Massachusetts USA, 2023

I was able to get the case study form I've started and my photo album of rays in my signature. Replying again to provide those easily. 
--
Annie Fitzgerald, Massachusetts USA, 2023
https://ecir.groups.io/g/CaseHistory/album?id=283825
https://ecir.groups.io/g/CaseHistory/files/Tucker%20Fitzgerald

Annie,
 I had to talk the vet into taking the hind xrays. I knew she was lame on the hinds and that the lamina was not attached, I could see it.
She has white hooves so it was easy to see the bruising but she was also toe landing and her whole hind leg would swivel over the toe
She took the xray and was shocked to see the gas pockets in the backs.  I had glove boots with pads on her on the hinds for 2 months but decided to get the clouds for the backs as well and it made a huge difference in the way she moved.  The wedge things are designed for use for a horse with negative plamar angle but can be modified to decrease the wedge angle.  They are heavy but I like how they decrease the shearing forces when turning.
--
Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Hi, Annie. Sorry to see Tucker here with laminitis. We know how stressful it can be to manage a laminitic horse and your team of professionals.

I wholeheartedly agree with Trisha: right now you need to remove *every*single*potential* laminitis trigger - uncontrolled PPID and high insulin - while simultaneously optimizing his comfort with deep bedding, trim, boots and pads. No hand-walking. No icing. Let him lie down as much as he wants. I would stand over every trim to make sure that no one, including any professional, removes a single nano-particle from the sole of any of Tucker's hooves. No clean up. No digging. He needs every bit of sole to be left in place.

I hope Lavinia and Dr Kellon will weigh in on the radiographs. 

Did the blood work you’re waiting for include insulin, glucose and ACTH? If the samples are still at the lab, your vet may still be able to request any omitted labs. 

Do you already have a back-up set of Cloud pads? I expect a big guy like Tucker to compress Cloud pads more quickly than a light horse, so it's good to have a spare set on hand. I assume he’s in a really deeply bedded and banked stall to help him get up and down? Blanketed for this extreme cold weather despite any long Cushings coat?

I know you have a lot going on right now! Would you add to your To Do list body shots of Tucker as described in the Wiki? I would expect a 16.1H Irish Sport Horse to weigh more than 1050 lbs. if his BCS is 5. I realize different lines have different body types.My ISH two decades ago could have excelled at jousting and weighed hundreds of pounds more than 1050.

Last, among the outstanding ECIR resources for acute laminitis are the first three Proceedings from the 2017 NO Laminitis Conference. They are free. Here is the link:
https://www.ecirhorse.org/proceedings-2017.php Don't fret about the shopping cart used to distribute the proceedings. You will not be asked to buy anything. Download especially:
Tiered Management Approach to EMS and PPID
Endocrinopathic Laminitis: How is it Different?
Acute Care for Endocrinopathic Laminitis

We're here to listen and to help. I can comment on my experience with glue-on boots for my laminitic horse, but first you should hear from Lavinia or Dr Kellon on the radiographs.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Hi Cass, thank you so much for your reply.

It sounds like I am following the directions listed above--no icing (my vet told me to do this at the start, which I did, but stopped once I found this group's wisdom), a VERY generously bedded and banked oversized stall, and supporting him in the cold temps. We have not yet had the "cold snap" moving across the USA but it's coming to us Friday night/Saturday, so I have my blankets ready to go (though he has not been blanketed in several years). Thank you also for reminding me about the spare Cloud pads--you are correct he's compressing them and I had it on my list to order another. I will do so right now before I forget again! Also yes, the EMS Cornell blood panel includes insulin, glucose, and ACTH. This is the same panel we submitted a month plus ago and it included all those things, I just did not get the detailed results back which is why the numbers are not in my case history. I am asking my vet to send them to me today.

I can definitely add body shots to that to-do list. I also need to get photos of his hooves for a member on the ECIR Facebook group who requested those, so I can add those to his album as soon as I get them (hopefully I will have a chance to during the workday today while I still have some daylight). You're probably right about his weight, he has dropped a fair amount over the last 6 weeks, but probably is still above 1050. I've never had the opportunity to actually weigh him on a scale so it's all been based on taping him and using judgment/comparison to others. I'd really love to actually weigh him but don't know how that would be an option besides hauling him to Tufts.

I eagerly await comments on the Xrays. The sinking and his size concerns me. Luckily no one has touched his sole--the farrier stressed to me she would not touch it because, like you said, he needs every bit of it to protect from penetration. He also has been an absolute beast to try to get him to eat his safe foods--he will eat his soaked hay at this point, but beet pulp/timothy hay cubes with his minerals is consistently rejected. He takes a couple bites then refuses even if I leave it in his stall with him overnight or longer. I've tried every taste tempter that's safe to no avail. He likes it for a day, then hates it again. I have resorted to syringing in the minerals to get him the building blocks he needs to grow more foot/sole. 

Thank you again and I will get those other photos done asap. 
--
Annie Fitzgerald, Massachusetts USA, 2023
https://ecir.groups.io/g/CaseHistory/album?id=283825
https://ecir.groups.io/g/CaseHistory/files/Tucker%20Fitzgerald

Hi Annie,

Welcome to a fellow New Englander!  Thank you for posting your case history folder and photo album.  When you get a moment, could you please save your .doc case history file as a .pdf and load that.  Most of us can read .doc files, including me with my Apple products, but some can’t.  Everyone can read a pdf file.  Thanks!

I’m by no means the one to offer definitive comments on this but I don’t see the rotation you mention.  There may be sinking, as evidenced by the lack of sole, but I’ll leave that for Lavinia or Dr. Kellon to comment on.  I would focus on booting and skip any shoes which would support the hoof wall and allow for further sinking.

The thyroid dysfunction is likely secondary to the IR/PPID.  It will self correct once the primary causes are rectified.  Thyro-l is recommended here to jump start weight loss but if Tucker has been on it awhile and doesn’t need to lose more weight, I would slowly wean him off it.

Has Tucker been treated for Lyme and Anaplasmosis now?  I did not see where you mentioned that.  Somehow I was able to read the. Case History but now I can’t locate it.  The link should be to the Case History file folder.  That way if you change the CH to update it, we are still directed to the correct place.  Those diseases can definitely precipitate laminitis and should be included in his case history.  Laminitis resulting from those might well be inflammatory but metabolic laminitis resulting from IR is not and won’t be helped by icing or Tylenol and other NSAIDs.

I want to correct this implication that Tylenol is an NSAID - not because it is steroidal but rather because it is not anti inflammatory.  Instead it is antipyretic and analgesic, both to a moderate extent.
--

Hi Annie, 

I agree with Martha you're going to need to deal with the lyme/anaplasmosis asap with antibiotics as it is definitely a cause of laminitis and if his infection is active then it could make the laminitis much more severe.  In my experience here, we don't see penetration of the sole when the laminitis is solely metabolic in cause, but if related to infection or poisoning, penetration seems to be more likely.

Once you have all your EMS bloodwork numbers, we should also be able to tell you if IR from uncontrolled PPID is also a factor.   Likely it is.  Very few horses do well on a low dose of pergolide for as long as Tucker has because of the progressive nature of PPID.  I can almost guarantee that the very high ACTH on Dec 26 is going to need a higher pergolide dose increase.  I'd go to at least 2mg, then retest in 3 weeks to see if the increase is enough.

I took a look at your xrays and can see that the rotation your vet described and demonstrated with the diverging white lines is called capsular rotation and that is actually a trim issue.  Lots of non-laminitic horses have this, too, because most trimmers leave toes too long (ie, too far forward) and the hoof wall at the toe gets pried away from the internal bones.  Laminitis can worsen this by reducing the strength of the lamellar attachment.  The solution is to bring the toes back horizontally until the dorsal hoof wall is not touching the ground, and keep them back.  You may need to request trim markups to see what is meant by that:
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help

Tucker has minimal to no boney column rotation, which would be "true rotation" from laminitis/founder.  He appears to have quite a bit of sinking but the coronary band is not marked on the rads so its difficult to see how much.  Next time you do xrays, tape a radio-opaque marker (nail, wire, key chain, nut, bolt, etc) at very top of the hoof wall and at the tip of his frog.

--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album

Thank you, Kirsten and Martha. Tucker has been treated with 30 days of minocycline for his Lyme/Anaplasmosis. We just completed that last week. Thank you for pointing out that I failed to include it in his case file--which I have now uploaded as a pdf but still link to the doc in my signature. I will correct all that now. I truly appreciate all this guidance--I am taking in a lot of new info and posting his case in several different places so I forget what I said where/when! The guidance from this group has been a godsend so thank you all so much. 

I am a bit frustrated that my vet did not mention marking the hoof to be able to read the xrays better. Shouldn't that be par for the course if we are looking to track the sinking/rotation? Just feeling a bit exasperated and feeling like if I had the proper info/resources to begin with he could be in a better place by now...

I am working on getting body shots and foot photos to add to his photo album today! Hopefully that will help. I see quite a bit of sinking as well...it's interesting to hear this could be partially due to the inflammatory nature of the lyme/anaplasmosis, which timing-wise did seem to be the trigger for all this. 

My vet said further sinking can occur at any time, no matter if all triggers are removed, due to the existing damage done to the foot structure. Is this the case?
--
Annie Fitzgerald, Massachusetts USA, 2023
https://ecir.groups.io/g/CaseHistory/album?id=283825
https://ecir.groups.io/g/CaseHistory/files/Tucker%20Fitzgerald

Annie,
IME
Regarding marking the hoof for xrays.  When I asked for it
2 different vets considered it silly to mark the hair line and would not do it and I did not have the wire to do it....One vet said she could mark the hair line after the xray was taken but then did not.
I suspect vets are not taught to problem solve with the  x ray for sinking the same way a good trimmer is. 
This group is so important to learn why and how to advocate for your horse.
--
Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Hi Annie,
I was thinking an Irish Sport horse might be a warmblood and, after doing some searching, it seems that's the case, in that’s it’s a cross between an Irish Draught and a TB.  TBs and WBs are less likely to be metabolically IR than other horses.  I would focus on bringing his ACTH down with added pergolide and follow the insulin at the same time.  It may well be that the elevated ACTH is driving high insulin and, once you get the ACTH under control, the insulin will no longer be an issue, if it is now.  My PPID WB never had an issue with insulin being high but I did keep his ACTH well controlled.
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Hi, Annie. Keep experimenting with taste tempters to persuade Tucker that mineral supplements aren’t poison. I know how hard it can be. Horses in pain aren’t inclined to experiment with new flavors. Don’t give up but also don’t be surprised if it all changes for the better when Tucker’s laminitis resolves. Some resources:
Picky eaters checklist

https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together/Picky%20Eaters%20Checklist.pdf

The toolkit I use to introduce new supplements to my non-food motivated Paint:

https://ecir.groups.io/g/main/message/28149

Start small. Getting half the minerals in is better than none. Sprinkling over hay might work and definitely works for salt. You can request Stabul1 samples directly from Anderson Feeds to see if a flavor appeals to Tucker. http://stabul1.com/stabul-1/

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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

I forgot to respond to the claim that further sinking can occur even after all triggers are removed. That’s exactly what ECIR aims to avoid! Further damage wasn’t my experience with acute laminitis last May. In fact after a realigning trim and boots and pads, my mare added sole depth within 5-6 weeks. That isn’t to say all pain was gone - it wasn’t. But the “founder” did not progress.

My case was different from yours, complicated in different ways. One thing our horses had in common was uncontrolled PPID. I persuaded my vet to prescribe increasing doses of pergolide until ACTH improved. We checked labs monthly, checked radiographs which showed the sole building thickness. 

Marking hooves for radiographs of a laminitic horse takes a little practice. You don’t have to do a lot: mark the tip of the frog with a tiny radiopaque marker, anything from a beebee to a tiny washer that you can glue to the frog. No thumbtack for Tucker unless you cut off the metal point, leaving a small disc.  Mark the very center of the dorsal wall where the hoof wall meets the coronary band the same way or use a straight piece of wire or shoeing nail on the hoof wall.  I don’t mark the entire hairline but I do trim the coronary band so it’s clearly visible in photos. 
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Thank you so much everyone for all your comments. They are SO appreciated. I am eagerly awaiting the blood test results from Cornell from Monday. Thank you additionally for the tips on marking xrays Cass--I will have this information ready for the next set in another month. 

I am wondering about blanketing--I saw I should blanket him in this upcoming cold snap. I should do this even if he has not been blanketed in years and has a thick full coat? He runs warm, so I am just hesitant to change this up on him all of a sudden, but if it is recomended I will do it. He is already wearing wool winter socks on both feet, hooves are fully covered, and they reach up to mid-cannon or so. I am running to pick up fleece-lined shipping boots today as well (in the meantime I'd been getting by with regular standing wraps and quilts which worked well enough, but won't cut it in these temps, plus I'd prefer the boots to avoid any slippage/uneven pressure). 
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Annie Fitzgerald, Massachusetts USA, 2023
https://ecir.groups.io/g/CaseHistory/album?id=283825
https://ecir.groups.io/g/CaseHistory/files/Tucker%20Fitzgerald

Annie,
IME,
just to be safe, can you protect/wrap his back feet/legs as well?
horses tend to bear more weight on their fronts so its easier to see the soreness there, but the backs have lamina and can have blood flow issues as well.
and if he is shifting his weight back they will start to suffer too.
I would blanket, just to ensure his system is willing to send blood to his feet.

--
Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Thank you Lesley! I will blanket to be safe. I do only have socks on the fronts but I will be fleece booting all 4 legs!
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Annie Fitzgerald, Massachusetts USA, 2023
https://ecir.groups.io/g/CaseHistory/album?id=283825
https://ecir.groups.io/g/CaseHistory/files/Tucker%20Fitzgerald

Hi Annie,

Since he hasn't been  blanketed for years  and has a thick full coat and he runs warm,if he were here(minus 34C,wind chill) I would opt to have a blanket ready. But I would watch how he is handling the cold,and feel in through his coat with my fingers to see if his skin  is toasty ,before blanketing. Assuming,of course,he has shelter available.Nature has given horses an amazing coat, unless of course PPID has messed with his temperature regulation.
OTOH, if I chose to blanket,I would keep an eye on him,to be sure he wasn't getting too warm.Sweaty wouldn't be good.
He'll let you know.

--
Lorna in Eastern Ontario
2002