Severe lameness in IR horse under vet/trimmer care


Karen Glennon
 

I am the caregiver the past approximately 4 years (not owner) of this horse:
19 year old draft dam, Friesian sire mare
Approximately 15.2 hands.
Overweight since I've known her, more so after her dam, who she's always been pastured with, died about 3 years ago. Living solo since but has 50+ cows in next pasture.
Cresty neck developed gradually,  approx 18 mo ago. Annual vet check and vet didn't bring concern to owner.
Intermittent lameness, became more problematic, vet put on bute. On bute for probably a year before I got owner onboard with a new vet. Changed to Previcoxx this spring.
Diet: on about an ¾ to 1 acre of weedy pasture. About ¼ to ⅓ if it is limestone rock outbreaks.
Free choice first cutting hay in a slow feed hay net - mixed grass with a little bit of alfalfa. I've had it tested at Equi-Analytics.

June 27, 2022
Finally got new vet in to look at her.
Insulin resistant 
X-rays show 10.8 degrees rotation front left and 14.6 degrees front right.
Possible abscess in right front observed on x-ray. Poultices with Epsom salt goop.
Vet started on Platinum Performance hoof supplement, Thyrol supplement on a 6 week step down schedule and switch from previcoxx to bute 2 grams twice a day
Begin feeding soaked hay.
Start 30 day stall rest 

Trimmer came and trimmed 4 days after vet visit, which was her scheduled 6 week trim. Vet emailed x-rays to him to go off of.

Continue supplements, meds, retrim in 2 weeks. Trimmer said she'd have good days and bad days and lameness remained fairly consistent. Retrim at 2 weeks and he took off heel mostly. No signs of abscess.  Things going along fairly the same until last Monday, June 27, when she was not wanting to weight bear on right front. Absolutely hoping lame.
Had vet out same day. Difficult to get her to stand square, wanted to park out but got xrays. Rotation on left 4.6, right 11.5. unsure if the right has additional rotation. No gas pockets noted on x-ray and positive for hoof tester all around hoof. She is standing with the hoof tipped, resting on the toe. She doesn't want to walk on the sole. She'll drag it back to back up and tip toe hop on a forward step. 

My question, how long can an abscess brew? How do you know it's something else? 

When I figure out how to attach the x-rays, I will.

Thank you,
Karen
Novice horse owner of my own little cob.



Bobbie Day
 

Hello Karen and welcome to the group! Since this is your first post here it prompts a welcome message which I will include below. It's great that your seeking help for this horse, is there a chance the owner would consider joining and create a case history for her horse? We're assuming you have permission to share the information with the owner, but we do strongly encourage them to join.
There is obviously a lot going on here, first off, no horse with IR issues (cresty neck, feet issues) should be on any kind of vegetation, weeds or not without a completely sealed muzzle.
I will also start with the hay; we don't find that alfalfa is suitable for most IR horses as it can make some foot sore. Is there a chance that you could obtain a good quality grass hay, or something from our safe feeds list? 
You say it's been tested, was it a wet chemistry test? As you will see in your message below, we suggest under 10% sugar and starch, but some horses need much less. What was the insulin number? 
There are drugs to help lower insulin, but we want to be sure we first address the cause of the elevated insulin first. You could talk to the vet about metformin.
Metformin 08.08.20 FINAL (groups.io)
I cannot stress this enough, we don't recommend NSAID'S as laminitis isn't inflammatory, you could try laminox, Jiaogulan (if the trim is good) to encourage circulation. Or Uckele's Phyto-quench is also recommended. 
Pain Relief Alternatives to Bute and Banamine (groups.io)
Uckele LaminOx 3.3 lb
Uckele Phyto-Quench Pellets 5lb
Just be sure it's the pellets, as the powder has yucca which isn't recommended. Or you can source devils claw for pain from bulk supplements and feed that if you prefer.
We also don't recommend PP, the owner would be much better off by balancing the hay to what the horse actually needs in their diet, the problem with these supplements is that they have so much that you don't need and not enough of what you do, it's also morse cost effective. I would really encourage the two of you to start the emergency diet outlined below until things settle down.
We really need a case history will all blood work and the x-rays you refer to, if you need help with this let us know. 
As far as abscesses, it can take a while for them to work their way out, but NSAID'S will hinder that process, so again it's best to taper off and start with the J-herb to help with circulation.
How to Taper Off NSAIDs.pages (groups.io)
Why NSAIDs & Icing Are Not Recommended .pdf (groups.io)
I know I've given you a lot to think about and you will find so much useful information included in your welcome message below, we realize it will take you awhile to get through this but please keep it handy and maybe share with the owner? It also includes many links to very important information, let us know if you have any questions. 

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 (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.

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. 



--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Eleanor Kellon, VMD
 

An abscess can brew for months, especially with NSAIDs on board. They do little for the pain but slow down resolution. This mare needs to be tested for PPID. She didn't suddenly become IR 18 months ago.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

Hi Karen,

Not all abscesses are visible on xray and from your description of the pain it seems most likely to be the cause.  To speed up the resolution of the abscess, NSAIDS need to be stopped (taper off to avoid rebound pain, as per Bobbie's welcome letter), and add jiaogulin to increase circulation to the hooves. You will notice jiaogulin speeds up hoof growth and pinkens up the gums--that's how you know it's working.  You can also poultice with a baby diaper and numatozine, or do Epsom salt soaks and wrap the hoof in plastic cling wrap or a plastic bag. 

Abscess pain is truly awful and gets worse before it gets better, so the faster you can get it to mobilize out of the hoof, the better off she'll be.

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