Topics

Uncontrolled founder pain

Suzie
 

My mare has been suffering from terrible pain since early March when she escaped onto lush green grass. We changed her hay to only teff grass and gave her bute for the pain, which did nothing. We switched to banamine and that helped a little. Then we added 30 tabs of tramadol 2x/day and she finally got some relief. We had been slowly weaning her off the meds. She was down to a 250 pound dose of banamine paste 3x/day and 10 tramadol 2x/day. The vet came and gave the mare dormo so the trimmer could give her a realigning trim on June 25. Her previous two trims were only superficial on the front feet because she was in too much pain to hold her feet up long enough. I gave also gave the mare extra banamine before and after the realigning trim. The next day after the trim, she was in a lot of pain. I began adding more pain meds. She's up to 750 in the morning, 500 at noon and 500 at bedtime and 15 tramadol 2x/day but she's still in so much pain. She walks stiff legged, stepping out more on the left front and barely catching the right front up. The right front coffin bone has dropped more than the left. I don't know if I should keep increasing her pain meds.  She's been taking them for a long time. She's also getting ulcergard once a day. She's still eating her food. she loves to eat! She tested positive for IR on June 25 and we started soaking her hay.
Suzie Kirkwood
Descanso, CA
2020

Sherry Morse
 

Hi Suzie,

You'll be getting a full welcome shortly but just to give you a head start it would be really helpful for us to know what her actual numbers are for glucose, insulin and leptin and if she was tested for PPID as well - and if so, what her ACTH level is.  Do you have her in boots?

If she is IR bute and banamine are contraindicated as they will not work on metabolic laminitis and the long term use of NSAIDs interferes with healing.  We recommend weaning off of any NSAIDs after the first week or so of use and you can certainly wean her off now, but you do need to taper off slowly (there will be info on this in the welcome email) to avoid a rebound effect. 

The key to making her more comfortable at this point is a proper trim and getting her diet correct - and you remembering to breathe.


Candice
 

Hello Suzie,

Welcome to the group! 

Below is going to be overwhelming, so please take it piece by piece and day by day. Sherry is absolutely correct about a proper trim and an overhaul on your mare's diet. The sooner you 
implement the diet the sooner your mare will find some relief. Did you have X-rays done of her feet? If not, this may be a great time to do so to see if there is any rotation going on. Also, please annotate if she has been properly tested for PPID and what her results were for IR. 

Teff hay is generally very high in iron even though it is lower in starch and sugar. That will counteract the absorption of copper and zinc, which throws off the balance of these important minerals a horse needs to have a healthy hoof (overall health really!). Please read the below welcome message and let us know if you have any questions. 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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. 

 --

~ Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History: https://ecir.groups.io/g/CaseHistory/files/Candice%20and%20Shark

Shark's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71507 

 

 

Hello
Sorry for what you and your mare are going through ...what helped my pony who foundered very badly was acetaminophen , Gabapentin , Pentoxifylline , and bute twice /day (this is what University Of Penn New Bolten Center recommends )along with his Metformin & Thyro L....also softride boots with the purple& turquoise gel insert for laminitis and deep bedded stall.


--
Michele Goldberg
Bernville, Pa
joined 5/19/2016

Kirsten Rasmussen
 
Edited

Suzi, that sounds really tough.  That's a long time for both of you to suffer. I understand you are working on your Case History?

Duct taping pads or rigid foam to the bottom of her feet might help with the immediate pain if you don't have boots that you can put pads in, as well as making sure all she is eating is soaked hay (1 hr cold, 30 min hot) and salt.  The fact that this has been going on since March suggests to me there is something she is still eating that is triggering it.  Did you see any improvement after you started soaking hay?  Can you get Triple Crown Natural Balance cubes and try substituting some, for hay (they are safe for insulin resistant horses)?  Does she have any access at all the fresh greens (grass/weeds/etc) and if yes, what can you do to stop her eating them?

The best thing to do for her pain is eliminate as many possible triggers.  Definitely look in to having her hay tested by wet chemistry methods for ESC and starch at a minimum (ask the lab to hold the sample for possible further testing after they send you the initial results)...if ESC and/starch are high then even soaking it may not make it safe for her to eat.  So even if you eliminate every other possible trigger, if the hay is too high in sugar and starch you will continue to have problems.

Once we see your case history, maybe we can help you troubleshoot for the cause of her ongoing pain, so please put as much detail in it as you can.

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

Suzie
 

she tested negative for PPID. her numbers for insulin and leptin are in the case history. not sure how all this communication works yet. can you folks see her case history, or do I need to restate her numbers here? she did have a realigning trim, which set her pain quite a bit with her pain level.

--
Suzie Kirkwood
Descanso, CA
2020

Suzie
 

also, she only gets teff hay, soaked at breakfast and dinner, and soaked grass hay pellets with her meds and supplements. She's been on banamine since March, but still in pain. so I should wean her off pain meds when she's still in pain?

--
Suzie Kirkwood
Descanso, CA
2020

Sherry Morse
 

Hi Suzie,

You need to add your Case History link to your signature to make it easier for our volunteers to find the information needed to answer your questions.  To do that:

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window where you typed in your name, general location, and year of joining.

3) Add this link to the next line under your year of joining:https://ecir.groups.io/g/CaseHistory/files/Suzie%20and%20Filaree and then add the link to your photos under that line: https://ecir.groups.io/g/CaseHistory/album?id=250438





When you are adding a link to you Case History or photos, make sure you make it "live". Adding a space after your link or hitting enter on your keyboard will turn it blue.
4) IMPORTANT: Scroll to the bottom and hit SAVE!

I'm not sure what you're trying to say about the realigning trim - when was that done?  It would be helpful if you could post more pictures of her feet as well as full body pictures - the directions on how to do this can be found here: Photos and Hoof Evaluation Help. Her x-rays are certainly not the worse we've seen here so hopefully we'll be able to help you get her on the right path soon.




Sherry Morse
 

Hi Suzie,

A couple of things jump out at me from the Case History -  Have you had the hay tested yet?  As Candice mentioned, Teff can be high in iron even if it's low in ESC and starch, so it's important to know what minerals are needed to help balance the hay.  In addition, what kind of timothy pellets are you feeding?  Not all pellets have a guaranteed analysis so while you may not think 1.5 pounds a day is a lot, if the ESC+starch is over 10% it could be causing an ongoing issue. 

Also, are you weighing the hay and pellets or are those amounts an estimate?  Based on her current weight and what you have as her ideal weight she needs to lose about 50 pounds so you would want to be feeding her 18 pounds a day (2% of her ideal weight) and according to your case history she's getting less than that.  If that is a weighed amount, how long has she actually been getting that amount and how much was she eating before?  Has she lost any weight on the limited diet?

As mentioned previously, NSAIDs including banamine are contraindicated for metabolic laminitis.  The fact that she has been on banamine since March with no improvement is a pretty good indication that it's not actually helping her and she should be weaned off of them.  To get her pain level under control you need to remove the triggers which in her case would be getting her insulin levels (and probably her glucose levels although that wasn't tested) down.  Since she's sore and exercise isn't an option her diet may be able to be tightened or she may be a candidate for metformin - Dr. Kellon would better be able to advice on that. 






also, she only gets teff hay, soaked at breakfast and dinner, and soaked grass hay pellets with her meds and supplements. She's been on banamine since March, but still in pain. so I should wean her off pain meds when she's still in pain?

Kirsten Rasmussen
 

Hi Suzie,  is it possible some of the dates in your case history are off?  Like has she really been on stall rest since March 2000 because of pain?  There are a lot of 2000's that I think could be 2020's?

I'm sure Lavinia will comment on her trim when she gets a chance.  To my eye the trim has steadily improved from March to June; however, in the June views it looks like there might be gas pockets in the dorsal wall of both front feet, which could be related to the pain she is in.  Not sure if soaking for abscesses would help, or more movement to mobilize things (ie out of box stall and into a small enclosure alone where she can take a few more steps now and then?).  Pushing the breakover back on her toes a little farther might also help alleviate some of the tearing pressure on her dorsal walls, which should help with her pain.  Good to hear you have padded Cloud boots for her!

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

Suzie
 

I thought I had added my case history. will try again. I'm saying that immediately after the realigning trim, my mare's pain level went through the roof. before the trim, her pain level was improving, but after the trim, she had a lot of pain.

I've been told by local barefoot trimmers that banamine is more effective than bute for foot pain. And as I said in my post, bute didn't touch her pain early on but banamine helped. thanks for your comments. i'll also try to load photos.

--
Suzie Kirkwood
Descanso, CA
2020

Suzie
 

Thank you. Is it possible to get Candance's response re-sent? I didn't delete it but can't find it.

I weigh and soak the hay for breakfast and dinner, 5.5 lbs each. The remaining hay at lunch and bedtime is an educated guess. I also weighed the timothy pellets to know how much to put in the case history. I don't know what her ideal weight should be. I estimated based on the little bit of fat pads she still has. How do you determine ideal weight? She's been getting that amount of hey since her onset of laminitis in March. On May 21 we started 4 teaspoons/day of ThryoL and she weighed 1142 by the calculator and 1082 by the tape. On July 5 she weighed 947 by the calculator and 953 by the tape, so she's lost 189 pounds by the calculator and 195 by the tape.

As I mentioned earlier, we have been advised that banamine and not bute is more effective for hoof pain and banamine did help relieve her pain. It was helping her until her setback with the realigning trim. I was weaning her off the banamine before the realigning trim, but had to bump it back up due to the increased pain level after the trim. 

We are waiting for the hay test results.
thanks again.

--
Suzie Kirkwood
Descanso, CA
2020

Lorna Cane
 

Hi Suzie,

To see Candice's message click on View All 12 Messages in Topic ,in blue,at bottom of page.

Go back to top and Candice's message is there.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Lorna Cane
 

Hi again Suzie,

You may be missing messages. This is from a message from Sherry, about how to add your CH and Photo Album links to your signature:

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window where you typed in your name, general location, and year of joining.

3) Add this link to the next line under your year of joining:https://ecir.groups.io/g/CaseHistory/files/Suzie%20and%20Filaree and then add the link to your photos under that line: https://ecir.groups.io/g/CaseHistory/album?id=250438

Remember to hit SAVE !!


--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Candice
 

Thank you Lorna for your help!

Suzie- please let me know if you cannot locate the message after following Lorna's directions. Otherwise I can resend all the information. It is further down in this same thread. 

ECIR is best navigated by a computer if that helps you?

--

~ Candice 

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History: https://ecir.groups.io/g/CaseHistory/files/Candice%20and%20Shark

Shark's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71507 

 

Suzie
 

Oh my goodness! I can't believe I used the wrong year! but actually, I can believe it. Completing the case history was a marathon for me. If I go back to correct the 2000 dates to 2020 should I do it as an update or ???? sorry to cause confusion and thank you for catching my mistakes. 

She didn't have a real realigning trim until June 25th. She was in too much pain to hold her feet up long enough for the trimmer to trim her. So on June 25th the vet came and gave her dermosedan so the trimmer could do a realigning trim. 

We drew blood to retest for IR yesterday. I don't understand your comment about her ACTH level being 86.6 to start. What is the implication?

She is turned out in a big area and walks around slowly, awkwardly. We're scared to trim any more at this point since the realigning trim set her pain level back so much.

I'll try to get photos of her body and feet for you. just had eye surgery so I'll see if my husband can help out.

thanks again.

--
Suzie Kirkwood
Descanso, CA
2020

Sherry Morse
 
Edited

Hi Suzie,
 
If you fix the dates in her CH now and redo the upload (make sure you save a copy on your computer and delete the old file) it's not an update.
 
Normal ACTH levels are about 9 - 35.  A horse that has a result of 86.6 is definitely PPID.  The post result just confirms that.

*I just realized that the 86.6 ACTH was Wendy's mare, not yours, but this bit is still true for a horse that has had a TRH test with that high a result to start: Going forward you don't need to do the TRH test because you already know she's PPID so just one blood draw to check if the current dose of Prascend is effective is enough.*
 
As far as the ideal weight - it's a bit of a guess but it's the one at which you can feel ribs and - depending on the horse - possibly see their outline, but not so thin that they have hollows in their flanks and not so fat that they look flabby.  I do know for my guy I would have told you his ideal weight was about 875 but at 860 - on a scale - and out of shape he looked fat.  He's currently fit and was 890 the last time he was on a scale. I also know my weight tape adds 20lbs so I keep that in mind as well.
 
That's where photos can help us help you more. If she's been steadily losing weight on the current hay and pellet amounts I'd continue with that until you feel she's hit her ideal weight.  At that point you may need to up her intake to keep her where she should be. 
 
It's hard to say from looking at the photos sideways, but I think her toes are getting a bit longer than they should be and are also starting to get a bit of a dip in them which is a sign than they need to be brought back more and help get her in better alignment.  I believe that the dips in both correspond with what appear to be gas pockets on the x-rays so there may be abscesses that are getting closer to coming out at this point.
 

 

 
 


 

Eleanor Kellon, VMD
 

Suzie,

It's totally understandable that your focus is on her pain but no pain medication is going to fix this, or even do a very good job of getting her relief. Pain relief is not the same thing as healing. You're doing all the right things with diet but there is an excellent chance her ongoing pain and pain after the trim is due to abscess/fluid collections. Have you ever slammed a finger in a car door? That's the type of pain unresolved collections trapped inside a hoof cause. It's not the trim itself that causes the pain, it's the change in hoof mechanics that changes forces on the capsule her body builds up around these collections and makes them leak, irritating the tissues. All the antiinflammatory medications do is slow down the process of helping them break free.

Her still long toes are also aggravating the situation because they are stressing her weakened laminae and pulling them apart.

IMO, you should wean her off the NSAIDs  (bute, Banamine, Previcox).  You can continue Tramadol but nothing is going to help much until you get these to drain.  Concentrate on soaking in warm Epsom salt solutions and poulticing soles and coronary bands between soaks. Wrap the poulticed feet in heavy duty plastic wrap. Get her on Jiaogulan or LaminOX.  If she wants to stay down and off her feet, let her.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Suzie
 

I'm very confused. my mare's ACTH was 20.6 on the Cornell Lab test which is well within the normal range of 9-35. What is TRH test? She is not PPID per the test results.

--
Suzie Kirkwood
Descanso, CA
2020

Suzie
 

thank you, Dr. Kellon. What do you suggest we use for a poultice after soaking in Epson salt?

--
Suzie Kirkwood
Descanso, CA
2020