Hopping lame but not an abscess

[Michen]

I’m so sorry this sounds utterly horrendous. I’d definitely just get her for the MRI if you can ASAP.

But you do need to think about what you would do even with a diagnosis. If a keratoma would you fund the op? If a fractured pedal bone would she box rest?

It sounds like these things wouldn’t be an option for her and it sounds unlikely that whatever this is, it’s going to not need box rest or treating somehow.

 

[Spirit2021]

Could he/she have laminitis because it kind of odd for a horse to be that lame .

 

[acw295]

Small update-on our 3rd vet now and they’ve concluded that for now to treat as for laminitis as an unusual 1 hoof presentation (although she now has a slight pulse in hinds this week which is new). So continue with deep bed box rest and bute but now she also has paracetamol. She was already on 1.5% body weight soaked hay so no diet changes to make.

She’s also wearing therapeutic hoof boots with gel inserts (soft riders) at vet recommendation and has had blood taken to check insulin.
If insulin ok then will do Cushings test when her pain is better.
Xrays will be repeated soon.

I first called them out 3 weeks ago for laminitis as that is always my first thought but first vet said abscess, so I won’t be surprised if that’s the eventual diagnosis. But it’s all rather exasperating when you’ve seen so many vets (plus farrier several times) and they thought not. Ho hum.

At least the paracetamol has helped a lot. Much happier pony in herself, although you can see it’s still sore.

 

[Birker2020]

But it’s all rather exasperating when you’ve seen so many vets (plus farrier several times) and they thought not. Ho hum.

.

Shocking is my reaction. Glad she is feeling happier in herself.

 

[acw295]

It's difficult - I understand why it didn't look like lami to start with. She was lame in one foot only (nerve block confirmed), she was unreactive to hoof testers in all feet. Pulse only in one foot. Xrays clear.
But I am so paranoid about lami that it's always been my fear (she already has limited grazing (never lives out), low sugar/starch molasses free food (balancer and chaff only), rationed hay and Lamigard supplement. No treats) - it's why she had an original Saturday emergency call out rather than wait and see (I'm sure yard thought I was mad as it looked like abscess lameness).

She now looks sore everywhere but then 3 weeks of box rest when you are old and arthritic will do that. The lami might be secondary to another issue in that foot or it could have been the primary all along.

I'm just hoping for an explanation (Cushings would be ideal as at least with the right drug regime she stands a chance). We'll give it everything we can to get her right, but I have a time limit in my head. If we can't make progress I'm not keeping her going. If lami vet says to expect a month of box rest minimum. In my head if we aren't getting anywhere at all after 6 weeks it's time to consider pts.
But now she is much more comfortable I am less frantic - and actually feel some relief that we are closer to an answer.

I'm aware my posts don't reflect well on vets but that's not true - they have been brilliant, we've had to see 3 people just because 2 calls were Out of Hours so it was whoever was on call. They've all taken it very seriously, it's just a bit of an unusual presentation and it still doesn't quite add up really. She's overweight as she has never been properly slim even when endurance and hunting fit, but she is by no means obese so something has tripped her over the edge - her management hasn't changed.

 

[ester]

It's so hard when you can see them sore and it can get tricky when they are also arthritic.
While I understand the reasons for not cushings testing with the pain I'd be concerned that if it is lami you won't be able to improve it without a meds trial. The lami app has been on high for a lot of the country over the last few weeks.

As a bit of an aside because we did not have such an acute onset in one hoof my then 25yo welsh was not right/sore all over/no pulses, only slightly reactive to hoof testers so ? arthritis all round and the ground was rock hard. Once it rained it became apparent that it was hoof orientated, he had a massive amount of sole shed and it's not happened in the 2 springs since with no management changes (like you we had it pretty much nailed as best could anyway).

 

[Spirit2021]

It's difficult - I understand why it didn't look like lami to start with. She was lame in one foot only (nerve block confirmed), she was unreactive to hoof testers in all feet. Pulse only in one foot. Xrays clear.
But I am so paranoid about lami that it's always been my fear (she already has limited grazing (never lives out), low sugar/starch molasses free food (balancer and chaff only), rationed hay and Lamigard supplement. No treats) - it's why she had an original Saturday emergency call out rather than wait and see (I'm sure yard thought I was mad as it looked like abscess lameness).

She now looks sore everywhere but then 3 weeks of box rest when you are old and arthritic will do that. The lami might be secondary to another issue in that foot or it could have been the primary all along.

I'm just hoping for an explanation (Cushings would be ideal as at least with the right drug regime she stands a chance). We'll give it everything we can to get her right, but I have a time limit in my head. If we can't make progress I'm not keeping her going. If lami vet says to expect a month of box rest minimum. In my head if we aren't getting anywhere at all after 6 weeks it's time to consider pts.
But now she is much more comfortable I am less frantic - and actually feel some relief that we are closer to an answer.

I'm aware my posts don't reflect well on vets but that's not true - they have been brilliant, we've had to see 3 people just because 2 calls were Out of Hours so it was whoever was on call. They've all taken it very seriously, it's just a bit of an unusual presentation and it still doesn't quite add up really. She's overweight as she has never been properly slim even when endurance and hunting fit, but she is by no means obese so something has tripped her over the edge - her management hasn't changed.

That’s my biggest worry with my horse he is a very good doer.

 

[acw295]

They've taken bloods for EMS, if that's positive she'll go on a thyroid drug (can't remember the name) costs about £600 for a month to help the insulin levels. If negative they said they might start on the Prascend anyway without doing the Cushings test first. But that depends on what exactly the initial bloods suggest. Or they might leave it a week and then do the TRH test as they hope that a week on the paracetamol might make a difference to the levels (she's having 3 x 20 paracetamol a day plus 2 bute for 5 days then they'll try 2 x 20 paracetamol plus the bute for 2 weeks).
I think I've understood that right. Vet does hope that there's a "cause" that can be medicated.

Off now to order the hoof boots - we're hiring some from the vets for now as apparently these take a month to arrive from USA but will need our own. So we're £1k in already with those and the shavings and the first bill.

 

[FFAQ]

Acw295 you could try getting in touch with hoofbootique.co.uk about boots. There are loads of therapy type boots available in this country, which would save you money both on hiring fees and postage from the US!
My mare is in easyboot clouds and if they made them in a human shape I would totally buy a pair for myself! Cavallo, old mac, easyboot trail, and equine fusion all work well as therapy boots with a nice soft pad in and those are just off the top of my head!
Best of luck for you and your girl - keeping my fingers crossed for you x

 

[SEL]

Definitely try one of the UK hoof boot places - I know many, many people who have ordered cloud boots and the right inserts from Hoof Boutique.

The thyroid drug is a bit hit and miss as to whether it works. Has the vet ruled out trying metformin first? Its a LOT cheaper.

We've got a small welsh pony on box rest with laminitis at our yard. That came out of the blue and she was on minimal grazing (pickings) at the time. Turns out her insulin levels are ridiculously high despite soaked hay and a very low NSC feed. Cushings negative, so we can only assume her body is so sensitive that the little grass was enough to push her over the edge.

Hope you start to see results soon - its awful when they are ill and you are struggling to get them well x

 

[PinkvSantaboots]

My friends horse presented almost exactly the same as yours and after 3 lots of x rays the third time did show laminitis but it took weeks to present on an x ray, he did actually have cushings so is on prascend and he made a full recovery although it was many months of box rest before he came right.

It's probably not what you want to hear but your doing all the right things, I will keep fingers crossed that it is not laminitis and something more minor though.

 

[alibali]

Really glad to hear your girl is more comfortable now. As someone with a pony who presented with chronic low grade lami in one hoof only I feel your pain. My boy was negative bloods for Cushing's but responded to a Prascend trial.

I will keep my fingers crossed for you both. It's so exhausting seeing them in pain but being unable to get to the bottom of it. I hope things continue to improve.

 

[acw295]

Quick update- bloods show raised insulin but not massive. Thursday we are doing the test where they have sugar syrup then bloods (forget the name) and a TRH stim test plus xrays if he thinks she’s comfortable enough to do them.

So EMS possible but given age he thinks Cushings is a possible contributor. Could very well be both. They want to do both tests before starting any medication. So hopefully she won’t deteriorate in the meantime.

Vet also going to send some suggestions for UK hoof boots so we’ll see what he suggests.
Thank you all for the support and suggestions.

 

[SEL]

Quick update- bloods show raised insulin but not massive. Thursday we are doing the test where they have sugar syrup then bloods (forget the name) and a TRH stim test plus xrays if he thinks she’s comfortable enough to do them.

So EMS possible but given age he thinks Cushings is a possible contributor. Could very well be both. They want to do both tests before starting any medication. So hopefully she won’t deteriorate in the meantime.

Vet also going to send some suggestions for UK hoof boots so we’ll see what he suggests.
Thank you all for the support and suggestions.

In humans that test is called a glucose tolerance test. They take baseline bloods before the sugar syrup and then will take again a couple of hours later. In a horse without insulin disregulation the insulin levels shouldn't really rise because the sugar will be taken up by the liver and muscles. In a horse with a problem (EMS) then you'll get markedly elevated insulin levels. I would, however, be concerned by a vet doing that test in a horse presenting with laminitis type symptoms because you are about to give it a lot of sugar - so if you do have an underlying problem then there is the risk of pushing your horse over the edge. It might be worth just saying to your vet 'how do we know that sugar syrup isn't going to trigger laminitis?'

 

[ester]

I was going to mention clouds too, they get used a lot for this.

 

[acw295]

Yes I had the human GTT version when I was pregnant (I had gestational diabetes as it turned out) the equine version we are doing next week is the Karo Light corn syrup one (as opposed to the dextrose type). Apparently the Corn syrup one is easier to get them to eat quickly.

I think the vet is convinced now that it is laminitis and it’s not going to make any difference but I will ask.

 

[acw295]

Another little update.
Vet did the insulin dysregulation test using the Karo corn syrup this morning https://liphookequinehospital.co.uk...t-for-assessment-of-insulin-dysregulation.pdf

Trying to syringe that in to a hungry horse isn’t funny. I’m still covered (had to go straight to work).

We also had the TRH stim test and xrays.

She came out of the stable for the first time in 9 days. Lameness is now almost completely gone, she’s comfortable on a turn as well as straight lines and has been doing excited mini rears in her stable and lifting her hind legs for a scratch so that’s all very encouraging.

Xrays show there is a small amount of rotation in the left fore. Right fore is fine. I don’t have them on email yet but will share them when I do.
It’s minimal in the LF and vet hopeful it can be corrected with trimming and shoeing etc. Her toe on the LF is much longer than the RF so the rotation might even be less than it looks once the toe corrected. Sole depth looks good.
We are continuing as we are with box rest, deep bed, soaked hay and the boots for another 2 weeks, then heart bar shoes and hopefully start with some movement (probably some gentle walking but not grass).
We will wean her off the paracetamol over the next week or so but continue with bute.

Test results should be back for Monday so we should know if we have EMS and/or Cushings and can then medicate accordingly.

I know it’s early days and they can go downhill but the improvement is huge at the moment and vet hopes we have avoided any major damage. But obviously we need to work out how to stop it happening again as she was already tightly managed. Awful as it sounds I’ll be quite relieved if it is Cushings as we have something to “do”.

 

[fankino04]

Another little update.
Vet did the insulin dysregulation test using the Karo corn syrup this morning https://liphookequinehospital.co.uk...t-for-assessment-of-insulin-dysregulation.pdf

Trying to syringe that in to a hungry horse isn’t funny. I’m still covered (had to go straight to work).

We also had the TRH stim test and xrays.

She came out of the stable for the first time in 9 days. Lameness is now almost completely gone, she’s comfortable on a turn as well as straight lines and has been doing excited mini rears in her stable and lifting her hind legs for a scratch so that’s all very encouraging.

Xrays show there is a small amount of rotation in the left fore. Right fore is fine. I don’t have them on email yet but will share them when I do.
It’s minimal in the LF and vet hopeful it can be corrected with trimming and shoeing etc. Her toe on the LF is much longer than the RF so the rotation might even be less than it looks once the toe corrected. Sole depth looks good.
We are continuing as we are with box rest, deep bed, soaked hay and the boots for another 2 weeks, then heart bar shoes and hopefully start with some movement (probably some gentle walking but not grass).
We will wean her off the paracetamol over the next week or so but continue with bute.

Test results should be back for Monday so we should know if we have EMS and/or Cushings and can then medicate accordingly.

I know it’s early days and they can go downhill but the improvement is huge at the moment and vet hopes we have avoided any major damage. But obviously we need to work out how to stop it happening again as she was already tightly managed. Awful as it sounds I’ll be quite relieved if it is Cushings as we have something to “do”.

Well that sounds positive, keeping fingers crossed for you x

 

[ester]

That's not awful, cushings gives you a tangible reason and a tangible solution.

She sounds a lot happier in herself!

 

[acw295]

Bloods are back, positive for EMS and negative for Cushings.
I have no idea how I’m going to manage the EMS-seems impossible tbh. I don’t think this has a happy ending sadly.
But we’ll keep going and see what happens when she can have turnout again.

 

[acw295]

Xrays attached. You can see that one has some rotation and much more toe-that’s the one she was lame on.
I’ll also upload the bloods in case any experts on that on here that can comment.

 

[acw295]

Here’s the bloods, not that clear cut as it goes! Re-test for Cushings probably but the EMS is supported by the laminitis and some fat in neck and near tail. She’s not massively overweight though, you can feel ribs etc.

 

[Birker2020]

Really glad to hear your girl is more comfortable now. As someone with a pony who presented with chronic low grade lami in one hoof only I feel your pain. My boy was negative bloods for Cushing's but responded to a Prascend trial.

I will keep my fingers crossed for you both. It's so exhausting seeing them in pain but being unable to get to the bottom of it. I hope things continue to improve.

I spoke to the vet about this morning about my horse (the abscess update one) and the fact that she's had a negative cushings test - is it still possible she could have laminitis if its a false positive reading and she says that that scenario is extremely rare. Sorry you were so unlucky.

 

[alibali]

I spoke to the vet about this morning about my horse (the abscess update one) and the fact that she's had a negative cushings test - is it still possible she could have laminitis if its a false positive reading and she says that that scenario is extremely rare. Sorry you were so unlucky.

One of my closest friends is a small animal vet and looks after my dogs and cats for me, it's a standing joke between us that all the animals I bring her have extremely unusual ailments that she's never seen in 25 years of practice ? So the fact my pony bucks the trend is no surprise! I still wouldn't discount laminitis though in your horses case if you can't find any other cause, you might just be victim to my kind of 'luck'.

Was it just a measure of baseline ACTH your vet did or did they do a stimulation test? I've heard on other social media reports of quite a number of false negative ACTH baseline blood results that have been retested strongly positive when a TRH stimulation test has been done. I was unaware of the stimulation test when my pony tested negative so he has never had this and was already on Prascend. Edited to add so my pony may well have tested positive if I'd done the stimulation test.