Laminitis from inhaler

scats

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Diva started on her inhaler last Saturday. I had spoken at length with the vet about the use of steroids and we agreed that oral steroids with her was too much of a risk at this time of year in particular, but that the systematic uptake of inhaled steroids is so low that the vet said he wasn’t aware of any cases of laminitis being caused because of this...
Of course Diva has taken it upon herself to prove him wrong and last night came down with her first ever bout of laminitis. I am strict with her management as she is a good doer and believed to have EMS- overnight turnout only in restricted area of her winter field, soaked hay in day (which she doesn’t even touch anyway) and kept in as much work as she can manage with her trachea. Vet agreed it is very coincidental that she had just started the inhaler and this happened. It might have simply been the final nail in the coffin, so to speak, but we do believe it’s had some involvement.

So pony is confined to barracks, deep bed and Bute and I am walking around in a total state because I feel like it’s all my fault. Trying to help one issue and I cause one even more horrendous. Just hoping we can get her through this. She’s bright and bubbly, standing fine, just uncomfortable when she moves. Warm feet and felt pulse in one last night but this morning it has gone.

Has anyone had a horse come down with laminitis after using an inhaler?
 
Oh I'm so sorry to hear this, poor Diva and poor you. Willow developed acute laminitis from oral steroids, she recovered with minimal rotation and was then on steroids via inhaler for a further 3 years, often on max dose, with no recurrence. You could never have foreseen this so don't be hard on yourself, hope she makes a speedy recovery x
 
That's so unlucky - I really feel for both you and diva. Properly been through the wars together.

No experience with one coming down after steroids (although the vets won't give my fat mare any right now), but years ago the welshie I rode for my friend came down after being given a wormer when he was a youngster. The vet said it was coincidence, but the yard gave the same wormer the following year and he came straight back down with it again.

He did recover. Shod in front, muzzled on grass 100% of the time, soaked hay when in the stable and once he was sound a lot of riding to keep his weight on the low side. Lost to colic at 16 sadly, but he never had another bout of lami under that routine and stayed sound until the day she lost him.
 
"There is currently no conclusive evidence to support a causal association between therapeutic systemic corticosteroid administration and the development of laminitis in healthy adult horses/ponies.
There is weak evidence of an association between administration of multiple doses of systemic corticosteroid and the onset of laminitis in adult horses/ponies with underlying endocrine disorders or severe systemic disease."
https://www.veterinaryevidence.org/index.php/ve/article/view/12/19

i.e. not a problem if there is no underlying condition, and probably would have had laminitis anyway if there is an underlying condition. Don't forget that many other things cause laminitis e.g. a bout of colic (which you may not even realise the horse had during the night) so don't think in any way that it is something you have done.
Horses are just designed to have 'issues' and sometimes it is the better looked after ones that have the most (the horse down the road that is half-neglected and in a manky paddock full of rubbish will NEVER get tangled in wire or have put its foot in a rabbit hole while the horse that is in the immaculately kept paddock half a mile away has a major accident from the tiniest thing.)
 
"There is currently no conclusive evidence to support a causal association between therapeutic systemic corticosteroid administration and the development of laminitis in healthy adult horses/ponies.
There is weak evidence of an association between administration of multiple doses of systemic corticosteroid and the onset of laminitis in adult horses/ponies with underlying endocrine disorders or severe systemic disease."
https://www.veterinaryevidence.org/index.php/ve/article/view/12/19

i.e. not a problem if there is no underlying condition, and probably would have had laminitis anyway if there is an underlying condition. Don't forget that many other things cause laminitis e.g. a bout of colic (which you may not even realise the horse had during the night) so don't think in any way that it is something you have done.
Horses are just designed to have 'issues' and sometimes it is the better looked after ones that have the most (the horse down the road that is half-neglected and in a manky paddock full of rubbish will NEVER get tangled in wire or have put its foot in a rabbit hole while the horse that is in the immaculately kept paddock half a mile away has a major accident from the tiniest thing.)

That&#8217;s exactly what my vet said when mine got lami with no obvious cause- he said it tends to be the ones who are best looked after :-( wouldn&#8217;t wish it on any horse of course but ur right, they are meant to have issues they are probably a terribly designed animal. They do get under your skin and into your heart tho with their big kind souls that more than make up for it <3
 
Yes. Like you I was told the risk was almost non-existant, that tests had shown the steroid dose stayed in the lungs. Also like you my lad is a chronic laminitic but was slim & showing no signs at the time. Fortunately I was still very concerned about the use of them so I monitored his pulses like mad & when they started to come up I stopped immediately and contacted the vet. I was told it was coincidence & to carry on, but didn't. He became slightly pottery but that was all & box rest (not great when breathing was the issue) fixed that quite quickly. I have no doubt that if I'd carried on with the dose it would have been a different story, and given already severe rotation it could have ended badly.
 
Yes. Like you I was told the risk was almost non-existant, that tests had shown the steroid dose stayed in the lungs. Also like you my lad is a chronic laminitic but was slim & showing no signs at the time. Fortunately I was still very concerned about the use of them so I monitored his pulses like mad & when they started to come up I stopped immediately and contacted the vet. I was told it was coincidence & to carry on, but didn't. He became slightly pottery but that was all & box rest (not great when breathing was the issue) fixed that quite quickly. I have no doubt that if I'd carried on with the dose it would have been a different story, and given already severe rotation it could have ended badly.

That’s really interesting, thank you. Glad your horse was ok.
How long did you keep yours in the box?
I think I’ve caught it early, she’s walking around her box absolutely fine, albeit still on two Bute a day at the moment. No detectable pulses now at all.
Plan is to stop Bute this week and see what we have.
 
I was always told the risk was absolutely minimal but if had laminitis previously then there was a higher risk. I have a miniature that has been on steroid inhalers for two/three years now and have never had an issue with laminitis with him. Sorry to hear you're having to deal with this, we have another wee chap who came to us with a history of laminitis and it is hard to manage to keep his weight on as he's old and last year we had mechanical laminitis with a farrier overtrim and it was touch and go whether he would make it.
 
That&#8217;s really interesting, thank you. Glad your horse was ok.
How long did you keep yours in the box?
I think I&#8217;ve caught it early, she&#8217;s walking around her box absolutely fine, albeit still on two Bute a day at the moment. No detectable pulses now at all.
Plan is to stop Bute this week and see what we have.

I kept him in until his pulses were almost impossible to find & he wasn't looking pottery, I can't remember how long that was. It's a bit of a fine line with him because he's better out and moving if possible. If you can get your girl off the bute & she still looks comfortable & her pulses are low then I'd consider turning out for a few hours & see how she goes. Has your farrier seen her, and if so what does he think?
 
OP have you had the stim test for cushings? My Older Appy had some dreadful breathing problems last summer, having tested negative for cushings. This carried on all summer and then when we had her stim tested her figures were over 800! Even on presecend her figures stayed high and we lost her in January to ataxia from the tumour which caused the cushings :(
 
I kept him in until his pulses were almost impossible to find & he wasn't looking pottery, I can't remember how long that was. It's a bit of a fine line with him because he's better out and moving if possible. If you can get your girl off the bute & she still looks comfortable & her pulses are low then I'd consider turning out for a few hours & see how she goes. Has your farrier seen her, and if so what does he think?

Haven’t been able to feel any pulses at all (she has a lot of feather) for the last 2 days. She’s still on two Bute a day but I might decrease it over the next couple of days and see what we have. She struggles being in because of her breathing, and the heat in her stable is bad today. I feel like I’m in an impossible situation.
Farrier coming this week.
 
OP have you had the stim test for cushings? My Older Appy had some dreadful breathing problems last summer, having tested negative for cushings. This carried on all summer and then when we had her stim tested her figures were over 800! Even on presecend her figures stayed high and we lost her in January to ataxia from the tumour which caused the cushings :(

Not tested her for Cushings, but we do suspect EMS. Her breathing is as a result of a tracheal collapse, but it worsens in the summer as the pollen causes further irritation to her, which is why we tried the inhaler.
 
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