Laminitis (grass induced)

spotty_pony2

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So some of you may know from other thread about thin soles and my boy feeling the stones and hard ground.

Well, a few days after that post he went pottery and more lame and it was pretty obvious what was wrong sadly. Vet came out and confirmed he had Laminitis in all four feet. 😢 I’m absolutely gutted and was in pieces tbh - he’s my heart horse and I’ve had him for almost 21 years. He is almost 27. He had blood tests for insulin resistance and cushings but thankfully the cushings test was negative still (he was tested about 18 months ago) and his insulin levels were also well within the normal range so Vet thinks it has literally been the sudden mild weather and the sudden rush of the grass coming through and the fact he is older that he is now more sensitive. She said his current diet is suitable for him, it will just be restricting his grazing. He isn’t overweight really - Vet has advised he needs to lose about 30kg so nothing major.

Fast forward 10 days and he’s still on box rest with soaked hay and is coping remarkably well. I am very proud of him. I ran Vet yesterday to update and she said he will need about 1-2 weeks in. I’m gutted as I just feel so bad about him having to be in even though I know it’s for his own good. He’s allowed to go in the arena for a roll and a hand walk now so that’s something. There is still heat in one front hoof but it doesn’t seem to be bothering him. There was a pulse still at the weekend but there doesn’t seem to be a pulse now. He’s walking fine, so hopefully we are going in the right direction. He’s also back down to his normal one Danilon per day and seems to be coping well on that.

I’m just hoping it’s not going to be months of box rest. Vet said the ones she had let out early because they seemed better had relapsed so it’s crucial for him to be in a little bit longer to make sure the laminae have fully recovered. I already know I wouldn’t put him through months of box rest and then I’d have to make a very difficult decision but his quality of life will always be paramount to me. I’m hoping he can go back to being turned out even if on a bit of track with restricted grazing and soaked hay. I just hope he can at least tolerate a bit of grass at the non risky but we won’t know that yet I guess.

I’m just wondering if there’s anything I can do to further reduce the heat in the one hoof that is left and has anybody else had an older horse get Laminitis caused just by the grass?

Any advice much appreciated - sorry this is so long.
 
Cold hosing can be really useful

Sorry this b**** disease has bitten you too 😔

Thank you, I know I’m gutted. He had it mildly in his hind legs 20 years ago! But at that time he was fat but it was also caused by rich grazing (old dairy pasture) I got him in regular work after that and he was always kept very fit. Then we started hunting and the problem seemed almost reversed. He has almost semi retired this year and I do think it has played a part but he has stated to age this past year and I physically can’t work him very much any more due to this. Vet thinks because he has pads in his front shoes and has Danilon daily for arthritis anyway it has helped him along for a little while. I actually wonder if some of the stiffness I have seen has actually been low grade Laminitis now.
 
I have literally just been through this with a much younger mare who very sadly had to be PTS. If I can give you one piece of advice it would be to ask your vet for a Karo Light test right away, insulin can be normal as it fluctuates throughout the day but the karo light test directly tests the body's response to sugar - if this comes back abnormal there are drugs that can be given to control the glucose levels. Have you had x-rays and full bloods? Laminitis can be caused from infections, lyme disease etc so full bloods are definitely worth it to rule out other causes. What I have learnt (no thanks to my vets, or ex vets now) is if not seeing significant improvement in a couple of weeks this is not normal and should be treated very seriously throughout the acute stage. My girl was negative for both cushings and insulin but kept declining and had catastrophic rotation, we came to the conclusion that she must have had something significantly wrong with her biomechanics which caused it.
 
Thank you, I know I’m gutted. He had it mildly in his hind legs 20 years ago! But at that time he was fat but it was also caused by rich grazing (old dairy pasture) I got him in regular work after that and he was always kept very fit. Then we started hunting and the problem seemed almost reversed. He has almost semi retired this year and I do think it has played a part but he has stated to age this past year and I physically can’t work him very much any more due to this. Vet thinks because he has pads in his front shoes and has Danilon daily for arthritis anyway it has helped him along for a little while. I actually wonder if some of the stiffness I have seen has actually been low grade Laminitis now.
Do you know if his blood glucose was high or normal?
 
I have literally just been through this with a much younger mare who very sadly had to be PTS. If I can give you one piece of advice it would be to ask your vet for a Karo Light test right away, insulin can be normal as it fluctuates throughout the day but the karo light test directly tests the body's response to sugar - if this comes back abnormal there are drugs that can be given to control the glucose levels. Have you had x-rays and full bloods? Laminitis can be caused from infections, lyme disease etc so full bloods are definitely worth it to rule out other causes. What I have learnt (no thanks to my vets, or ex vets now) is if not seeing significant improvement in a couple of weeks this is not normal and should be treated very seriously throughout the acute stage. My girl was negative for both cushings and insulin but kept declining and had catastrophic rotation, we came to the conclusion that she must have had something significantly wrong with her biomechanics which caused it.

I’m so sorry to hear about your mare. That’s interesting, I will ask about the Karo light test. No he hasn’t had X-rays at this stage, Vet does believe we have caught it early thank goodness. There is only so much I will put him through at his age. He means the world to me, but the life he is going to be able to lead at the end of all of this needs to be of good quality and that is at the forefront of my mind. Vet did mention about drugs to reduce glucose but said bloods show he doesn’t need any other drugs at this stage.

Edited to add: I’ve just looked up the karo light test and realised what it is! He was going to have this test a couple of years ago as he needed his coffin joint medicating. Vet said steroids would be risky at his age and with the location (and rightly so as that is the worst foot!) and he said he could only have steroids if he did this test first to test his levels. I decided to opt for the more expensive for safer arthramid so we never did the test. Might be an idea now though. vet this time has said she couldn’t rule out EMS without an extra test but to treat him as if he has it as management but this is definitely food for thought!
 
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Normal - even with being on the grass two hours before the blood test and having his normal feed. Vet said that is a good sign.
This is why the Karo Light test is so useful, a set amount of the syrup is measured according to weight then bloods are taken 60-90 minutes after - it is much more accurate than if a horse has simply been having grass or feed a while before. It was explained to me that laminitis is the symptom of a bigger cause - laminitis can't simply be caused by too much grass, if it is the grass then it is the body's response to sugar. If it is not cushings either then it is likely something biomechanical, or severe stress related, or even that they have ingested something toxic etc. Sending hugs as this illness is just the most devastating to deal with, it is so cruel
 
Normal - even with being on the grass two hours before the blood test and having his normal feed. Vet said that is a good sign.
It is a good sign because it suggests he's not insulin resistant; minor insulin resistance could show as elevated blood sugar despite normal serum insulin because the body wouldn't be responding to the insulin to lower the blood sugar as it ought
If you don't have this it's likely just an influx of proflammatory food (growing spring grass rich in simple sugars, potassium and nitrogen) causing issues for an older body.
I would keep up NSAIDS, low sugar feed and getting weight off (improves insulin response even if it isn't elevated) and cold hose feet 20 min 1-2 times a day for pain relief and anti inflammatory effect. But don't be afraid to push the vet for further diagnostics if no improvement in 2wks
You can glucose challenge (karo) if you want but if horse is basically improving and you intend to maintain laminitic management going forward there's not a lot of point, unless progress plateaus or horse regresses
All the best
 
It is a good sign because it suggests he's not insulin resistant; minor insulin resistance could show as elevated blood sugar despite normal serum insulin because the body wouldn't be responding to the insulin to lower the blood sugar as it ought
If you don't have this it's likely just an influx of proflammatory food (growing spring grass rich in simple sugars, potassium and nitrogen) causing issues for an older body.
I would keep up NSAIDS, low sugar feed and getting weight off (improves insulin response even if it isn't elevated) and cold hose feet 20 min 1-2 times a day for pain relief and anti inflammatory effect. But don't be afraid to push the vet for further diagnostics if no improvement in 2wks

All the best

Thank you, yes I will be. I sometimes think the easiest thing for them to say is just increase box rest which isn’t fair. I will wait the week or so and then see what she says next. Corn syrup test sounds like the likely route though.
 
Thank you, yes I will be. I sometimes think the easiest thing for them to say is just increase box rest which isn’t fair. I will wait the week or so and then see what she says next. Corn syrup test sounds like the likely route though.
The box rest is awful but the reason they are so keen on it is that movement when the laminae is damaged can cause further rotation unfortunately. The general rule of thumb is 30 days after they have finished being on pain relief - really feel for you
 
This is why the Karo Light test is so useful, a set amount of the syrup is measured according to wait then bloods are taken 60-90 minutes after - it is much more accurate than if a horse has simply been having grass or feed a while before. It was explained to me that laminitis is the symptom of a bigger cause - laminitis can't simply be caused by too much grass, if it is the grass then it is the body's response to sugar. If it is not cushings either then it is likely something biomechanical, or severe stress related, or even that they have ingested something toxic etc. Sending hugs as this illness is just the most devastating to deal with, it is so cruel

He had been standing under himself for a while behind but Vets and myself both believed it was caused him taking pressure of his hocks as he has arthritis. He has had osteopen injections and this improved dramatically so again this was thought to be arthritis. Now I wonder if the osteopen has been treating the inflammation caused by the Laminitis and that is what it is. Interestly he had his osteopen too injection a week before he go Laminitis - my thought was this was linked - Vet said she has heard of him r being a cause and it’s not risky as it it’s not a steroid but I do still wonder.
 
Do you have any symptoms of cushings? I have found the ACTH test to be unreliable, I always look for symptoms to confirm a positive result or lack of them for a neg. one.

I would x ray to see what the damage is. That may affect your long term decision.

Thank you, no he doesn’t have any symptoms.
He’s not even close to the concerning levels.
 
He had been standing under himself for a while behind but Vets and myself both believed it was caused him taking pressure of his hocks as he has arthritis. He has had osteopen injections and this improved dramatically so again this was thought to be arthritis. Now I wonder if the osteopen has been treating the inflammation caused by the Laminitis and that is what it is. Interestly he had his osteopen too injection a week before he go Laminitis - my thought was this was linked - Vet said she has heard of him r being a cause and it’s not risky as it it’s not a steroid but I do still wonder
It might even be worth exploring whether the arthritis could have caused the laminitis, could be a combination of unnatural weight bearing and the body's inflammation from the arthritis
 
The box rest is awful but the reason they are so keen on it is that movement when the laminae is damaged can cause further rotation unfortunately. The general rule of thumb is 30 days after they have finished being on pain relief - really feel for you

Yes I understand why it just makes me feel guilty but he is coping really well. I have sedalin on standby but haven’t needed to use it yet. He is allowed to do controlled walking for 5-10 mins in the arena thank goodness as this is stopping him from getting too stiff and also I’m a great believer in a little bit of steady movement is good for reducing colic risk.
 
It might even be worth exploring whether the arthritis could have caused the laminitis, could be a combination of unnatural weight bearing and the body's inflammation from the arthritis

That’s a good point! I wouldn’t be surprised if it was linked to something like this. I wonder how they could prove this?
 
That’s a good point! I wouldn’t be surprised if it was linked to something like this. I wonder how they could prove this?
I'm not sure - I will defer to someone more knowledgeable on that point! I wonder if they are able to tell via inflammatory markers in bloods? You say there is heat now only in one foot, it would be interesting to know if the arthritic changes are worse in that leg - I expect x-rays would be the only way to find that out
 
I'm not sure - I will defer to someone more knowledgeable on that point! I wonder if they are able to tell via inflammatory markers in bloods? You say there is heat now only in one foot, it would be interesting to know if the arthritic changes are worse in that leg - I expect x-rays would be the only way to find that out

That is the foot which he has mild side bone in.
 
I bought Rigs as he was finishing 3 months of box rest for lami. His ems score was in the hundreds and his cusghings 27.5 so borderline. The vet recommended no grass at all for a year.

I did get him on some form of grass 6 months later, so 9 months post lami attack. This is when I had the Caro syrup test. I would not have done it earlier as it could have triggered a lami attack as it essentially starves them then loads them with sugars. I would not do that with one with active lami.

Even 9 months on, I only tested him with Caro syrup as I believed his life would be significantly better with some natural grazing. We did all we could to make it less likely to tip him over. He was starved from 3am, had his test late morning, then some exercise to use any excess sugars as we would not know if he was processing them or not until potentially too late. Obviously, you could not work a horse who is having an active lami attack, so this preventative measure can't be done.

It's a balancing act.

His test was low scoring, so grass was started at 15 minutes a day, muzzled. Then 15 minutes twice a day, around a week of each. By the end of summer, he did 4 hours on sparce grass, with a muzzle. We have built this up year on year, until last year he could do 16 hours a day, still muzzled. All forage was soaked or tested low sugar/starch.
 
I bought Rigs as he was finishing 3 months of box rest for lami. His ems score was in the hundreds and his cusghings 27.5 so borderline. The vet recommended no grass at all for a year.

I did get him on some form of grass 6 months later, so 9 months post lami attack. This is when I had the Caro syrup test. I would not have done it earlier as it could have triggered a lami attack as it essentially starves them then loads them with sugars. I would not do that with one with active lami.

Even 9 months on, I only tested him with Caro syrup as I believed his life would be significantly better with some natural grazing. We did all we could to make it less likely to tip him over. He was starved from 3am, had his test late morning, then some exercise to use any excess sugars as we would not know if he was processing them or not until potentially too late. Obviously, you could not work a horse who is having an active lami attack, so this preventative measure can't be done.

It's a balancing act.

His test was low scoring, so grass was started at 15 minutes a day, muzzled. Then 15 minutes twice a day, around a week of each. By the end of summer, he did 4 hours on sparce grass, with a muzzle. We have built this up year on year, until last year he could do 16 hours a day, still muzzled. All forage was soaked or tested low sugar/starch.
The benefit of doing the Karo Light test during acute lami is that you know for certain whether it is the sugars that is the cause, so you can get them on the right medication quickly to flush out the sugars. I had my results back in just over 24 hours - if it had been abnormal I would have had the medication from my vet same day
 
When O/H's pony went down with grass induced lami (our first case in a joint ownership of over 100 years 🙈) said pony was just 4, the leanest one in the entire herd of 20 and fortunately it was, in the words of our excellent vet, a very mild attack. Had him Karo Light tested just to make sure and results showed no sign of insulin resistance. He was only on box rest for 1 week, off bute, pulse free and sound within 2 days. However, he has been stable to sin bin (which does have some very short grass cover) to stable with well soaked hay, Dengie molasses free chaff and a suitable balancer + salt ever since. We only moved into said field which triggered the attack to get out of the one which was covered in a vast carpet of toxic acorns - dammed if you do, dammed if you don't:eek:
 
The benefit of doing the Karo Light test during acute lami is that you know for certain whether it is the sugars that is the cause, so you can get them on the right medication quickly to flush out the sugars. I had my results back in just over 24 hours - if it had been abnormal I would have had the medication from my vet same day
There is definitely a risk to it though; it is quite individual. I would do/have considered it for my NF mare but never the spotty whose EMS is way too severe and regards doing it to an active laminitic it depends on cause and bloods. It can be really beneficial to do but very much down to individual circumstances which should be discussed with the vet with a contingency plan if it worsens symptoms (paracetamol, preemptive gliflozin administration etc).
 
When O/H's pony went down with grass induced lami (our first case in a joint ownership of over 100 years 🙈) said pony was just 4, the leanest one in the entire herd of 20 and fortunately it was, in the words of our excellent vet, a very mild attack. Had him Karo Light tested just to make sure and results showed no sign of insulin resistance. He was only on box rest for 1 week, off bute, pulse free and sound within 2 days. However, he has been stable to sin bin (which does have some very short grass cover) to stable with well soaked hay, Dengie molasses free chaff and a suitable balancer + salt ever since. We only moved into said field which triggered the attack to get out of the one which was covered in a vast carpet of toxic acorns - dammed if you do, dammed if you don't:eek:

This sounds similar to my boy. My Vet said she thinks he has been unlucky. He is the slimmest out of the three too. I’m quite glad he is in now though because it’s growing stupidly out there at the moment and it’s going to be mold again this week. My Vet is good and has texted me back this evening - I sent her a few videos from today. She is happy with his progress but thinks it isn’t a good idea to reintroduce grass at the moment with how it is but then said ‘maybe he can start hand grazing for 5 mins per day in a few weeks’. Now I like to follow vets advice of course I do but if I hand graze him for 5 mins he will probably get as much as he would get if he was out for an hour in a restricted paddock. I would have thought turning him out on a bare bit with soaked hay would have been better for him that letting him gorge for 5 mins? 🤔
 
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