Mystery Laminitis cause _ not cushings.

[katef2020]

I have had 2 welsh ponies go down with laminitis .
One has cushings and is 22 and is on pergolide other isnt and is 18. Both had their ACTH levels checked last month and 22 year old was well controlled at his normal level and 18 year old was in normal range.
They are both slim, ridden regularly PC ponies. The 22 year old has had laminitis badly 3 years ago before we had him and one very mild 2 day episode since 2 years ago and nothing since.
The 18 year old has been fine for the 2 years we've had him and unknown previous history. He was in a loan home where he was on sparse grazing and hacking and developed laminitis there, so I brought him home. No obvious cause from what they were doing.
He then improved to normal and was hacking again, but has now gone pottery again.
They are both fed low sugar diet and same grazing they are always on ( not rich).
Usually on hay, slowly switched to non heating haylage we always have a few weeks ago - could this have triggered it ? But - are now been back on hay for a week and no difference.
18 year old is 100% some days and trots round yard in small circles, then next day is pottery. This has been going on for 6 weeks since he returned from loan home. He is not standing on his heels and you can only tell he is not 100% on a circle. Bute seems to improve it a bit. Farrier says very tender on soles. Plan is to put clogs on him tomorrow to support his feet and see what happens.
22 year old has been fine, but now gone pottery and put immediately in clogs which have helped.
Farrier says he is less tender on soles, but more symptoms in terms of standing on heels ( although back to normal in clogs)
He did have a 4 day period when he missed his pergolide dose about 10 days ago when person housesitting forgot (!), could this have given his cushings enough time to cause his laminitis ?
Obviously its great to get them more comfortable with their clogs / bute etc, but I want to get to the cause ! Neither have particularly hot feet or racing digital pulses.
Sorry about all the questions - any advice / ideas welcome as I am a very experienced owner who looks after our oldies well and is baffled ( as are our vets) as to reason for this double whammy .

 

[L&M]

The only thing I can think is grass related - our grass is still growing as it is still so mild. Either that, or in combination with the haylage?

My lami prone/cushings chap has been fine this winter so far, as has limited turnout and is in full work. However he recently has an acth blood test, and has gone up by 20, which is a bit worrying. He is currently only on half a tablet pascend per day and am loath to raise it as went ataxic when on a higher dose....

Sorry not to have been much help and hope you get to the bottom of it.

 

[WandaMare]

Sounds as though it was the haylage as they are both affected, and once they have it then the sugar levels in hay can maintain it if not soaked. My old laminitic would often get episodes bought on by just a particular bale of hay as the sugar content can vary so much from one bale to another. As soon as he was pottery I had to soak for at least 12 hours until he came sound again, the vet put him on Metformin eventually because he was so prone to lami, it worked for him. If I fed him the laminitic 'safe' bagged haylage he would get it too, but he loved it, so I used to give him a small haynet of it for his lunch only, as a treat.

 

[Orca]

It does sound like the haylage or something else that they've both ingested. I know grass has been too good for too long this year for many equines! Have they had any other medications/ wormers, etc?

 

[_HP_]

Have you had xrays taken? It could be rotation that hasn't been corrected.
Is the 18 yr old showing any other signs of a Cushing's? The test isn't totally reliable and should be used alongside symptoms and late Laminitis can be a symptom.
Lots of useful info here...
http://www.thelaminitissite.org/ppid.html

 

[katef2020]

Thats really interesting about your ponies super sensitivity - that could explain why the younger one seems fine one day and then pottery the next. Anyone got any other tips for best feeds then for maintaining weight whilst minimizing sugar content, while still being super palatable as they are both fussy feeders and wont touch alfa a oil or unmolassed sugar beet .

 

[Sugar_and_Spice]

Could it be EMS causing the laminitis in the younger one not cushings? Also, if they were mine they'd have box rest even for mild laminitis and a walk out in hand to keep them sane, no opportunities for trotting because I don't think it's helpful to jar the hoofs when the laminae attachment is weak. I don't find it at all surprising that a laminitic pony shows up lamer after it's been trotting.

 

[vanrim]

the acth test is useless. you need the thyroid response hormone test. my mare had 6 laminitic attacks and 6 normal acth tests. she then had trh test done and her levels were through the roof. she was put on prascend and hey presto no more laminitis.

 

[Nudibranch]

The ACTH test is not useless. TRH looks at thyroid function. ACTH is produced by the adrenal glands. Totaly different, and misleading for anyone considering the ACTH test. It is a very useful tool for diagnosing PPID, and has saved a lot of horses.

 

[JillA]

the acth test is useless. you need the thyroid response hormone test. my mare had 6 laminitic attacks and 6 normal acth tests. she then had trh test done and her levels were through the roof. she was put on prascend and hey presto no more laminitis.

IME the best way to diagnose is a pergolide trial, or in the case of one of yours, up the dose for a period. Bear in mind that it hasn't been that long since the end of the seasonal rise, and this unseasonal mild weather might well have extended it. What does your vet say?

 

[fusspot]

My Welsh D went down with Laminitis literally overnight,was very fit as had just done regionals,never had it before-I have owned him all his life.He was on Haylage,was in early August so grass had gone off a bit.Carrying a bit too much weight but not classed as overweight.Vet ran normal bloods for Cushings etc and all came back clear-as it was quite unusual she pressed that she knew there was an underlying reason but what-it finally showed when we ran the Glucose test-not even the starvation bloods showed anything-he had Equine Diabetes-his levels should have been below 80-the vet ran late to take the bloods and should be done 11/2 hours after he has eaten the Glucose-after 3 hours his tests showed he was 200.Off the Haylage onto soaked hay,went from Hi Fi Lite-which still contains a lot of sugars and onto Hi Fi Molasses Free and Hi Fibre Nuts-he was sound a week later and back in work 5 weeks later.He goes out for minimum 5 hours a day muzzled in winter and 9 hours a day in the summer-always muzzled.Just got to be so aware of the sugar contents as even the vet was shocked that says it's good is so high in sugar.He also has 1/3 mug twice a day of Lo Cal Balancer which I can up and down as I feel his condition needs it.Hope yours are improving.

 

[vanrim]

My mare had 6 attacks of laminitis and 6 negative acth tests. She clear had cushings and should have been put on Prascend. These forums are littered with people who have had the same experience. The acth test is not reliable and in my opinion is a complete waste of money. There are far too many false negatives,

The ACTH test is not useless. TRH looks at thyroid function. ACTH is produced by the adrenal glands. Totaly different, and misleading for anyone considering the ACTH test. It is a very useful tool for diagnosing PPID, and has saved a lot of horses.

 

[vanrim]

Perhaps you should tell my vet - Leahurst - that they are using the worn test for Cushings!

The ACTH test is not useless. TRH looks at thyroid function. ACTH is produced by the adrenal glands. Totaly different, and misleading for anyone considering the ACTH test. It is a very useful tool for diagnosing PPID, and has saved a lot of horses.

 

[vanrim]

http://now.tufts.edu/news-releases/new-diagnostic-protocols-ppid-horses
This recommends the TRH test for PPID diagnosis.

IME the best way to diagnose is a pergolide trial, or in the case of one of yours, up the dose for a period. Bear in mind that it hasn't been that long since the end of the seasonal rise, and this unseasonal mild weather might well have extended it. What does your vet say?

 

[Nudibranch]

I prefer the advice of my vet to Google and forum hearsay...and both of my PPID horses always had high ACTH levels and therefore did not need further investigation. It is unwise to blanket state that the test is useless based on one horse. There is also Cushings syndrome, which is different to Cushings disease, along with a variety of similar issues like EMS. The term Cushings these days is outdated. And FWIW the only definitive diagnosis is postmortem, which is why a pergolide trial makes sense regardless of test results.
Please don't say it's "rubbish" based only on your own experience. That's bad science to say the least.

 

[Nudibranch]

Perhaps you should tell my vet - Leahurst - that they are using the worn test for Cushings!

erm, where did I say it was the wrong test? I pointed out it is a completely different test, so you cannot rubbish the acth just because it was negative in your horse.

 

[_HP_]

http://www.thelaminitissite.org/ppid.html

'The TRH stimulation test, testing ACTH (not cortisol), may be useful when ACTH or DST results are borderline or unexpected (i.e. if a horse with physical symptoms tests negative for PPID). ACTH is tested before and soon (10 mins or 30 mins) after injecting 1mg TRH. Retesting resting ACTH during the seasonal rise (August - October northern hemisphere) may be just as useful.'

 

[OldNag]

The ACTH test is not useless. TRH looks at thyroid function. ACTH is produced by the adrenal glands. Totaly different, and misleading for anyone considering the ACTH test. It is a very useful tool for diagnosing PPID, and has saved a lot of horses.

I had one who tested borderline with the ACTH test and then high reading with the TRH test. (Vet would not prescribe Prascend without knowing the level, hence TRH test).

Another gave a high reading with the ACTH test.

Different tests as Nudibranch says. After my experience with the first pony I was reluctant to use the ACTH test at all with the second but took vet's advice to go with the ACTH test, and only use the TRH if the ACTH was inconclusive.

 

[YasandCrystal]

Thats really interesting about your ponies super sensitivity - that could explain why the younger one seems fine one day and then pottery the next. Anyone got any other tips for best feeds then for maintaining weight whilst minimizing sugar content, while still being super palatable as they are both fussy feeders and wont touch alfa a oil or unmolassed sugar beet .

My chronic laminitic pony is fed a non cereal high fibre mix to which I add a small cup of micronised linseed twice a day. I tend to stick with hay for him. The grass is still quite lush, none of my herd have dropped any weight and they are only on a small feed and hay.

 

[JillA]

Thats really interesting about your ponies super sensitivity - that could explain why the younger one seems fine one day and then pottery the next. Anyone got any other tips for best feeds then for maintaining weight whilst minimizing sugar content, while still being super palatable as they are both fussy feeders and wont touch alfa a oil or unmolassed sugar beet .

Rowan Barbary do one or two and I have just bought some Saracen ReLeve - cereal free but smells fruity - the horses LOVE it. Mix it with Equibeet and see what they think? Plus micronized linseed for even more condition, and mine also get grass pellets added.
I am always shocked to read wheat among the contents of many mixes - we were always taught to avoid wheat like the plague, for fear of laminitis.

 

[Boulty]

If you haven't had either of them tested for EMS at any point then I would. If they won't tolerate starving then I believe test can be done after them just having access to hay but no hard feed (check with your vet). If both affected at same time and main thing that's changed is haylage then I'd suggest that may be it. Perhaps it was cut earlier than normal / from different grasses or maybe we've just had a good year for it. Are you soaking hay at moment? If not then maybe look into doing so. As for your loaned pony never being quite right since coming back I'd guess there was something in his loan home managementwise that didn't suit that has perhaps affected hoof quality (or he could even just not have been trimmed in the optimal way for him which could have a cumulative negative effect on foot balance) It is a lot warmer and wetter than it should be for time of year so grass quality won't be as poor as normal for time of year either which may not be helping you. Good luck