steroid hock injections led to laminitis, now diagnosed with EMS, help & advice please

JEZA

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Our homebred, 15.2hh warmblood cross cob, 15 year old gelding, was "not quite right" behind.
Hock xray showed very mild changes and the vet advised steroid injections into each hock.
The cob was overweight with a VERY cresty neck. Unfortunately the vet didnt think to do a blood test for EMS before injecting steroids into both hocks 4 weeks ago.
1 week later cob got SEVERE laminitis. We are now 4 weeks into box rest (he couldnt leave the stable if he wanted to, as he cant walk).
Xrays last week have shown no rotation, but a blood test yesterday has shown EMS. Vet is recommending thyroid hormone for 2 months.
The cob is not overweight in his body, but has a huge crest. he is in quite a bit of pain with his feet.
Does anyone have any experience of a horse recovering from this? any advice. Feeling very upset as hes a beautiful horse.
 

doodle

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My horse has just had hock steroid injections. My vet said the risk of laminitis is so low that he dosnt usually mention it.
 

Cragrat

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I'm really sorry to hear that OP - no experience , but hopefully the steroid effect will eventually wear off???

My TB had steroid hock injections a couple of years ago. He is far from overweight - he is a naturally active type that looks lean whatever he's fed. The vet was reluctant to do both hocks at once, and said it was better to do one hock at a time, to reduce the risk of laminitis.
 

JEZA

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I'm really sorry to hear that OP - no experience , but hopefully the steroid effect will eventually wear off???

My TB had steroid hock injections a couple of years ago. He is far from overweight - he is a naturally active type that looks lean whatever he's fed. The vet was reluctant to do both hocks at once, and said it was better to do one hock at a time, to reduce the risk of laminitis.
Your vet was very wise.
 

Merlod

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My ems pony has just recovered from a bout of laminitis (no rotation) brought on by a too good batch of hay. I understand your worry as progress is hard to see and it does feel like there has been no improvement, mine's had a couple of bouts (4 in 10 years) so I have come to see a pattern and I find it takes 2-3 months box rest from the "can't walk" stage to being sound and starting to introduce back to turnout and regular routine.

I would invest in some hoof boots and pads - I use boa's with easycare soft comfort pads which allow me to move him out of the stable whilst I muck out. Really look at what you are feeding - whilst a lot of laminitis marketed feeds are acceptable in sugar and starch a lot of the ingredients are not ideal for ems (byproducts, molasses/mologo, nis, gm ingredients) and regarding hay and I would really recommened, after my most recent experience, to get every batch of hay tested or to buy pre tested hay (which is what I do now). Good luck with your boy.
 

GinaGeo

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Sort of. Mine first got bad when breathing issues required steroids. But when he was off work with an unrelated injury and without work the EMS was spiralling out of control.

A good pair of hoof boots with pads will help keep him comfortable. And the turning point for mine was Metformin, it doesn’t seem to work for all. But it helped to get mine comfortable enough again, so that I could work him and keep the weight down.

Before it his feet were too sore to work him, but we couldn’t sort the EMS without working him to get the weight off. His diet was already as restricted as I dared, but he’s always been a horse that needs proper hard work to keep his weight down.

I keep him on a track system, without grass. He’s easier to manage and I don’t have to worry about grass sugar spikes. He puts weight on if he so much looks at a blade of grass.

Once he’s back in proper work I can drop off the Metformin completely and manage him with exercise.

It’s a long road, but you can manage them.
Best of luck ?
 

holeymoley

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I imagine your boy already had EMS prior to steriod injection and they have just tipped him over the edge.

Mine went through awful rotational laminitis and came through but it was a very shoogly road. Has the vet done tests to determine why he has EMS? What is he fed? I used Levothyroxin which was brilliant but only once he was over the initial acute stage. In terms of shoeing he was in pads with frog supports initially and then remedially shod with heartbars.
 

holeymoley

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Fwiw- I would never inject my guy with steroids as it would probably end him, as much as he’s back to fighting fit with no fat pads/crest etc. I’ve always known there would be a risk with steroid injections, I’m surprised the vet didn’t mention anything as I thought it was fairly common that they can bring on laminitis. Perhaps I am wrong though.
 

SadKen

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Did the lami coincide with the very cold weather we had? I have read on social media of several and know of at least 1 case in person of lami in EMS horses during the cold weather snap. Presentation was lami stance, almost crippled, but no pulses or rotation.

Reading online (I am very interested as my previous mare had lami) there was a piece describing constriction of the blood vessels in very cold weather specifically affecting EMS horses, resulting in a presentation of lami. It frequently is blamed on frosty grass, but it is similar to Raynaud's disease in people. Helped by travel boots to keep legs warm. Of course I am not wanting to contradict your vet. In terms of recovery, EMS sites on social media talk about jiangulan as a good help to increase circulation. Maybe worth looking into further. Good luck, lami is awful whatever the cause.
 

Floofball

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So sorry your horse is suffering ? you say horse was very overweight with a cresty neck, then not overweight in body but had a cresty neck? A vet should really notice the cresty neck as adipose fat is a symptom of ems. I had a ‘fat horse blood test’ done during lameness investigations, he was positive for ems but still had sterold injections but at half recommended dose. Thyroid meds were discussed but it was thought cruel to give to my lad as he needed box rest for the lameness and the drug makes them hyper - but I believe it works well if horse can exercise. You can reverse ems by getting weight down - lots of helpful advice on the laminitis site re ems and weight management ?? Good luck with him - no rotation is very good news ??
 

bouncing_ball

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Fwiw- I would never inject my guy with steroids as it would probably end him, as much as he’s back to fighting fit with no fat pads/crest etc. I’ve always known there would be a risk with steroid injections, I’m surprised the vet didn’t mention anything as I thought it was fairly common that they can bring on laminitis. Perhaps I am wrong though.

I think you are right. I also think there was a legal case over a top dressage horse that got steroid induced laminitis. The case hinged on the vet not making owner aware of the risk. I’m not sure what the outcome was.
 

be positive

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I am surprised the vet did not mention the laminitis risk of steroids. My vet would be very reluctant to inject anything native or cob type with steroids due to laminitis risk especially if over weight.

I am also surprised, and disappointed, that it was not mentioned and if the horse was obviously cresty it should have been more than a passing comment, I had a poorly pony earlier this year that was not overweight, he was dropping weight as he was not really eating and the vet was still very careful to make the risk clear, he had steroid injections over a period of a week or so as on balance the risk of laminitis was worth taking in order to help him in other ways, he recovered and has not had any problems with his feet but they were monitored closely for a month.
The last one to have hock injections was lower risk, a bit tubby but evenly so, she was also given a warning and monitored carefully, I had a livery that got it very mildly after injections into coffin joints but that resolved within a week or two with very little treatment required.
 

scats

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I’m very surprised that your vet didn’t mention this risk, particularly with a cresty horse. Our vets mention the risk as a matter of course.

I imagine your horse already has EMS and was walking that fine line that a lot of EMS types do. It doesn’t take much to increase the toxicity in the body and trigger a full blown attack and a steroid injection would absolutely do that.

My only experience is with an EMS pony who had a severe breathing disorder and was prescribed a steroid inhaler. We discussed the risks, but at the time the vet said there was no evidence of any attack of laminitis as a result of an inhaled steroid, as the amount would be too small. They even checked with several other vets. We gave it a go as a last resort really (we were fighting a losing battle anyway) and it tipped her over into mild laminitis.

I absolutely would not give anything steroids if they are carrying excess weight or show signs of insulin resistance.
 

vmac66

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My mare had an unknown condition. The vet treated with steroids, they were throwing everything they could at my horse at the time. The vet said steroids could cause laminitis but felt that was the lesser of the two evils at the time.
 

Red-1

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Did the lami coincide with the very cold weather we had? I have read on social media of several and know of at least 1 case in person of lami in EMS horses during the cold weather snap. Presentation was lami stance, almost crippled, but no pulses or rotation.

Reading online (I am very interested as my previous mare had lami) there was a piece describing constriction of the blood vessels in very cold weather specifically affecting EMS horses, resulting in a presentation of lami. It frequently is blamed on frosty grass, but it is similar to Raynaud's disease in people. Helped by travel boots to keep legs warm. Of course I am not wanting to contradict your vet. In terms of recovery, EMS sites on social media talk about jiangulan as a good help to increase circulation. Maybe worth looking into further. Good luck, lami is awful whatever the cause.

I have heard this too, interestingly, the cold induced lami seems (anecdotally) to go hand in hand with much reduced chance of rotation.

So sorry your horse is suffering ? you say horse was very overweight with a cresty neck, then not overweight in body but had a cresty neck? A vet should really notice the cresty neck as adipose fat is a symptom of ems. I had a ‘fat horse blood test’ done during lameness investigations, he was positive for ems but still had sterold injections but at half recommended dose. Thyroid meds were discussed but it was thought cruel to give to my lad as he needed box rest for the lameness and the drug makes them hyper - but I believe it works well if horse can exercise. You can reverse ems by getting weight down - lots of helpful advice on the laminitis site re ems and weight management ?? Good luck with him - no rotation is very good news ??

I also was told by my vet that EMS in fat horses can be reversed by losing weight. Before I bought him, my horse was fat with a crest and was diagnosed EMS after a lami attack. He is now all slimmed off and is having repeat blood tests this month to see if it has resolved. Unfortunately, although I do think the EMS has resolved, he was also borderline cushings, which I think has escalated. At least there will be Eds for that, if necessary.

With no rotation, I think there is a good chance of recovery back to work. I bought mine just as he finished 3 months of box rest, have a look at the "I just bought my first cob" thread fro the rehab we have done. It has included 6 months of no grass and all hay has been soaked, strictly portion controlled. My 15.1 cob was reduced to 8kg hay, before soaking. I have fed barley straw in moderation, to help him feel fuller, introduced very slowly so he didn't bung up. Also a good fit and mineral supplement, fed in plain straw chaff initially.
 

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I’m really sorry that you and your horse are going through this, OP.

My vet always mentioned the possibility of steroid induced lami when giving hock injections to my Cushing’s mare. She says that the risk is low, but she still won’t medicate an overweight horse - I was asked to get 40kg off her once before she had her hocks medicated with steroid.

Btw, gel injections (arthramid) do not contain steroid and do not carry a lami risk, so there is always those as a safer option for lami prone horses. They are more expensive, but longer lasting and IME last much longer than steroid jabs anyway, so I no longer use steroid jabs for any horse.

The very cresty neck should certainly have alerted the vet to the possibility of EMS, it’s a classic sign.
 

Morganfan

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Jeza, there is light at the end of the tunnel. My Morgan had EMS, I sad had because he is now classed as normal in blood work. However he was over weight and cresty. His diet was changed to low suger/starch everything, minimal grazing and although he still has a slight crest the rest of him is good. He does still have slight fat pads on his shoulders which I doubt will go, vets are rally happy with his weight and body score.. He had laminitis a few years ago, which with the vet and farriers working together he was totally sound after 7 months (could be lightly ridden after 4) we did do shoes (which I don't like) but it worked. He has just had his hocked injected with Arthramid, I was lucky the vet said there was a real risk of laminitis using the steroids with his history of EMS, so I chose not to do steroids. For the past 2 years he has been in full work xcountry, sj and dresage, PC etc. don't give up hope, keeping them in work as soon as you can is a big factor in getting the EMS under control, I am lucky both my daughter and granddaughter ride my boy to keep him in work. I wish you all the best and hope you get a successful outcome.
 

Backtoblack

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I would suggest that the steroid injection is the "straw that broke thecamels back". you say the horse is cresty. a typical sign of EMS. Does he have fat pads on the hollow above the eyes too ?All I can suggest is appropriate vetrinary care and good nursing and your horse may recover from the lami attack. in my experience once horse has ems it never gets over it its then a life time of very limited grazing and soaked hay for life. all food needs to be less than 10 sugar and starch combined. have your hay tested by forage plus and do not feed haylage or any grain or pony nuts. hope your horse recovers from the lami .
 

oldie48

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It is helpful to hear peoples different stories as I would have said the injections carried a very low risk of inducing laminitis. My old boy had cushings but was not overweight, he had regular steroid injections which worked very well for him. I discussed the potential for laminitis with my very experienced vet and was told that injections into the hock capsule carried very little risk however he would be reluctant to give the horse a steroid injection anywhere else. FWIW Fatty went home to his owner and developed laminitis, he was cresty despite my attempts to reduce his weight and clearly had EMS although not diagnosed. Just a small change in his diet was enough to spark a really bad attack, poor thing!
 

Lurfy

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My athletic tb developed laminitis after cortisone injects for severe hives. This was about 8 years ago now and I have managed it ever since. He will never have cortisone again. Fortunately he had no pedal bone rotation, but does need reduced grazing in Spring. He is retired now not related to the laminitis, he came fully sound again after this initial bout. Good luck OP, I hope your boy recovers fully. We treated him with ice buckets for each hoof twice or three times daily until the symptoms reduced. Good luck.
 

ITPersonnage

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Really sorry for both you and your poor horse. Metformin really helped my poor mare when she developed EMS, does work by shifting the weight. Best of luck with it, really is awful seeing them in such pain. Edited to echo what others have said, bear in mind that from now on you will have to actively manage this and never allow them to get even the slightest hint of fat. It's grim but even a slight wobble on the shoulders was enough to tighten up the feed rations again, and low sugar diet forever onwards. Sorry but this is tough love at its toughest.
 

brighteyes

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I’m really sorry that you and your horse are going through this, OP.

My vet always mentioned the possibility of steroid induced lami when giving hock injections to my Cushing’s mare. She says that the risk is low, but she still won’t medicate an overweight horse - I was asked to get 40kg off her once before she had her hocks medicated with steroid.

The very cresty neck should certainly have alerted the vet to the possibility of EMS, it’s a classic sign.

I would suggest that the steroid injection is the "straw that broke thecamels back". you say the horse is cresty. a typical sign of EMS.

I think the vet here missed a very serious red flag. There is NO excuse for crestiness. Ever. Sorry, I get so cross about overweight horses needlessly tipped over into laminitis, either by a lifetime of overfeeding and/or the PPID contribution to extra cortisol in the blood and the same effect and outcome. If it was made a prosecutable welfare issue, we might see less of it. Poor horse is paying the price now. Very sad. I hope the OP questions the vet closely on the treatment and gets a successful and permanent management plan in place. It's going to be long, costly and (sadly) with no guarantee of a good outcome.

My horse has just had hock steroid injections. My vet said the risk of laminitis is so low that he dosnt usually mention it.

Well, he won't need to in a lean, athletic animal! It's the EMS indicators they should have taken into account. IMO the EMS was a more serious risk than the stiff hocks.
 
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