Steroid induced laminitis

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l_i_z_z_i_e

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My poor horse has come down with laminitis as result of Prednisolone steroids she was having for a severe skin allergy. She has ongoing skin problems, and has had these before with no ill effect on a number of occasions.

Monday last week she was incredibly itchy, had the vet out for this and this is when the course of oral pred was started. 2 sachets morning and night monday, 2 evening tuesday, 1 weds eve, and 1 thurs eve is what she had. She had the week off on the field as she was too itchy to stable (she had also been out 24/7 before this for about 2 weeks. Sat I was out of the day but she seemed fine in the morning when I saw her, Sat even she was hopping lame on what looked like one front leg.

Called Vet out Sat night, who thought abcess, removed shoe and told to poultice for a few days then get farrier. Farrier came Weds morn, also thought prob abcess, dug around a bit but couldn't find anything. Put shoe back on and she seemed a little better. Advice (between him and vet as he is vets farrier to and went there next) was to stop bute (which was started Sat) and see how she was in a couple of days.

Went up the following morning and she could hardly walk :-( got her in from the field and called farrier, who came out ten mins later (he is good :-)) and still thought it was abcess at this stage. Bit more digging around and still found nothing. Said it could be lami, and to get vet and see what they say. Vet comes out a couple of hours later, says def not typical lami. Tested all over with hoof testers and no reaction anywhere (which she said she would expect with lami, especially after bad foot had been poulticed for 3 ish days so softer). In the end we decided to nerve block the 'lame leg' to see how the other legs looked once that was done. Obviously lame in the other legs after this, and lami diagnosed. She is on box rest (luckily has stopped scratching to a great extend), with foam pads and the usual recommendations. She didn't want to move around at all Thurs morning, but luckily is a lot happier this morning, and is starting to cause a bit of trouble from being cooped up inside for 24 hours!

Does anyone have any experience with steroid induced laminitis, and are there any different steps you followed? What are the chances of re-occurrence following on from this episode? Any tips, ideas, previous experiences greatly received.

Thank you in advance.
 
I don't have experience, but I read up on it when I was offered steroid treatment for a condition my gelding has (a vasculitis). The research strongly suggests that steroid induced laminitis is actually quite rare, and is only likely to happen in horses which have an underlying predisposition. It might be a good idea to test for cushings/ EMS/ IR in your horse once things settle down. I ended up refusing the steroids because my gelding has mild cushings.
 
l_i_z_z_i_e said:
Does anyone have any experience with steroid induced laminitis, and are there any different steps you followed? What are the chances of re-occurrence following on from this episode? Any tips, ideas, previous experiences greatly received.

Thank you in advance.
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Further to my comments on your other post, in my experience, once fully recovered your horse shouldn't be considered a "laminitic" he should be able to cope with life as before, but never given steroids again......at all.
Recovery period estimate however could easily be 6 months box rest sadly.
 
So sorry to hear this, OP, I hope you and your horse can settle into this difficult new regime, it's never easy.

There will probably be many who disagree with me, but, for this reason, I would never give any horse of mine steroids, it's never worth the risk.
 
No experience of steroid induced laminitis but I would treat as sugar/diet/metabolic sensitive laminitis (soaking hay etc.) and I also would not assume that once recovered you can carry on as before I'm afraid, so I agree with SE that there is/was probably a predispostion.
 
OP you treat the same and wait for symptoms to subside, recovery can be fast but only if caught early and there has been no rotation, i would test for ems and cushings for peace of mind.

i would be rather unhappy with delayed diagnosis though
 
I also second testing especially for Cushings with the skin allergy problems. A low sugar, high forage diet with a really good balancer will also help the skin.
 
amandap said:
No experience of steroid induced laminitis but I would treat as sugar/diet/metabolic sensitive laminitis (soaking hay etc.) and I also would not assume that once recovered you can carry on as before I'm afraid, so I agree with SE that there is/was probably a predispostion.
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Sorry but I have seen this twice and in both cases in horses with no prior metabolic issues, let alone laminitis. One was a 27 ex racer TB, sort who could live in knee deep grass all spring without any reaction, the other a Trackener x draught who was fit and had fantastic feet all year round. I'm not saying that pre existing issues might be there in this case but let the OP follow vets advice on it as he knows the horse.

Echo the avoid steroids at all costs comment, I am the same after witnessing these cases, only in life or death situation would I agree to their use.
 
I would be very unhappy not to warned about this well known and potentially life threatening side effects of steriods .
I have never been given steroids to give without the laminitis warning from the vet ( fatty had lots of steroids when he had his heart problem )I am amazed you were not warned and appalled the vet missed it .
I hope recovery is straight forward .
 
I have used preds on Percheron X a very good doer with no side effects. Tookk other hunter to Rossdales for lameness issue. He was 17.3 Shire Cross very long and never fat. Had steroid injections in both front feet.

We were told the risk but felt in his case no risk really. Wrong!! He had laminitus but fortunatel not badly and made a full recovery quite quickly.
 
Ditchjumper2 said:
I have used preds on Percheron X a very good doer with no side effects. Tookk other hunter to Rossdales for lameness issue. He was 17.3 Shire Cross very long and never fat. Had steroid injections in both front feet.

We were told the risk but felt in his case no risk really. Wrong!! He had laminitus but fortunatel not badly and made a full recovery quite quickly.
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steriod induced laminitis has nothing to do with the weight/body condition in most cases and unless there is rotation often the symptoms go shortly after the drugs are out of the system
 
Thank you all for the opinions.

Just to clarify, may horse has very bad ongoing skin allergy issues, and has done for a number of years now. I have known from the beginning about the risk with steroids, but it unfortunately get so bad sometimes that we have to give her something. This time she was shaking from head to toe as she was so itchy, scratched patches off her, would just gallop around the field. In the end she had to have the steroids, as we had had hold of her from 6 am until 3pm when i called the vet out and they had to sedate her to try to let her calm down. I don;t know what I will do if this happens again as it is so distressing for her and to watch.....obviously she won't have steroids ever again. I have already returned the box of sachets I have on standby.

When I first called the vet out for the lameness, they did say there was a small chance it could be lami, and she was fenced off in a tiny little pen in field with only soaked hay. She couldn't have come in then as the itching was too bad, but we did this 'just in case'. Unfortunately the 'just in case' was correct :-(

She has never shown any signs of lami previously, when on steroids, with grass, feed etc etc

Good advice re: cushings test, and I will discuss this with the vet today. They will be out on Thurs to xray I think so will get it done then just to be safe.

Luckily I think she is starting to feel a bit better, as yesterday she started kicking the stable door again with her front foot, which I imagine she wouldn't do if it hurt too much. She does always usually kick the door for breakfast etc.

Really hope xrays don't bring too bad a news this week :-(
 
Also just to add on, she went up to Rossdales to see a skin expect a few years ago and steroids are really the only way to manage her skin when she is bad, so it was unavoidable to give them to her during a flare up.

Having done a lot of research into this over the last few days it does seem that laminitis as a result of Oral Prednisolone is pretty rare. Much more common in the use of other steroids via injection.

She was so stressed when she was itchy this time, coupled with a week off work to avoid her getting hot and her itches worse, I think it was just too much for her.
 
Lami from oral steroids is actually a fairly low risk. Vets have to manage risk versus benefit when they give out steroids and with a horse showing allerigic/inflammatory reasons and with no prior history of laminitis or risk factors then giving oral prednisolone is not an out of the question thing to do.

OP you will obviously now have to be very careful with your horse. I would also suggest cushings/EMS testing.

2 years ago now my young (6 at the time) mixed breed competition horse was showing cyclical energy levels. Around May time he had a sudden drop in oomph and when the vet examined him he noticed an increased respiratory rate and a tracheal wash showed raised inflammatory markers. The horse wasn't showing marked respiratory distress but we put this down to pollen allergy and treated with a course of ventipulmin and oral pred. The horse spent all summer up & down and was eventually diagnosed with an orthopaedic problem which at the time took all the blame for all the problems we had been seeing.

Fast forward to a year later and in the spring of his 7yo year he was boarderline laminitic. Didn't have a proper attack thankfully as I acted quick. But on testing him he came back very positive for cushings disease. A 7yo sporthorse who I suspect had been struggling for a couple of years. I don't think giving him steroids helped matter and had I known he was cushings we certainly wouldn't have gone that route - but hindsight is a wonderful thing and I wouldn't rule out pred for other horses in the future if it was indicated.
 
Sounds awful! Did they identify a possible cause at Rossdales?

I do think looking closely at diet is worth a try and also keeping a diary so you can identify any possible triggers.Review diet and perhaps strip back to straights and no sprays/chemicals. Perhaps contact Sarah at Forage Plus or try one of their (expensive)ready made balancers. I suggest FP because they take a different approach from feed make dietitions, adding only commonly deficient minerals in UK forages and at higher levels.
Just some ideas which may be of no use to you and feel free to reject. x
 
amandap said:
Sounds awful! Did they identify a possible cause at Rossdales?

I do think looking closely at diet is worth a try and also keeping a diary so you can identify any possible triggers.Review diet and perhaps strip back to straights and no sprays/chemicals. Perhaps contact Sarah at Forage Plus or try one of their (expensive)ready made balancers. I suggest FP because they take a different approach from feed make dietitions, adding only commonly deficient minerals in UK forages and at higher levels.
Just some ideas which may be of no use to you and feel free to reject. x
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The cause wasn't really identified. The allergens were just the ones that come up in most horses really, dust, feathers, mice, some pollen. I tried the immunotherapy, but it made no difference. To be honest I think she just has the most sensitive skin, as what triggers her off one time won't again. One thing that always does in fleece, no fleece rugs or numnahs near her. This time i think it was set off by having her saddle and a numnah on for about 4 hours, not ridden for that long but the saddle was on her that long at a dressage comp I hacked to.

I have cut out all hard feed and swapped to haylage for weeks as a trial, and trialled out 24/7 with nothing but that doesnt seem to affect it. I don't really use fly spray when she is itchy as that does make it worse, but if she isn't itchy she can be covered in spray with no affect.

Haven't heard of forage plus before but will look into it, thanks x
 
Sensitive skin can be due to lowered immune response and this can be linked with Cushings (PPID) as well as mineral imbalance or deficiency. Some vitamins such as vitamin E can be crucial as well. Omega 3 oils are another thing that can be short, especially with restricted grazing and in winter and of course amino acids such as lysine which the horse can't make in it's body. These are the reasons the so called barefoot diet recommendations have come about, as hooves are part of skin really. It's not a BF diet it's a horse diet, low sugar, high fibre with good (even bespoke in difficult cases) minerals in a good balancer with whole linseed for balanced omega 3&6.
I'm no expert just what I've learned and experienced over time.
I wish you the best and fingers crossed for laminitis recovery.
 
amandap said:
Sensitive skin can be due to lowered immune response and this can be linked with Cushings (PPID) as well as mineral imbalance or deficiency. Some vitamins such as vitamin E can be crucial as well. Omega 3 oils are another thing that can be short, especially with restricted grazing and in winter and of course amino acids such as lysine which the horse can't make in it's body. These are the reasons the so called barefoot diet recommendations have come about, as hooves are part of skin really. It's not a BF diet it's a horse diet, low sugar, high fibre with good (even bespoke in difficult cases) minerals in a good balancer with whole linseed for balanced omega 3&6.
I'm no expert just what I've learned and experienced over time.
I wish you the best and fingers crossed for laminitis recovery.
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Thank you.
 
popsdosh said:
How the hell did the Vet miss the obvious! !!!!
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they didn't - just said it wasn't typical lami which it isn't if it doesn't react to hoof testers and they diagnosed lami after nerve blocking straight after so I don't see what the vet has done wrong?

OP sounds like an unfortunate set of circumstances given that your horse was better out as too itchy to be in, hopefully it will resolve well and asap.
 
ester said:
they didn't - just said it wasn't typical lami which it isn't if it doesn't react to hoof testers and they diagnosed lami after nerve blocking straight after so I don't see what the vet has done wrong?

OP sounds like an unfortunate set of circumstances given that your horse was better out as too itchy to be in, hopefully it will resolve well and asap.
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Thank you. They didn't miss this and that is hwy she was fenced off in a tiny pen in the field with soaked hay...just in case. She was only shjowing signs of any lameness on one foot, no pulse on other legs, or heat in feet at this stage. But they did say always a chance it could be lami without the typical signs, and hence it was treated carefully just in case. Just turns out it was :-(

Luckily she seems to be feeling a lot better now. She isn't lying down as much, is causing trouble being in, and has started to kick the stable door again.....hoping that means her feet don't hurt so much!

She has squished down the first set of pads and I added a new pair to these this morning. On removing all of the tape only the initially lame leg still has a pulse and heat in the foot, and the others seems much better (not quite 100%) so hopefully she is heading in the right direction.
 
She is ridiculously bored though. Any ideas on how to entertain a laminitic? Obviously all food related toys are out. She is currently getting old cereal boxes which she shreds, and old milk bottles to throw around. She doesn't have any interest in a football or a big 'tigger' teddy!
 
I am thrilled to read you are using pads, such great support in laminitis. I don't suppose you have a grass free area she could go in where she would be settled?
My pony goes in the barn with her mates outside the barred gate in a yard and when she is moving better, off any pain relief, she joins them wearing her pads. They are a long standing herd though so no hooning and they all have the soaked hay diet. Hay is put in piles around the yard.
If you have a suitable area run it past the vet.
 
amandap said:
I am thrilled to read you are using pads, such great support in laminitis. I don't suppose you have a grass free area she could go in where she would be settled?
My pony goes in the barn with her mates outside the barred gate in a yard and when she is moving better, off any pain relief, she joins them wearing her pads. They are a long standing herd though so no hooning and they all have the soaked hay diet. Hay is put in piles around the yard.
If you have a suitable area run it past the vet.
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Thanks. They vet did say that when the medication has ended we can take her for a little mooch to her pen for a short while and see how she is. Unfortunately there is grass everywhere, and its getting longer by the day!!

She lives with my parents, and has 4 acres sectioned off into different fields. If this is a long standing issue we can make her a pen outside with some sort of decent surface in it, but at the moment there is grass everywhere, or a nasty stone driveway which would hurt her feet. Luckily we have the flexibility to do this on parents land. I have read that pea shingle is very good?

I need to arrange to borrow some sheep or something to eat some of it down really.
 
Pea gravel area can be great. There are also hoof boots and pads during recovery and for use if ever footy in the future. I like a variety of surfaces for my lot but when in laminitis things might have to change until well on the road to recovery, unless you can use boots.
Thinking about facilities for longer term management is always a good idea especially if grass restrition is likely to be needed. Some ideas here and if you google Paddock Paradise loads of ideas will come up. http://www.performancebarefoot.co.uk/barefoothorsepaddockparadisetrack.html
 
I'd second looking at setting up a track system/paddock paradise in the paddocks. Definitely works a treat limiting grazing but encouraging movement, get it started now and get her out on it asap. The movement will encourage the blood to keep pumping which is essential for recovery, the longer stood about the longer and harder the recovery will be for the whole body. If you want any ideas or info on setting up a 'track' feel free to PM me. It was my laminitics last resort and saved her life!!!

Another good feed to introduce would be Thunderbrook, give Debbie a call and discuss all of the issues ongoing, she is amazing and really knows her stuff.
 
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