Steroid injections & laminitis - the risk?

SEL

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The diva horse's hocks were x-rayed last November and found to have arthritic changes at the grand old age of 6. Tried catrophen to no effect and planning steroids.

Despite getting her weight down the vets are saying they think there is a laminitis risk as she's a very good doer. I've been doing my on-line googling and from what I can tell the risk of laminitis from a one time injection isn't that high, its multiple injections that increase the risk.

I'm a bit stuck. She's got PSSM and is getting less and less tolerant of exercise because her hocks are sore - and without the exercise her muscles get sore. A few weeks of danilon and the stomach issues flared up, so that's now off the agenda too.

My gut feeling is to go ahead with the steroids and just keep everything crossed. Apart from the usual low sugar / starch protocol is there anything else I can do to minimise the laminitis risk?
 

PinkvSantasboots

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If I were you I would have a ems test done before going ahead with steroids it sounds like she may have something metabolic going on, I personally would never give a horse steroids if they were high risk having had 2 with laminitis it's not something I would want to do if I thought it could have been prevented.

my mare was given the only option of steroid for an old injury I did suspect she had a metabolic condition so I had her tested for cushings and ems, she tested positive for both so steroids was a definite no and she was retired unfortunately she did go down with laminitis and I lost her but she did have almost a year living a natural happy life living out.
 

Clare85

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With a metabolic issue already, I don't think I would risk the steroids personally. Our pony was given half a single dose of steroid as part of her headshaking investigations in November. I was concerned about it so our vet ran bloods to check insulin levels beforehand (which were fine), pony was a good weight and is managed carefully due to her type (13.2hh traddie cob). Vet felt the risk was as low as it was possible to be. However, she still came down with laminitis. It was mild and we were braced for it so she only showed symptoms for a couple of days, but I felt horribly guilty for allowing the steroids into her system.
 

Kezzabell2

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I've known a lot of horses have steroid injections for their hocks, including mine, none of the horses I've known have had laminitis because of it!! Although the injections didn't last even a year on my horse, so I his hocks fused in 2015 and haven't looked back. The horse in the stable next to mine has just had his 3rd lot of injections, he seems to need them annually now, but he is 18 (my horse is 7 this year, so was diagnosed at 4)
 

SEL

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With a metabolic issue already, I don't think I would risk the steroids personally. Our pony was given half a single dose of steroid as part of her headshaking investigations in November. I was concerned about it so our vet ran bloods to check insulin levels beforehand (which were fine), pony was a good weight and is managed carefully due to her type (13.2hh traddie cob). Vet felt the risk was as low as it was possible to be. However, she still came down with laminitis. It was mild and we were braced for it so she only showed symptoms for a couple of days, but I felt horribly guilty for allowing the steroids into her system.
I might ask about running bloods first - although with PSSM I'm not entirely sure what that would show from an insulin perspective because they tend to be the opposite end of the spectrum from EMS type disorders. I'm also not sure my vet would know either!
 

Hexx

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I lost my horse to steroid-induced laminitis. He was on high dose steroids for IBD/tumors in the colon (symptoms the same, treatment the same, but difficult to sometimes decide which one it is).

He was on 120 tablets a day for 3 months and was very poorly. It was likely that I would have lost him anyway, but the laminitis hit hard and fast and within two weeks of diagnosis he was pts.

Unfortunately, the vet missed the laminitis and diagnosed a bruised sole, it wasn't until I got a second opinion that the laminitis was found.

In hindsight, there are lots of things I could have done differently, but I think the main one would have been reducing the steroids.

So, my advice would be no - don't risk it.
 

SEL

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I've known a lot of horses have steroid injections for their hocks, including mine, none of the horses I've known have had laminitis because of it!! Although the injections didn't last even a year on my horse, so I his hocks fused in 2015 and haven't looked back. The horse in the stable next to mine has just had his 3rd lot of injections, he seems to need them annually now, but he is 18 (my horse is 7 this year, so was diagnosed at 4)
Without sounding horrible - its good to know there are others out there with young horse who had arthritis and came good! I have a sneaking suspicion we will end up fusing the hocks too, but the vets want to start with the 'safest' option first. It doesn't feel that safe to me, but I have an unrideable horse at present so I'm a bit lost as to best way forward. They are telling me its my call but like Clare I will feel dreadful if I make her more sick as a result....
 

SEL

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I lost my horse to steroid-induced laminitis. He was on high dose steroids for IBD/tumors in the colon (symptoms the same, treatment the same, but difficult to sometimes decide which one it is).

He was on 120 tablets a day for 3 months and was very poorly. It was likely that I would have lost him anyway, but the laminitis hit hard and fast and within two weeks of diagnosis he was pts.

Unfortunately, the vet missed the laminitis and diagnosed a bruised sole, it wasn't until I got a second opinion that the laminitis was found.

In hindsight, there are lots of things I could have done differently, but I think the main one would have been reducing the steroids.

So, my advice would be no - don't risk it.
That's awful - and definitely makes me want to push them to discuss other options.
 

Tiddlypom

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It sounds like it's imperative that your girl is made comfortable to assist with controlling her PSSM.

My vet said that the risk of lami following an intra articular injection of steroid is minimal. Even so, she would only medicate my lad (for high ringbone) if he did not weigh over a predetermined ok weight for him (620 kg, down from a high of 670kg). He had several injections over a period of 18 months or so, and never suffered an adverse reaction.

Lost him in the end, but that was due to other unrelated issues.

Good luck, I'd go for the joint injections if I was in your place.
 

Kezzabell2

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Without sounding horrible - its good to know there are others out there with young horse who had arthritis and came good! I have a sneaking suspicion we will end up fusing the hocks too, but the vets want to start with the 'safest' option first. It doesn't feel that safe to me, but I have an unrideable horse at present so I'm a bit lost as to best way forward. They are telling me its my call but like Clare I will feel dreadful if I make her more sick as a result....
Its scary really, my friend contacted me for advice last week as they think her horse has hock spavins too, he is also only 6.

My other friends mare had her hocks fused at 6.

There's a horse at my yard who was recommended steroid injections yesterday, he is about 13, so a bit older but still not old.

Another on my yard who's 7 that has arthritic changes in his front foot (my horse also has this)

There seems to be so many young horses these days with bone issues/arthritic changes! it makes me wonder if we are doing something wrong with them? Is there something that we are feeding them that is causing these issues? or are we just better at investigating?

My mare made it to the grand age of 31, she got arthritis in her knee at 28 but it never caused her any issues!!

its all pure madness to me
 

ester

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My vet did say there was a collaborative paper about to be published (this was last year) suggesting the risks are not as high as they thought they were and that it tends to be horse owners worrying each other. I do think joint injections should probably be considered totally different to the effect of those given orally.

Mine (native pony, old, tested negative for ppid) has been joint injected three times, twice into coffin joint in fairly quick succession and once into hock. His feet show up worming but no sign of the injection.
 

Pigeon

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It's such a catch 22 situation!

Has she had laminitis before? Has she been tested for cushings?
 

Pigeon

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Its scary really, my friend contacted me for advice last week as they think her horse has hock spavins too, he is also only 6.

My other friends mare had her hocks fused at 6.

There's a horse at my yard who was recommended steroid injections yesterday, he is about 13, so a bit older but still not old.

Another on my yard who's 7 that has arthritic changes in his front foot (my horse also has this)

There seems to be so many young horses these days with bone issues/arthritic changes! it makes me wonder if we are doing something wrong with them? Is there something that we are feeding them that is causing these issues? or are we just better at investigating?

My mare made it to the grand age of 31, she got arthritis in her knee at 28 but it never caused her any issues!!

its all pure madness to me
I think better at investigating, but also less discriminating at breeding. I posted a thread a while back - so many breed from lame mares!! I've seen horses for sale for 10k plus whose legs stand only a slim chance of holding up into old age, just based on bad angles. :(
 

PorkChop

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I've had one come down with steroid induced laminitis, (one injection), not nice. But have also had several horses have steroids with no ill effects.

However if my Vet was concerned about the risk, considering how widely used they are, I would hold off for a while. Ask them about Osphos, made a big difference to one of mine that I didn't want to give steroids to.
 

oldie48

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My TB had cushings and arthritis in his hocks but had never had laminitis. My vets are a very well known equine hospital and their advice was that he was no more likely to come down with laminitis as a result of the steroids than any other non cushings horse. He got the steroids and was fine and it extended his working life by several years. I trust me vets to give me the right advice and if he had developed laminitis I would have considered him "unlucky" rather than my vets being negligent.
 

Ali27

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My good doer who is ulcer prone has had her stifles and sacroiliac medicated on two different occasions and was fine! One was in Dec and the other in May. I made sure that she was on restricted grazing and soaked hay for a few weeks after.
 

Kezzabell2

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I think better at investigating, but also less discriminating at breeding. I posted a thread a while back - so many breed from lame mares!! I've seen horses for sale for 10k plus whose legs stand only a slim chance of holding up into old age, just based on bad angles. :(
this is very true, I've seen people say if its broken, breed from it!
one of the horses I mentioned earlier has just come to my instructor after competing at dressage nationals and doing very well! she was concerned that he wasn't going forward like he did as a 4 year old. so investigated and found issues in his front foot! its crazy to think "professionals" competed him and didn't question why he was "lazy"
 

SEL

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Thanks all. She's never had laminitis to my knowledge and my trimmer tells me she can't see any sign of it in her feet.

I think a long chat with the vet is needed. It doesn't help that the flippin grass is coming through - soaking hay on 1 March. Bring back winter!
 
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Low dose of steroids into back for kissing spine and my mare went down with steroid induced laminitis. Not overweight, no indications she would be at risk and vet really shocked. It is rare vet told me this was his first experience in 40 years of practice but I would definitely be wary of going the steroid route with a horse that could be predisposed.
 

Lurfy

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I'm with Hexx, I would avoid steroids if at all possible. I also have a horse with steroid induced laminitis. He's a 17hh tb with no history of laminitis. 5 years ago he got terrible hives, his body was covered in welts and lumps overnight. Vet came and prescribed 5 days of cortisone injections. Bumps were gone on day 5 and he was hobbling. I will never get over the guilt of injecting him with that stuff. Anyway we rahabbed the laminitis with ice therapy, diet etc etc. He had no pedal bone rotation, thank God, so he is fine these days. We manage him every Spring as anyone with a laminitis prone pony/horse does. He has had two small episodes in 5 years which was triggered by spring grass, so we have to be very careful with him. It is a pain, but I am glad to still have him as he is part of the family.
 

ester

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see five days of cortisone injections (systemic) is very different to a single joint injection where the whole intention is it stays in the joint space. Not saying it doesn't happen but I am not sure the tales of laminitis from systemic steroid use are that helpful when discussing joints.

Brunocat was yours one jab or more out of interest.
 

Impu1sion

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I lost my much loved mare 12 months ago due to steroid induced laminitis. The Vet had injected her hocks due to arthritis and had said the risk was small. She was also a good doer (and had also come out in hives a few months before). In hindsight, I don't think I would take the risk. It wasn't a difficult decision to make at the time as she was in such pain in all 4 feet, painkilling injections did not even touch it :-( Good luck OP, it's a tough decision.
 

oldie48

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see five days of cortisone injections (systemic) is very different to a single joint injection where the whole intention is it stays in the joint space. Not saying it doesn't happen but I am not sure the tales of laminitis from systemic steroid use are that helpful when discussing joints.

Brunocat was yours one jab or more out of interest.
This is exactly what my vet told me, when the tb had a systemic steroid injection for a very nasty skin infection that wouldn't clear up I was warned of the potential risk of laminitis, tb was at that time younger, slim and not suffering from cushings and had not had any laminitis. Many years later when needing a steroid injection into the hock, he was older had cushings and my vet did not consider laminitis was a serious risk. We are talking about different things here. When the same TB went down with severe cellulitis, we discussed steroids as an option but decided to see take a watching brief and only use them if it became absolutely necessary as there was a clear risk. My view is if you have a good vet that you trust, it's better to take their advice, it's what we pay them for.
 

canteron

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SEL, I recently had steroid injections in my horses feet - but having done more research now rather wish I hadn't, or at least I wish I had understood the risks more clearly. One of the risks is that the steroid injections reduce the inflammation, but also impact on the cartilage. If you can sort out the weight, diet, exercise first and then make the decision on the steroid injections is what I would do if I was in the same situation again (my horse was overweight due to lack of exercise, although one vet said he didn't think that was a factor, common sense says it is).

Also, can you give your horse 24hour turnout, that really seems to help (maybe try some sort of a track system?) and does your horses pain respond to bute in the short term while you deal with other issues. Also, it really may or may not be helpful, but if you look at the "Thunderbrook Feeds" website, there is their philosophy on managing Laminitus and also if you talk to them they are convinced they have strong opinions about Prascend and why it is banned for humans in some countries. It may or not be relevant, but I try to follow their advice as closely as possible without being evangelical.

Finally, due to the horses natural biorhythms (losing weight in Winter, gaining weight in Summer) if your horse is overweight, it is probably best to tackle it quite seriously now as you are running out of time to deal with it before Spring really kicks in (which can't help).
 

Hexx

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I have to say that it didn't help that the vet totally missed the laminitis and put the lameness down to a bruised sole - sticking to that diagnosis even when both the YO and I queried it. So there was a delay of about 7 days before the final laminitis diagnosis was made by a different vet. He also had a raging infection in his neck which we didn't know about until the vet (different vet) lanced an odd lump on his neck that turned out to be about 2 litres of pus!

His pedal bones dropped and rotated by 14 degrees and 16 degrees in 10 days, so it happened fast. After he was pts, the farrier, who happened to be there, took his shoes off to give me and found that the pedal bone had come through the foot - so I had made the right decision.

Mis-diagnosing vet was dealt with!
 

Casey76

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SEL, I recently had steroid injections in my horses feet - but having done more research now rather wish I hadn't, or at least I wish I had understood the risks more clearly. One of the risks is that the steroid injections reduce the inflammation, but also impact on the cartilage. If you can sort out the weight, diet, exercise first and then make the decision on the steroid injections is what I would do if I was in the same situation again (my horse was overweight due to lack of exercise, although one vet said he didn't think that was a factor, common sense says it is).

Also, can you give your horse 24hour turnout, that really seems to help (maybe try some sort of a track system?) and does your horses pain respond to bute in the short term while you deal with other issues. Also, it really may or may not be helpful, but if you look at the "Thunderbrook Feeds" website, there is their philosophy on managing Laminitus and also if you talk to them they are convinced they have strong opinions about Prascend and why it is banned for humans in some countries. It may or not be relevant, but I try to follow their advice as closely as possible without being evangelical.

Finally, due to the horses natural biorhythms (losing weight in Winter, gaining weight in Summer) if your horse is overweight, it is probably best to tackle it quite seriously now as you are running out of time to deal with it before Spring really kicks in (which can't help).
OFGS pergolide isn't "banned" in some countries. It was voluntarily withdrawn in the US after studies showed an increased risk of valvular heart disease. It is still available in many countries for it's licensed indications. Also to point out that the human dose of pergolide for Parkinsons disease is much greater (weight for weight) than that used in horses for PPID. The use of pergolide in humans has decreased in recent years after newer, more effective drugs for Parkinsons have been released onto the market.
 

SEL

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I spoke to a friend whose opinion I respect this morning and have decided to get a second opinion from a different vet practice. Whilst my current vet is extremely experienced from a lameness perspective, the metabolic issue concerns me.

She's already on 24 hour turnout in a small track system, with soaked hay. Although she has a big belly, she doesn't have those odd fat pads anywhere. Her crest is wobbly, but her bottom muscles are rock solid so she's definitely struggling with the disease.
 
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