Subclinical Laminitis

[southerncomfort]

20 year old mare with no history of lameness or laminitis (no cresty neck, no fat pads and ribs can be felt, but is in soft condition) has been having occasional short episodes of lameness that seemingly resolve themselves within a few hours.

Vet thinks subclinical laminitis associated with cushings disease. She's taken lots of blood and I'm treating it as laminitis at least until we have the results.

However, I'm a bit confused about what's being tested for. She says one of the tests is for laminitis....I'm not sure what this is and Google isn't helping me out!

I know she is also testing for EMS. She also said she'd be testing for cushings but that it wasn't an ACTH test and that she would probably need an ACTH test doing next time. Again, I'm not sure what's being tested..?

Can anyone help me out please?

I've only ever had one with laminitis/cushings and that was several years ago so I'm sure everything has changed now!

 

[Pearlsacarolsinger]

I have no idea what he vet was doing, our Cushings horses both had ACTH tests to diagnose and one had TRH-Stim test, which she needed to fast for. If I thought that my horse had Cushings related laminitis, I think I would be asking the vet to prescribe Prascend to do a trial before the test results came back.

 

[southerncomfort]

I have no idea what he vet was doing, our Cushings horses both had ACTH tests to diagnose and one had TRH-Stim test, which she needed to fast for. If I thought that my horse had Cushings related laminitis, I think I would be asking the vet to prescribe Prascend to do a trial before the test results came back.

Thanks PAS. As I say, I wondered if things had changed since I last had one with cushings.

She took 5 or 6 vials of blood and if none of them were for ACTH, I've no idea what they're for.

 

[Pearlsacarolsinger]

Thanks PAS. As I say, I wondered if things had changed since I last had one with cushings.

She took 5 or 6 vials of blood and if none of them were for ACTH, I've no idea what they're for.

As you are paying for the tests, I think I would ring the surgery to find out what you are paying for.

 

[southerncomfort]

As you are paying for the tests, I think I would ring the surgery to find out what you are paying for.

Thats what I'm thinking.

I'll give a ring in the morning.

 

[meleeka]

It sounds like you need a new vet! ACTH test is fairly cheap and the most likely cause of any laminitis. Not to test for that is just weird!

 

[southerncomfort]

It sounds like you need a new vet! ACTH test is fairly cheap and the most likely cause of any laminitis. Not to test for that is just weird!

Thats how I feel to be honest.

I just don't understand the concept of a test for cushings that isn't either ACTH or the fasting test.

This was a young vet who I think has only joined the practice recently.

Definitely going to call in the morning and ask for an explanation.

 

[cauda equina]

You can get free tests for ACTH - IRRC you still pay the vet for the visit/ blood sampling
https://www.careaboutcushings.co.uk/voucher-terms

 

[southerncomfort]

You can get free tests for ACTH - IRRC you still pay the vet for the visit/ blood sampling
https://www.careaboutcushings.co.uk/voucher-terms

Yep. I asked if they would download the voucher at the clinic and she said oh this isn't the full ACTH test so the voucher doesn't apply but you'll be able to use the voucher against future monitoring...?

I looked again at the slip she gave me and it says Rainbow Laminitis screen. So I looked on the Rainbow website and I think this is what she is referring to:



Pony is sound again today.

Is this how subclinical laminitis normally presents?

Farrier was here last week and he didn't mention any signs of laminitis

I'm thoroughly confused by the whole thing to be honest!

 

[cauda equina]

That's weird that the vet said 'the voucher doesn't apply' - I wonder why not?
When I've used it it's been for horses with suspected Cushings as a first investigation

As you're now treating your horse as a laminitic if she improves that would suggest laminitis, so you might get an answer that way
It's such tricky condition. I have one I assume has laminitis if he's 'off', even though vets and farriers have always said he doesn't have it

 

[holeymoley]

Yep. I asked if they would download the voucher at the clinic and she said oh this isn't the full ACTH test so the voucher doesn't apply but you'll be able to use the voucher against future monitoring...?

I looked again at the slip she gave me and it says Rainbow Laminitis screen. So I looked on the Rainbow website and I think this is what she is referring to:

View attachment 79259

Pony is sound again today.

Is this how subclinical laminitis normally presents?

Farrier was here last week and he didn't mention any signs of laminitis

I'm thoroughly confused by the whole thing to be honest!

These are just standard tests. If any of those were ridiculously high she would be suggesting the cushings test.

That's what I think she's maybe doing. I've just had all these done on my laminitic- I have them done every year to check levels.

ETA- on reading again, if she thinks it's leaning towards cushings then I don't see why she's not just done a cushings test but I suppose there's more of a chance here to see whether it's cushings or metabolic.

 

[southerncomfort]

These are just standard tests. If any of those were ridiculously high she would be suggesting the cushings test.

That's what I think she's maybe doing. I've just had all these done on my laminitic- I have them done every year to check levels.

ETA- on reading again, if she thinks it's leaning towards cushings then I don't see why she's not just done a cushings test but I suppose there's more of a chance here to see whether it's cushings or metabolic.

Thanks. I think that's what confused me because I'd already said that I planned to test for cushings this Autumn as a precaution.

Anyway hopefully we'll have some answers soon!

 

[Pearlsacarolsinger]

Just be aware that the ACTH test doesn't always pick up Cushings. We had a mare who was ACTH tested several times, always came back within normal range but slightly higher number each time. We weren't convinced and had the TRH-Stim test, the result came back at 800, when the upper normal reading is 100. Needless to say, she went on Prascend immediately.

 

[southerncomfort]

I'm feeling really confused and worried about this pony.

Just going to chuck all my thoughts down here in the hope it helps me see things more clearly!

So I requested the results via email. Email didn't arrive but another vet called me. I wasn't told if the results indicate laminitis or not, which the original vet said the test should show.

I was told that the results indicated both EMS and cushings. I didn't hear the insulin level as the line was bad but vet said it was high and suggested a period on Metformin which I'm happy to do. Vet said ACTH level was high, but then said it was 74 and should be below 50. But having googled, the cut off point has been raised to 100. So in that context the ACTH level is actually within normal levels. However she's been prescribed 1 prascend a day for a month and then retest.

To be clear, if these drugs help her I'm happy for her to be on them.

My worry is that we might be barking up the wrong tree. She is definitely in soft condition but she isn't overweight. She has a massive rib cage which can make her look big but ribs can be felt easily and seen when she moves, she has no fat pads and no crest. I'm now soaking all her hay etc and she is mostly in her stable with short periods in the school.

Reason I called vet in the first place was intermittent, infrequent lameness, sometimes in right front, sometimes in left front. I also thought I'd felt heat in right fetlock area.

I've just weaned her off bute and she's mostly sound but is occasionally catching the tip of her right front hoof and slightly knuckling over on it.

My worry is: has the focus on laminitis/cushings etc meant that something else has been missed? Or is it possible for their to be rotation in one foot only and how would this sit with the intermittent nature of the pain?

I'm thinking of asking for x-ray. She isn't insured due to age so I can't spend a fortune but feel like I need more info so I can stop worrying!!

 

[meleeka]

Usually if they have pain from laminitis they will put the foot down quickly, heel first, to take the pressure off the sole. ‘knuckling over’ isn’t something i’ve ever seen with laminitis pain. It is possible to have rotation in only one hoof, but xrays would be the only way to tell.

I have no experience of EMS. ‘Luckily’ mine have only had laminitis on its own or when undiagnosed with cushings.

My sure way of telling if there’s low grade laminitis (apart from pulses) is to turn them in a tight circle on concrete. This is really painful for a laminitic and any soreness will be obvious.

I think you could go one of two ways now, either give the meds for a month and then see if they make a difference (in which case the diagnosis was correct) or get her x rayed. The meds are probably cheaper but xrays would probably be better for your peace of mind if nothing else.

 

[southerncomfort]

Usually if they have pain from laminitis they will put the foot down quickly, heel first, to take the pressure off the sole. ‘knuckling over’ isn’t something i’ve ever seen with laminitis pain. It is possible to have rotation in only one hoof, but xrays would be the only way to tell.

I have no experience of EMS. ‘Luckily’ mine have only had laminitis on its own or when undiagnosed with cushings.

My sure way of telling if there’s low grade laminitis (apart from pulses) is to turn them in a tight circle on concrete. This is really painful for a laminitic and any soreness will be obvious.

I think you could go one of two ways now, either give the meds for a month and then see if they make a difference (in which case the diagnosis was correct) or get her x rayed. The meds are probably cheaper but xrays would probably be better for your peace of mind if nothing else.

Thank you.

I've only ever had one other with laminitis/cushings and it presented completely differently to this, hence my confusion, however the vet said that's why she was describing it as subclinical.

I did ask I'd something else could be going on too but she seemed quite focused on lami/cushings so I just accepted it.

I'll pop her back on bute while I mull over what do next.

 

[Gloi]

Going straight onto a whole tablet of prascend can sometimes cause problems like depression. It is sometimes advised to start with half a tablet and build up if levels aren't controlled by that.

 

[OrangeAndLemon]

My sure way of telling if there’s low grade laminitis (apart from pulses) is to turn them in a tight circle on concrete. This is really painful for a laminitic and any soreness will be obvious.

Sorry but I'm thread hijacking a bit. Mine is currently on box rest for suspected laminitis but shows none of the normal symptoms. He is fine turning on concrete and is closer to sound on hard surfaces but on soft sand or grass, looks very uncomfortable. Only saw the vet yesterday so we're just starting box rest but like yours OP, mine has inconsistent lameness, mostly left front but sometimes right front. No pulses, heat or anything else. Always worse in soft surfaces, better on hard.

 

[southerncomfort]

Going straight onto a whole tablet of prascend can sometimes cause problems like depression. It is sometimes advised to start with half a tablet and build up if levels aren't controlled by that.

I'll admit to ignoring the vet on that front and starting on half a tablet at least for the first week.

The little cushings pony we had before became very depressed and stopped eating so I took her off it for a couple of weeks and then started again with just a tiny fraction of a tablet and built up very slowly.

 

[southerncomfort]

Sorry but I'm thread hijacking a bit. Mine is currently on box rest for suspected laminitis but shows none of the normal symptoms. He is fine turning on concrete and is closer to sound on hard surfaces but on soft sand or grass, looks very uncomfortable. Only saw the vet yesterday so we're just starting box rest but like yours OP, mine has inconsistent lameness, mostly left front but sometimes right front. No pulses, heat or anything else. Always worse in soft surfaces, better on hard.

That sounds familiar!

Mine can be walking along sound as a pound and then suddenly go dog lame, then a couple of hours later be completely sound again. Very odd!

 

[meleeka]

Sorry but I'm thread hijacking a bit. Mine is currently on box rest for suspected laminitis but shows none of the normal symptoms. He is fine turning on concrete and is closer to sound on hard surfaces but on soft sand or grass, looks very uncomfortable. Only saw the vet yesterday so we're just starting box rest but like yours OP, mine has inconsistent lameness, mostly left front but sometimes right front. No pulses, heat or anything else. Always worse in soft surfaces, better on hard.

Did the vet say why they think it’s laminitis as there are no typical symptoms? I’ve never heard of a laminitic that’s better on hard ground, not one that didn’t have even slightly raised pulses.

 

[OrangeAndLemon]

Did the vet say why they think it’s laminitis as there are no typical symptoms? I’ve never heard of a laminitic that’s better on hard ground, not one that didn’t have even slightly raised pulses.

She said it was in her mind as a likely option because he's overweight. He's been dieting for 2 years and is the fittest and healthiest he's ever been. Yes, his body condition score is still a firm 4 rather than a healthy 3 but he was a solid 5 before. I think its because she's seeing him on one day not as a progression.

If he was worse on hard I'd accept it more easily but he is avoiding soft ground at every opportunity. Like the OP, I'm worried we're missing something else.

She said it wasnt a nailed on diagnosis (wonder if the insurance company will see it that way at renewal time) and we'll follow up with lameness workshops if not right in a fortnight.

 

[southerncomfort]

Quick update.

Things have carried on pretty much in the same vein I.e sound for a few days then sore on a front foot and tripping before going sound again.

This morning she has raging heat in her left fore and the sole is very soft, so just to cover all bases I'm going to whack a poultice on for a couple of days. If nothing happens I'm going to book her in for x-rays.

 

[Pearlsacarolsinger]

Quick update.

Things have carried on pretty much in the same vein I.e sound for a few days then sore on a front foot and tripping before going sound again.

This morning she has raging heat in her left fore and the sole is very soft, so just to cover all bases I'm going to whack a poultice on for a couple of days. If nothing happens I'm going to book her in for x-rays.

What does your farrier think?

 

[southerncomfort]

What does your farrier think?

He came just a few days before I called the vet and confirms that he saw no indication of laminitis (or abcess). ?‍ However, the more I read about sub clinical laminitis it is possible that their weren't any visible signs.

Today she is completely sound again. Never known anything like it, hopefully the meds will kick in soon and stabilise things a bit.

 

[scats]

I have a mare who presents with lami like that. She had a toxic response to a wormer earlier in the summer and we struggled to get her back to normal afterwards. She would seem fine and then one day come out really sore and then within 12 hours she was seemingly fine again. I’ve realised now just how oddly low grade lami can present and *touches wood* we seem to have got control now. She’s lost a huge amount of weight but I have to micro manage everything she eats and be very aware of anything that can trigger her off- this includes stress/anything new happening on the yard etc.
She has EMS.

 

[southerncomfort]

I have a mare who presents with lami like that. She had a toxic response to a wormer earlier in the summer and we struggled to get her back to normal afterwards. She would seem fine and then one day come out really sore and then within 12 hours she was seemingly fine again. I’ve realised now just how oddly low grade lami can present and *touches wood* we seem to have got control now. She’s lost a huge amount of weight but I have to micro manage everything she eats and be very aware of anything that can trigger her off- this includes stress/anything new happening on the yard etc.
She has EMS.

Thanks scats. I was talking to another lady who said the same. She said initially she thought she was looking at navicular.

I'm going to speak to vets as she's hopping lame again today. I'm concerned that keeping off grass and soaking hay, plus metformin and prascend, hasn't had any impact yet.

 

[planete]

I had the same kind of problem with my old horse who definitely had Cushings but was medicated and managed for it. The vet maintained it was laminitis, the farrier that it was not. First vet did a crap set of x-rays which showed no rotation and not much else (just a black and white picture). A different vet x-rayed the feet again soon after revealing quite advanced arthritic changes in the front feet (black, white and various shades of grey). My farrier got the horse sound again with trimming and glue-on shoes.

 

[southerncomfort]

I had the same kind of problem with my old horse who definitely had Cushings but was medicated and managed for it. The vet maintained it was laminitis, the farrier that it was not. First vet did a crap set of x-rays which showed no rotation and not much else (just a black and white picture). A different vet x-rayed the feet again soon after revealing quite advanced arthritic changes in the front feet (black, white and various shades of grey). My farrier got the horse sound again with trimming and glue-on shoes.

This is it. I've had a niggling worry throughout that something else is going on as well as laminitis.

I think ultimately xrays are going to be the only way to set my mind at rest.

Glad to hear that your horse came sound again.

 

[scats]

Thanks scats. I was talking to another lady who said the same. She said initially she thought she was looking at navicular.

I'm going to speak to vets as she's hopping lame again today. I'm concerned that keeping off grass and soaking hay, plus metformin and prascend, hasn't had any impact yet.

My friends pony, same yard as me, was diagnosed with laminitis yesterday. Initially called out for hind limb lameness and a bit stiff in front that seemed to work off after a couple of trot ups. Farrier said not laminitis but lame behind. I’ve been a bit on and off about which leg I thought was lame but I definitely picked up on hind lameness and wondered if front was start of arthritis as he seemed to trot it off easily. No heat, so reaction to hoof testers, turns fine, faintly visible pulse if really searched for hard.
Vet came and thinks laminitis and hind leg issue as a result of compensating. Pony now in the box on soaked hay.
So many horses now aren’t showing typically for laminitis and I think it can be easily missed.