Thoughts for what to ask the vets to test for gratefully received!

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
So...

Grizzled old shetland's been recovering from laminitis since the spring. X-rays show gradual improvement over time. Vet has no answers for why it's taking so very very long for her to get fully better. I think there has to be a reason for it but the best he can come up with is doing the Cushing's test again (which was negative in the spring).

Concerns:
- It's been SIX MONTHS on low sugar tested haylage and shavings bed with box rest. Recently swapped over to straw and that made no difference, she's still improving at the same rate.
- She's been slowing down for two years. X-rays are clear in front for arthritis so vet suspects maybe been heading this way for laminitis gradually - yet in that time she's gone lame twice and spent time resting in the field, no muzzle, and IMPROVED. Surely if it was all due to low grade laminitis, a month off in August at grass would have given us a full blown episode, not a recovering pony?
- I manage all mine as if they are laminitis prone, all the time (because they're all natives). She started to want to slow down in full work (so 5-6 fast rides a week with plenty of cantering), on low sugar haylage, negligible low sugar feed, in the winter... not ideal 'getting laminitis' conditions.
- She's lame behind coming out of the stable in the mornings, until she's started to move a bit more. Being in so long made her really stiff, so we started taking her on gentle walks while I muck out (with vet approval). So moving as much as she wants to basically. In contrast to what I expected, she chose to move more each day and THE MORE SHE MOVES, THE FASTER SHE IMPROVES. Surely that shouldn't be the case? Anyway, when new pony arrived, she wanted to come on new pony's short 'getting used to traffic' walks down the road and back. In two and a half weeks she's gone from footy as anything and almost hobbling on the yard entrance stones/gravel, to only slightly footy on them. Vet said yesterday she's the brightest he's ever seen her, and the x-rays were still an improvement from last time, so the movement isn't hurting her recovery.

Needing the exercise makes me think EMS or something similar - but I'm getting nothing from the vet except 'give it time'. I can give it time, she can stay off the grass forever if needed, but it's no life being stuck in a tiny pen or stable day after day after day. At least now she has her little walks, but we really do need some answers. If it's not Cushing's, what else would explain her not improving at any reasonable rate despite low sugar/starch diet and being nice and slim (+ she's had all the rest and Bute recommended, correct deep bed etc etc). She shows no other signs of Cushing's - no fat pads, no curly coat, sheds normally etc.
 

Highmileagecob

Well-Known Member
Joined
24 December 2021
Messages
2,830
Location
Wet and windy Pennines
Visit site
Possibly Cushings, and a bit more digging than the standard ACTH test may be required. Could be EMS related - read up on type 2 diabetes, because that is basically what EMS is, and if a link to PPID can be established then it is likely that the pony's body is not shutting down the protein requirements as the colder weather halts the grass. This in turn keeps insulin levels high, which causes circulation problems in the lower limbs and feet, and you may also notice hindgut problems creeping in as the winter digestion is generally upset. Maybe check out the barefoot rehab sites to see whether any of the navicular and laminitis threads are relevant to your girl, as your rest and controlled exercise may be helping more than you think. Sorry if this sounds a bit jumbled, I am thinking aloud and remembering what I went through with my old cob - he started with a cough and a whole host of other issues cropped up. Fortunately, the EMS was easy to control once I got my head round what was happening. Exercise played a big part, as it is a recognised way of lowering insulin levels.
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
We've stuck to the steady walk out each day and gradually extended it, as she is keen to go further. Also started the Global Herbs LamiPro supplement. A week after starting the supplement, she walked out of the stable sound in the morning (instead of her usual first 5 mins of looking a bit sore). Same again today, so fingers crossed the improvement will stay! Proves to me it's hormonal/metabolic, as nothing else has changed. She even came for a little led walk with the other ponies two days ago and spent her time being cheeky (climbing banks, swishing through leaves, trying to nip the pony in front, tangling child/pony who were leading her up in her lead rope...) which must show she's feeling better!
 

Pearlsacarolsinger

Up in the clouds
Joined
20 February 2009
Messages
46,940
Location
W. Yorks
Visit site
I would ask for the TRH-Stim test for Cushings. It's much more likely to be accurate than the ACTH. We had a mare tested 3 times, each time 'within normal range' but each reading was higher than the last. We were suspicious of her symptoms and had the Stim test done, the result of that was *8 times* the normal maximum. She was put on Prascend immediately.
 

paddy555

Well-Known Member
Joined
23 December 2010
Messages
13,654
Visit site
are you basing that fact it is not cushings on the ACTH test? Mine tested at 17 and, as I didn't believe the results, he tested at 11 a couple of weeks later. He had full blown cushings. I put him on a trial of prascend and got a different horse.
I'm afraid I have little confidence in the ACTH test.

I would either do a TRH test or alternatively put on a trial of prascend for 3 months and see if there is any change.

I would have thought that "old" and laminitis were 2 major symptoms/factors of cushings
 

PinkvSantaboots

Well-Known Member
Joined
25 August 2010
Messages
24,026
Location
Hertfordshire
Visit site
I tested my mare 3 times 3rd time was borderline she had symptoms so they can give false results sometimes.

I tested Louis twice his 2nd one borderline but because his coat was so awful that year and didn't shed my vet prescribed Prascend his on half a tablet a day now.

I would test for ems and ask for Prascend just because of her symptoms, my mare had both but only just borderline results but she got laminitis so they put her straight on Prascend anyway.
 

paddi22

Well-Known Member
Joined
5 December 2010
Messages
6,361
Visit site
there was some evidence floating around about how restricted movement can cause laminitic effects in the feet due to low blood flow getting to the hooves? I'll try and find it and post a link. if motion on a surface is helping her I would keep doing that.
 

paddy555

Well-Known Member
Joined
23 December 2010
Messages
13,654
Visit site
there was some evidence floating around about how restricted movement can cause laminitic effects in the feet due to low blood flow getting to the hooves? I'll try and find it and post a link. if motion on a surface is helping her I would keep doing that.


would be interested to read that if you can find it. :)
 

tristar

Well-Known Member
Joined
23 August 2010
Messages
6,586
Visit site
there was some evidence floating around about how restricted movement can cause laminitic effects in the feet due to low blood flow getting to the hooves? I'll try and find it and post a link. if motion on a surface is helping her I would keep doing that.

my grandfather said sometimes movement could help
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
Thanks for the link! We’re realigned and have been sound in walk for a long time now - weeks… which is why I am guessing the vet said she could move.

So happy with the supplement though. She’s been becoming increasingly cheeky this week - nipped me asking for polos one day, argued with friend and had a kicking match, tried to boss friend and kids around, is being cheeky when led - much more her normal self! I have missed her mischievous Shetland antics…
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
Is there a reason she can't be turned out in a larger area now? Even if muzzled?

I was waiting for her buddy to eat the rest of the grass in her little area - have now recruited a bigger, greedier buddy who is doing a better job of clearing it all. Will then extend the straw base so nothing grows back and she will have a small paddock. Have just started leaving her out at night (rugged, with shelter) and she was much happier this morning. Small steps!
 

Orangehorse

Well-Known Member
Joined
25 November 2005
Messages
13,653
Visit site
my grandfather said sometimes movement could help

The dealer/farmer family we have known for years and years - bought horses from the old father, says that movement improves laminitis because the hoof is working correctly and helping the blood supply. Obviously not in the first inflamed stages.
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
2 months after starting LamiPro with no other changes. This morning she kept trying to trot when led, culminating in breaking free from small child and galloping up the hill in glee, bucking and squealing in joy. I would have got a video but was too stunned with happiness to move. She then arrived at the top where I was, cantered round a bit more then allowed herself to be caught. Bless her, she’s feeling so much better! She even jumped over the rail on the way back to her field.

Fingers crossed this continues, was so so good to see her feeling well and cheeky again.
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
Just updating… took another Cushings test (negative) and finally got her tested for EMS (positive with levels of 33). She is however cautiously sound now (thanks to the LamiPro!!), so vet has suggested work to get the levels down and moving the haylage/straw ratio to 40:60 rather than 50:50 as we were doing. Also suggested boots for this summer for the stony paths as there might be some residual soreness. So…two walks twice a day for the foreseeable future (at least the kids are old enough to do it themselves now!) and then gradually working towards fitness for full work. She leads beautifully so can be ponied around the countryside with the rest of us once she’s ready.

Vet also suggested clipping, but I have had a horse get lami from being too cold and I am not sure this is a plan for this year while she’s so recently improved. For next winter we will though.
 

Pearlsacarolsinger

Up in the clouds
Joined
20 February 2009
Messages
46,940
Location
W. Yorks
Visit site
Just updating… took another Cushings test (negative) and finally got her tested for EMS (positive with levels of 33). She is however cautiously sound now (thanks to the LamiPro!!), so vet has suggested work to get the levels down and moving the haylage/straw ratio to 40:60 rather than 50:50 as we were doing. Also suggested boots for this summer for the stony paths as there might be some residual soreness. So…two walks twice a day for the foreseeable future (at least the kids are old enough to do it themselves now!) and then gradually working towards fitness for full work. She leads beautifully so can be ponied around the countryside with the rest of us once she’s ready.

Vet also suggested clipping, but I have had a horse get lami from being too cold and I am not sure this is a plan for this year while she’s so recently improved. For next winter we will though.
I am glad that she is improving, albeit slowly. Was the Cushings test another ACTH test?
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
Shetlands….devious little self destructive creatures. She ate back the bush in her paddock (previously eating bush has not caused an issue), far enough that she could get to the tiny bit of grass behind it by the fence. Like, less than a feed bag in size patch of short grass shaded by the back of the bush she destroyed. Then…guess what? Ouchy feet with pulses in both. Aaaaaaaargh!

Especially since vet said the grass at this time of year would be safe (I didn’t agree at the time and definitely don’t now!).

More electric fencing has been put up…pony feeling MUCH better a mere 24 hours afterwards. Of course.

I am glad that she is improving, albeit slowly. Was the Cushings test another ACTH test?

Yes - vet says let’s attack the EMS and get her levels down, then do the fancy Cushings test if that doesn’t fix the laminitis . She has been started on Ertugliflozin now with the aim to sort that so we can get her sound enough to stand up to proper work. Then we can hopefully keep it down through exercise (and staying in the grass free paddock).
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
Levels have dropped to normal on Ertugliflozin after one month. So that’s good, and she’s comfier on her feet - but not comfy so we now have a pony with normal blood insulin whose front feet still hurt, and are warmer still than they should be.

Next stop the other Cushings test (levels so far 12.5 a month ago, 15 today on ACTH), then shoes…
 
Last edited:

SilverLinings

Well-Known Member
Joined
12 August 2017
Messages
3,170
Visit site
Levels have dropped to normal on Ertugliflozin after one month. So that’s good, and she’s comfier on her feet - but not comfy so we now have a pony with normal blood insulin whose front feet still hurt, and are warmer still than they should be.

Next stop the other Cushings test (levels so far 12.5 a month ago, 15 today on ACTH), then shoes…

I have only just read the thread, it sounds like you and the pony have had a difficult few months. It's great the levels have dropped and the pony has been able to move about a bit more, but I'm sorry to hear her feet are still not pain free. This isn't a great time of year for laminitis, is it possible she is snaffling grass that you're not aware? Does she graze in hand when your children take her out?
 

Gloi

Too little time, too much to read.
Joined
8 May 2012
Messages
12,281
Location
Lancashire
Visit site
Levels have dropped to normal on Ertugliflozin after one month. So that’s good, and she’s comfier on her feet - but not comfy so we now have a pony with normal blood insulin whose front feet still hurt, and are warmer still than they should be.

Next stop the other Cushings test (levels so far 12.5 a month ago, 15 today on ACTH), then shoes…
You can get good Shetland sized boots.
 

maya2008

Well-Known Member
Joined
10 August 2018
Messages
3,449
Visit site
This isn't a great time of year for laminitis, is it possible she is snaffling grass that you're not aware? Does she graze in hand when your children take her out?

Kids walk her round the woods - no grass there yet, or I lead her if we go off the yard. Her pen is electric fenced with tall wooden posts and multiple strands to ground level, doubly so in places and it’s mud and straw in the wooded bit so not much ever grew there even before we trashed it and covered everything in straw. Fencing is scary zappy and she cannot reach anything. Vet says she can’t get any thinner and has approved the diet. So nowhere to go there.

To the person who mentioned boots - we have boots but her turnout area is muddy when it rains and they cannot stay on 24/7. I am completely aware that shoes mask the problem but we have fixed everything there is to fix, tested and x-rayed and checked everything yet still…

So unless there’s a miracle with the Cushings test, the plan is to knowingly mask it all and give her some pain free time to enjoy life. Then we’ll see. At this point, there’s nothing medical left to fix, so this is the best option. She’s nearly sound now, but still not. Shoes might just tip her over the edge and let her have some fun. I won’t begrudge her that.
 
Last edited:

Pearlsacarolsinger

Up in the clouds
Joined
20 February 2009
Messages
46,940
Location
W. Yorks
Visit site
I would definitely push for the TRH-Stim test. Our Appaloosa mare tested well within normal range on the ACTH test several times but proved to be 8 times the acceptable top figure on the stim test.
 

Mary3050

Well-Known Member
Joined
6 February 2019
Messages
565
Visit site
I would do a ACHT test as suggested as cushings doesn’t always show up first off. Also if not already done check for EMS I had similar with one showing now progress then the test for EMS came back hight and the medication made a massive difference!
 
Top