Weight bearing laminitis

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Does anyone have any experience/advice on this please? My 24 year old gelding has been stiff all summer, initial vet said given his age and that he loosened up reasonably quickly when walked out of his box that it was probably arthritis, and gave me bute for when he was particularly bad/before farrier etc. Over summer his condition stayed generally the same, he?s kept on very restricted grazing and was out overnight in a small paddock. Two weeks ago he started to look a lot more lame behind, particularly on his right hind. Got a different vet out, nerve blocked his right hind between Pastern and hock, which gave some improvement but really not much at all. Two days later he went into the vets for a lameness workup, and x-rays showed pedal bone rotation in both fronts (LF 3.5 degrees, RF 5.5 degrees) and his left hind (13 degrees) but none in his visibly lame right hind. The vets also x-rayed his joints in his right hind and found nothing at all, no arthritis whatsoever. Came home with a prescription for box rest, bute and a remedial farrier for a trim this week and heart bars in a couple of weeks time. Farrier came today and basically said if we can?t resolve the problem in his right hind, which he rests constantly, then the prognosis for recovery of his left hind (with the 13 degree rotation) is really poor as he has weight in it all the time. I am arranging for the vet to come again this week and will be asking for more advice but I?m feeling quite dejected by it all and I?m not really sure what to ask the vet or how to proceed 😞. Really worried that unless we can find some miracle cure for the right hind his pedal bone will come through his sole on his left hind and I don?t want him to be in any more pain than he?s already in. He?s quite happy in himself, enjoying his big bed and tiny haynets. Any advice welcome. I?m currently just treating it like any other laminitic episode as I?m not sure what else to do 😞
 

JillA

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Have a read on here, particularly about remedial trimming and underlying metabolic issues http://www.thelaminitissite.org/ The trimming protocols on there have a better success rate than something like heart bar shoes.
Has your vet tested for Cushings? And is your farrier prepared to discuss with you and in possession of the xrays? Personally I would always prefer a really good trimmer, since they are more open to discussion and let you know what they are doing and why - IME farriers think they know it all and don't discuss. You need to both be on the same page and treat the whole horse as well as getting his feet balanced and right.
 

SEL

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It is probably worth having a physio out as well. He could just be resting that leg because he's sore and compensating somehow - so its not actually that leg which is the problem.
 
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Have a read on here, particularly about remedial trimming and underlying metabolic issues http://www.thelaminitissite.org/ The trimming protocols on there have a better success rate than something like heart bar shoes.
Has your vet tested for Cushings? And is your farrier prepared to discuss with you and in possession of the xrays? Personally I would always prefer a really good trimmer, since they are more open to discussion and let you know what they are doing and why - IME farriers think they know it all and don't discuss. You need to both be on the same page and treat the whole horse as well as getting his feet balanced and right.
Thank you for replying!

The farrier I?m using is one a friend has used for a long time, he has been very proactive with contacting the vet, reviewing the x-rays etc (had them on his phone whilst he was trimming!) and was happy to discuss what he was doing and the plan of action with me in quite a lot of detail, so so far I am happy with what he is doing, so I think I am on the right track with him! I completely agree that communication and us all being on the same page is vital. He did say today that he feels the vets need to do more investigation, as he can only work with the information he has and there?s clearly more going on than just the laminitis. I will rediscuss the next steps regarding heart bars or trimming etc when he comes next. I?d rather try trimming to be honest but I?ll consider all options.

He was tested for Cushings in December and came back below the threshold, I asked the vet about testing again and they suggested we wait until November time, but I will ask again this week (and about the EMS test, but he basically is treated like an IR horse anyway in regards to feed and management).

I?ve been stalking the laminitis site over the years but will brush up on my remedial trimming knowledge there!

Hoping I?m not fighting a losing battle 😞
 
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It is probably worth having a physio out as well. He could just be resting that leg because he's sore and compensating somehow - so its not actually that leg which is the problem.
Thanks for replying 😊

I had a physio booked for Sunday but we?ve postponed it as she was concerned about moving his legs around too much with the degree of rotation in his hind. I could try another physio perhaps?! You are right that the cause and effect could be backwards - the laminitis could be caused by the lameness in his right hind, or the lameness in the right hind could be caused by compensating for the laminitis. Not sure how we can know but if it is the latter I?m not sure how we can fix it either 😞
 

be positive

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Did they do more blocks on the off hind to find the area causing trouble as it would help if you knew if it was the foot or not, is there any chance it could be an abscess or has that been ruled out?

The physio is right to be cautious about treating him at this stage without a veterinary diagnosis as it could do more harm than good.
 
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Did they do more blocks on the off hind to find the area causing trouble as it would help if you knew if it was the foot or not, is there any chance it could be an abscess or has that been ruled out?

The physio is right to be cautious about treating him at this stage without a veterinary diagnosis as it could do more harm than good.
Thanks for replying 😊

The vet who did the two block block on Tuesday suggested four block blocks be done, but the vet on the day went straight to x-Ray as he could see he was uncomfortable on all four feet, and with the rotation they found they didn?t proceed to blocks, but I think blocks are going to have to be the next stage as we definitely need to establish where the pain is in that right hind.

In regards to abscesses, the vet who came out Tuesday, the vet who saw him on Thursday and the farrier who came today all used the hoof testers on both hinds to check for abscesses and couldn?t find anything. The farrier also thought abscess as from seeing how lame he is he would expect it to be an abscess or a fracture, but nothing too concerning from the hoof testers and nothing showing on the x-rays. He?s had an abscess before, years ago, in the same leg and I honestly thought he had broken it. He?s not quite that bad this time but still clearly very sore. Not sure if there is another way of determining an abscess?! I?ve not objections to chucking a poultice on to see if it helps but nobody has suggested it might yet!
 
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Don't know if my recent experience with laminitis will help you but it might be worth a try. My laminitic EMS cob who was very lame on both fronts(worsening rotation) with 2 danilon/day had casts fitted on both fronts(she's never been shod) and walked away more or less sound. She's off the danilon completely. Obviously its early days but it means she should soon be able to have graduated, gentle walking exercise to hopefully get the EMS under control. Good luck anyway.
 
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Probably should add that he isn?t an ideal candidate for nerve blocks, he?s had them done twice in the time I?ve had him, and his huge legs and rhino-like skin mean that the needles often snap, or the anaesthetic doesn?t kick in. The vet on Tuesday double doses the LA and the one on the outside of the leg appeared to kick in within a few minutes, but the one on the inside failed the pen poking test at 5, 7, 10, 12 and 15 minutes. By this point though she had already suggested he was best off going into the clinic as there was only so much we could do at the yard.
 
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Don't know if my recent experience with laminitis will help you but it might be worth a try. My laminitic EMS cob who was very lame on both fronts(worsening rotation) with 2 danilon/day had casts fitted on both fronts(she's never been shod) and walked away more or less sound. She's off the danilon completely. Obviously its early days but it means she should soon be able to have graduated, gentle walking exercise to hopefully get the EMS under control. Good luck anyway.
Thanks for replying! That?s really interesting and glad to hear you are making progress! Apologies if this is a really stupid question but what do you mean by casts? Do these go on the hooves like boots? What are they made from? It sounds like this could be an option for us and something I could discuss with the vet & farrier 😊
 
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Have a look at www.equicast.com . Don't think we can buy them off the shelf here but a vet/trimmer/farrier should be able to. My cob had the dental impression material applied to the back of her hoof first then the cast was wrapped on. I have to say it was not my vet or farrier who suggested this but a brilliant vet/trimmer who I had contacted in desperation for a 2nd opinion. I know one size does not fit all but its good to have options.
 

JillA

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Get him tested now - December and November are in the low season, there is a seasonal rise in ACTH levels in summer. Quite apart from the false negatives often obtained he could be low in winter and through the roof in summer. Prascend is a good management tool and should resolve any problems if he IS Cushingoid.
Is your vet an equine vet???
 

Leo Walker

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Doe he have any sinking of his pedal bone or is it just rotation?

I kept my 6yr old going for nearly 4 months. He looked bright and happy in himself right up until the end pretty much. I called time as his pedal bone was sitting on his sole and was only 5mms from coming through. Knowing what I know now if there was ever another horse with lami that had sinking I'd PTS in the beginning. The prognosis is pretty poor once the pedal bone does that.

At 24 I would definitely be thinking the same thing, esp with issues with the other limb and already being managed as EMS etc.
 
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Have a look at www.equicast.com . Don't think we can buy them off the shelf here but a vet/trimmer/farrier should be able to. My cob had the dental impression material applied to the back of her hoof first then the cast was wrapped on. I have to say it was not my vet or farrier who suggested this but a brilliant vet/trimmer who I had contacted in desperation for a 2nd opinion. I know one size does not fit all but its good to have options.
Thank you for this, I will have a look around the site and have a chat with my vet & farrier 😊 so glad this worked for you!
 
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Get him tested now - December and November are in the low season, there is a seasonal rise in ACTH levels in summer. Quite apart from the false negatives often obtained he could be low in winter and through the roof in summer. Prascend is a good management tool and should resolve any problems if he IS Cushingoid.
Is your vet an equine vet???
Vet is definitely an equine vet! I think the reasoning behind waiting was that he was tested eight months ago and below the threshold then, but I can get him retested this week when the vet is out, it was my understanding that they just adjusted the thresholds for seasonal rises and they drop again in November? As he is on box rest he won?t be affected by the changes in the grass currently, so I think the vet felt I would be more likely to get a positive result with the lower thresholds but to be honest I?ve been so focused on the rotation and lameness I?ve possibly misunderstood that.
 
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Doe he have any sinking of his pedal bone or is it just rotation?

I kept my 6yr old going for nearly 4 months. He looked bright and happy in himself right up until the end pretty much. I called time as his pedal bone was sitting on his sole and was only 5mms from coming through. Knowing what I know now if there was ever another horse with lami that had sinking I'd PTS in the beginning. The prognosis is pretty poor once the pedal bone does that.

At 24 I would definitely be thinking the same thing, esp with issues with the other limb and already being managed as EMS etc.
Thank you for replying. I am essentially hitting the same conclusion as you - even if we can get the Cushings meds in him and heart bar shoes on, whatever the problem is in the right hind is just going to continue to make the left hind rotation worse and very few lamenesses that are that pronounced are solved overnight.

The hind with the 13 degree rotation has 1.1mm of sole, which the vets said was 9mm less than the other hind but the farrier said that?s just because the other hind hasn?t had the sole pared away as much by the farrier. So not ideal but we are still in the 1cm+ range at the moment.

I think I am hoping for a miracle but I am coming to terms with the fact that isn?t very likely 😞
 

Leo Walker

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It is a hideous thing to go through. I was the same with regards to the miracle. Then I came down one day and caught him when he thought he was alone and he looked so miserable. I had him PTS the next day. It was heart breaking but as time went on it was clear it was the right thing to do. People think lammi is always treatable, but actually it really isnt in an awful lot of cases :(
 

JillA

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Vet is definitely an equine vet! I think the reasoning behind waiting was that he was tested eight months ago and below the threshold then, but I can get him retested this week when the vet is out, it was my understanding that they just adjusted the thresholds for seasonal rises and they drop again in November? As he is on box rest he won’t be affected by the changes in the grass currently, so I think the vet felt I would be more likely to get a positive result with the lower thresholds but to be honest I’ve been so focused on the rotation and lameness I’ve possibly misunderstood that.
How very odd - sounds like your vet is seeking a negative result, rather than a positive one needing treating. Does the horse have any other symptoms - fat pads, a crest, patchy hair loss, lethargy? I don't think the seasonal rise is grass related, I think it is daylight hours and warmth that kicks it off
 
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It is a hideous thing to go through. I was the same with regards to the miracle. Then I came down one day and caught him when he thought he was alone and he looked so miserable. I had him PTS the next day. It was heart breaking but as time went on it was clear it was the right thing to do. People think lammi is always treatable, but actually it really isnt in an awful lot of cases :(
I'm certainly being realistic about it, and I'm not going to let him get worse but hopefully we can help him get better. The next vet visit will hopefully reveal more, I am prepared to make the call to PTS if the prognosis is really poor but the vets so far are indicating there is still something to go on, so will keep fighting until that changes. I'm so sorry you didn't have a better outcome, and it is a difficult call to make regardless of the circumstances, but your boy was so lucky to have an owner that gave him a dignified end.
 
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How very odd - sounds like your vet is seeking a negative result, rather than a positive one needing treating. Does the horse have any other symptoms - fat pads, a crest, patchy hair loss, lethargy? I don't think the seasonal rise is grass related, I think it is daylight hours and warmth that kicks it off
I'm not sure what result the vet was seeking really but I did indicate to the vet that I want a positive Cushing's result in all honesty as it at least gives me something to medicate, as currently all I can give him is Bute which doesn't seem to be making a huge amount of difference.

He is cresty, but always has been (I got him at 7 and even when in full work he never lost his crest), he has been tested for Cushings four times in his lifetime, each time in summer bar the last one (which was in December) and has always been below the threshold. He has always held his coat but it isn't long, thick or curly, and not patchy. He's a cob so very hairy anyway! Definitely urinates a lot. No pot-bellied appearance. Not lethargic at all. Not showing any signs of getting sweaty at the moment, but has always sweated up when worked hard but not when worked lightly (ie. a gallop up a hill would get him sweaty but not walk and trot work).

I will push the vet to test again when they visit this week!
 
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Now would be a good time to test for ppid/cushings, we are in the seasonal rise now, it dips back come November..you can always test for ems too as they can go hand in hand..
Thanks for replying! The vet is attending at 2pm on Monday so I will get the Cushing's test done then. I will hold off on the EMS test for now as I fear it will be difficult to get the 12hr starving done. He will be having further vet visits in the next few weeks so I will see if I can get a morning appointment and get the EMS test done after he has been starved overnight.
 

ester

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Essentially I think unless you test now you will be wondering until November. I?ve tested mine over several years (now 25) and never even been borderline. I agree that it?s helpful if it comes up as gives you something to treat!

I will say that I have currently made a decision that if he gets lami now I will call it a day, in part due to his other issues but mostly because it?s so very painful and it would be impossible to improve management without compromising his quality of life (already kept on a track system etc).
 
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Does anyone have any experience/advice on this please? My 24 year old gelding has been stiff all summer, initial vet said given his age and that he loosened up reasonably quickly when walked out of his box that it was probably arthritis, and gave me bute for when he was particularly bad/before farrier etc. Over summer his condition stayed generally the same, he?s kept on very restricted grazing and was out overnight in a small paddock. Two weeks ago he started to look a lot more lame behind, particularly on his right hind. Got a different vet out, nerve blocked his right hind between Pastern and hock, which gave some improvement but really not much at all. Two days later he went into the vets for a lameness workup, and x-rays showed pedal bone rotation in both fronts (LF 3.5 degrees, RF 5.5 degrees) and his left hind (13 degrees) but none in his visibly lame right hind. The vets also x-rayed his joints in his right hind and found nothing at all, no arthritis whatsoever. Came home with a prescription for box rest, bute and a remedial farrier for a trim this week and heart bars in a couple of weeks time. Farrier came today and basically said if we can?t resolve the problem in his right hind, which he rests constantly, then the prognosis for recovery of his left hind (with the 13 degree rotation) is really poor as he has weight in it all the time. I am arranging for the vet to come again this week and will be asking for more advice but I?m feeling quite dejected by it all and I?m not really sure what to ask the vet or how to proceed 😞. Really worried that unless we can find some miracle cure for the right hind his pedal bone will come through his sole on his left hind and I don?t want him to be in any more pain than he?s already in. He?s quite happy in himself, enjoying his big bed and tiny haynets. Any advice welcome. I?m currently just treating it like any other laminitic episode as I?m not sure what else to do 😞
Right hind limb lameness can be caused by hind gut ulcers as the colon is on that side ,but may be worth asking your vets opinion .
 
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Essentially I think unless you test now you will be wondering until November. I’ve tested mine over several years (now 25) and never even been borderline. I agree that it’s helpful if it comes up as gives you something to treat!

I will say that I have currently made a decision that if he gets lami now I will call it a day, in part due to his other issues but mostly because it’s so very painful and it would be impossible to improve management without compromising his quality of life (already kept on a track system etc).
Thank you for replying. Lami is just rotten and I completely understand your decision to PTS rather than treat; in a lot of ways I wish I was strong enough to make that call now myself but rightly or wrongly I just can't yet. He is my first (and only) horse so I've not been in this position before, and as much as I am worried about leaving it too long, I feel I need to know what the problem is, and that it is beyond treatment without compromising his quality of life, before I can make peace with making the call. Hopefully I can get an answer from the vets soon so I can move forwards in the right direction, whichever direction that is.

You are absolutely right about me just wondering until November, it doesn't really achieve anything to wait and there isn't really a good reason not to test now. Vet comes on Monday so we can get the blood drawn then. If we can get him on Prascend and help with the laminitis side of things we will be narrowing the list of problems. It certainly won't 'fix' him if you see what I mean, but happy to make slow progress as long as we are making some progress!

I am going to have a frank chat with the vet on Monday regarding the long term prognosis. I have always said that I will let him go before I let him suffer (as I am sure most horse owners would!) and it still seems like it is early days in a lot of ways but there also doesn't seem to be an end in sight which is far from ideal. Long term box rest for a 24 year old is pretty pants to be honest - so far he seems to be coping okay with it but we are only on day seven :(.
 

ester

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I do totally get that, mine is first and only too, I know it is also a damn site easier to make those decisions.

In part it is because I?m 200 miles away so ?what if? discussions have been had and realistically because he is likely somewhat metabolic now lami is quite high on that what if list. He?s never had it even though he was grossly overweight when purchased. But it also depends on personal experience, I?ve seen far too many small ponies expected to cope with it, sometimes year after year.
 
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I do totally get that, mine is first and only too, I know it is also a damn site easier to make those decisions.

In part it is because I?m 200 miles away so ?what if? discussions have been had and realistically because he is likely somewhat metabolic now lami is quite high on that what if list. He?s never had it even though he was grossly overweight when purchased. But it also depends on personal experience, I?ve seen far too many small ponies expected to cope with it, sometimes year after year.
It is an awful condition, my horse first came down with it in 2011 when he was at an equine college whilst I was at uni (fed like a racehorse, which he certainly is not) and through careful management he fortunately hasn?t had it since then. I?m not entirely convinced it is diet related this time round as his management is pretty spot on but if he needs that Prascend then that could be the issue. Seemed a little happier on his sore right hind so possibly we are making some progress but it is certainly too early to tell.
 

Bertolie

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I will hold off on the EMS test for now as I fear it will be difficult to get the 12hr starving done. He will be having further vet visits in the next few weeks so I will see if I can get a morning appointment and get the EMS test done after he has been starved overnight.
I had my mare tested for EMS yesterday. Diagnosed with laminitis at the end of June. Rotation in both fronts with some sinking. On a strict diet to lose weight but its not working so we arranged to test for EMS. We did the Karo Light test rather than glucose and she only needed to be fasted for 3-6 hours. She did have the appearance of a child that had just consumed a tube of blue smarties 😂 and it did take more sedation than usual to take the xrays we had planned! Just have to wait for results now.
 
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OP, if the ACTH test still comes back within normal range, ask for the TRH test. We were suspicious that one of ours had Cushings, she kept testing 'within normal range' on ACTH test but when vet did TRH test, she was *eight* times over the usual limit. Unfortunately by that time the Prascend didn't make so much difference.
 
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