Weird laminitis

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soloequestrian

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This is happening to the horse of a friend of a friend, so I am getting the info very much secondhand.... there is one vet involved already, a very good farrier, and soon to be another very good vet, however I thought I would post on here just to see if anyone has been through similar and might say 'but have they tried x or tested for y' because things are not looking good at the moment.
Highland pony, already quite fat, let out onto good grass just after the recent rain and sunshine, came down with (seemingly) mild laminitis. Immediately removed from grass, though on large ration of hay and normal feed as owner didn't think the laminitis was linked to the obesity. Just don't ask. Horse blood tested, and liver enzymes came back odd - apparantly indicitive of insult around a week previously. Feet x-rayed several days later, and apparantly pedal bone of one has 'dropped' 15mm (where from and to, we wonder, but still obviously something very wrong). The biggest thing though is that even now, having been seen by vet and farrier and on every drug known and finally on reduced rations, things are not improving, and actually seem to be deteriorating. There is a suggestion that something else is going on, that either triggered the lami or has resulted from it, but no suggestions, as far as we know, of what that might be.
So, garbled I know, but if anyone has experienced anything similar it would be really useful to know.
Thanks!
 
Was the horse wormed, particularly with a long-acting wormer like moxidectin or praziquantel? It can set them off.
 
Depending on the regime and how it is being implemented - not all regimes are helpful. Some advice regarding diet for example and the stress of the regime can make some horses worse.
 
When you say the pedal bone has dropped 15mm, does that mean the founder distance is now 15mm, or that it is 15mm greater than previous x-rays? Neither is great but the latter would be disastrous. There has been some reasonably solid research showing that laminitics with >15mm founder distance have a much poorer prognosis. It is possible that there has been such extensive laminar separation that even small amounts of movement while on box rest are enough to trigger further acute attacks of inflammation.
What drugs is the pony on? I would suggest that Metformin is absolutely essential, and at the high dose rate given three times daily (15mg/kg). If things are going poorly I would also be using trilostane (Vetoryl). Depending on pony's age then pergolide would also be sensible. If things are urgent then treat now test later is a valid approach.
There can be very variable individual sensitivities to different painkillers used also. For example, I can think of laminitic horses that improved with bute, but went backwards on Metacam, and vice versa. I would consider a changeover from one to another, with no time off in between necessary. Personally I have had some success with flunixin (finadyne) in extremely painful laminitics.
What is being done in terms of foot support? Shod or barefoot? Any frog supports in place?
Does the pony have extremely hard hoof capsules? If so then a dorsal hoof wall resection may be appropriate. I have had some great successes (and some total failures) with the technique, but it seems to work best when the capsule is extremely non-pliable - perhaps because the inflamed laminae have no room into which to swell.
I would double check that the hay is being soaked (I would do minimum of 12h then rinsed) as well as just reduced amount. In terms of hard feed I would give no more than a low calorie balancer, maybe with some unmolassed chaff if needed to hide any drugs.

With regard to the liver enzymes, could you find out which enzymes were altered, and what the numbers were? (GGT and AST are most commonly measured on routine biochemistry). Was there any abnormality of albumin or globulin level? Were bile acids measured? There is no way of "dating" a liver insult based on liver enzyme levels alone. Were the bloods taken before or after pain killers had been given? Bute can often cause minor enzyme increases with no actual problem.
 
If the hay isn't being soaked please suggest it is soaked (min one hour up to overnight) and rinsed. This will help with weight loss as well.
Hope the pony improves.
 
When my horse had lami a few years back i rang the Laminitis Trust and they told me how much and what to feed etd, he was only allowed 6lb of hay which isn't much so I triple netted it so it took longer, they need to weigh how much hay they are giving and soak it
 
Lots of good suggestions here - when Pasha was very bad we used styrofoam pads and they helped immensley - the farrier came out and cut them accordingly to offer the most appropriate support for him according to the x-rays.

I agree soaking the hay is a very good idea as is Metformin, even if it's a short term solution just to help the pony turn the corner.

Given the bloods, I would also put the pony on a good liver tonic (Global Herbs Restore is very good) and as suggested cut out all feed other than vits/mins and unmollassed chaff.

I really hope the pony does start to improve x
 
My horse had seemingly 'mild' laminitis and went from here to PTS in 2 months as pedal bone rotated alarmingly fast and was just above sole, with huge gas pockets, horse aged 8 diagnosed with Cushings. Was not overweight, 16vet fab and I stuck rigidly to rules; box rest, weighed/soaked hay. Horse not good at box rest - not good for keeping adrenalin levels down. so Cushhings check maybe, if not already done? Heartbreaking for all concerned and i hope the news your friend's friend has is better
 
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