tyner
Well-Known Member
On Jan 10, my horse was immobilized in his field, presenting with a classic laminitis stance. Pulses in 3 feet on initial presentation, but bounding in RF. Very painful on this foot, where there was also possible evidence of a puncture/bruise. He's holding it up. It takes a nerve block on RF to move from field, when its blocked he moves inside seemingly sound. LF is somewhat tender on hoof testers, but its taking a lot of weight from RF. Hinds not affected by hoof testers. Farrier points to an indentation in the sole of the hoof, between the frog and white line, suggesting the discomfort is possibly coming from an abscess or puncture. Vet says there is no question but laminitis. After 3 days inside, and hoof icing on vets advice, he moves comfortably in the box with no bute. I scratch my head thinking about what could have caused this. Bloods checked for EMS/insulin levels during the "acute" phase and found that his levels were much lower than those taken during the summer (taken as a reference measure-- he was not showing laminitis signs or footsoreness then). His Insulin levels in summer were in the upper third of the reference range so its something we were watching. His diet is as it should, everything he's ever had is under 10% combined sugar and starch, no concentrated feeds. There was no frost on the grass that day. His hay is analyzed, his pasture is fine too, he spent all summer and spring out with no issues. There was only a pulse on the RF. Xrays taken show no pedal rotation on any foot, his white lines are tight and there was no clear triggering factor for acute laminitis, except a course of oral steroids that he had taken without incident since December. He doesn't have the typical profile for a metabolic laminitis case, he's a 5 year old TB, not overweight, no crest, no hoof rings, etc.. He has pretty good feet, well balanced, angles not terrible, sole depth in front could be better but not horrible, hoof quality is good, no flaring or cracks. No stress or work on hard ground. No history of laminitis. I know there is a causal link with laminitis and corticosteroids, but it is statistically very small for the type of steroid he was on and for his body type, etc. However the vets that diagnosed him with "laminitis" said they are certain the steroid use was the triggering factor.
7 days after he presented with "acute laminitis" symptoms, after things started to get more comfortable, he started to get more painful on the RF hoof once again, despite all triggering possibilities taken away, so they brought him to the horsepital. Radiographs found a sub solar abscess under the point where the farrier found the earlier indentation in the foot. Vets said this abscess was a seroma from laminitis. A small opening was made in the sole and it started to drain, which they bandaged with a dry poultice. They kept him in the horsepital, keeping it dry as it continued to drain for a week. Warm tubs/wet drawing poultices were not used. An alternative draining track was not opened. His comfort levels were directly correlated with the abscess draining, as soon as it was opened he was immediately more comfortable and moved soundly. After the abscess stopped draining the hospital said he could come home, and to continue managing for laminitis. He was moving soundly at walk. Upon bringing him home, we found it was immediately clear the abscess was not done draining. I followed the vets advice to keep clean and dry. The residue was visible on the bandage for 5 more days. As the abscess closed, he became more and more uncomfortable on his foot. It seemed clear the abscess was not completely drained. I asked the vets to take more radiographs to locate the abscess so my farrier could open an alternative draining track.
The radiographs showed that the abscess was not completely drained, migrating from the sole to the white line. Sadly, the pictures also showed a deformation of the pedal bone directly under the spot where the farrier pointed out the possible puncture/bruise visible on the sole on the first day. He went back to the horsepital. The orthopedic surgeon who analyzed the radiographs suggested a likely connection between the defect in the sole and the damage to the pedal bone, maybe from trauma by a puncture injury or from a bacterial infection. He does not think the abscess is related to laminitis, and has a hard time believing my horse has laminitis as there is no laminar separation, no rotation, and no triggering factors for it, besides the very small statistical possibility of acute laminitis from the cortersteroid treatment. He suggests trauma to the sole likely caused the defect, bacteria entry, hoof pain, and the resulting abscess. The other vets at the practice who diagnosed laminitis, and oversaw his treatment in the horsepital for two weeks (who did not properly manage the abscess by not allowing it to drain properly thus allowing the resulting infection to take hold longer..) continue to say the laminitis diagnosis is correct.
As I wait for the MRI results to come back to see if the infection has reached the pedal bone, my question remains, does this horse have laminitis?
All signs for me point to no. On the first day it certainly looked that way, looking at the painful presentation. But putting it all together, a puncture and related abscess seems much more plausible, given the radiographs, the pain concentrated in the RF and clear lack of contributing factors. The farrier assessment and the orthopedic specialist's assessment seem sound. But the initial vets keep saying his pain is laminitis aggravated from the steroid treatment. They can't point to anything specific just a confluence of things together that would trigger acute laminitis, but it just seems so unlikely, when you count the small statistical likelihood and the absence of other laminitis signs. A seroma from laminitis would likely present elsewhere. The LF hoof pain and pulses my farrier suggests is due to taking more support from the painful opposite hoof-- solar bruising is visible there. I called the laminitis diagnosis into further question when the vets suggested putting regular keg shoes on him to improve his comfort -- which makes no sense at all for a laminitic horse-- 4 farriers were aghast at the suggestion.
If it is laminitis, what would be the definitive proof, if you have no rotation or no apparent inflammation/separation in the laminae? Is it possible to prove?
Acute Laminitis pain and a sole puncture wound, I imagine could present very similarly. But after two weeks in the hospital, wouldn't the difference been clear? It is frustrating to think that he was in the hospital for all that time with a wound and grumbling abscess brewing that was not treated aggressively or investigated properly, allowing infection to spread. He's now back in the hospital with a suspected infection in the bone. Despite the new radiographs, the initial vets attachment to the laminitis diagnosis continues. Why is this, is it denial, an attempt at self-preservation, or does admitting a changed diagnosis appear as a mistake, making them liable for something professionally? Or does my horse really have laminitis and I am the one that is refusing to admit reality and too ignorant to recognize laminitis when its staring me in front of the face? I've challenged myself on this final question and keep coming up with the same answer-- no, but I don't have a vet degree. And thats the difference-- the initial vets that diagnosed "laminitis" and oversaw his first two weeks in the hospital are some of the lead professors at one of the UK's top veterinary teaching hospitals.
I'm sad for all my horse has gone through. These past weeks have been awful and he's been so incredibly patient. I've trusted his care and welfare to these professionals, yet I am losing confidence. I feel the vets are not being transparent with me, or looking at all the facts of my horse's case. What am I not seeing here?
7 days after he presented with "acute laminitis" symptoms, after things started to get more comfortable, he started to get more painful on the RF hoof once again, despite all triggering possibilities taken away, so they brought him to the horsepital. Radiographs found a sub solar abscess under the point where the farrier found the earlier indentation in the foot. Vets said this abscess was a seroma from laminitis. A small opening was made in the sole and it started to drain, which they bandaged with a dry poultice. They kept him in the horsepital, keeping it dry as it continued to drain for a week. Warm tubs/wet drawing poultices were not used. An alternative draining track was not opened. His comfort levels were directly correlated with the abscess draining, as soon as it was opened he was immediately more comfortable and moved soundly. After the abscess stopped draining the hospital said he could come home, and to continue managing for laminitis. He was moving soundly at walk. Upon bringing him home, we found it was immediately clear the abscess was not done draining. I followed the vets advice to keep clean and dry. The residue was visible on the bandage for 5 more days. As the abscess closed, he became more and more uncomfortable on his foot. It seemed clear the abscess was not completely drained. I asked the vets to take more radiographs to locate the abscess so my farrier could open an alternative draining track.
The radiographs showed that the abscess was not completely drained, migrating from the sole to the white line. Sadly, the pictures also showed a deformation of the pedal bone directly under the spot where the farrier pointed out the possible puncture/bruise visible on the sole on the first day. He went back to the horsepital. The orthopedic surgeon who analyzed the radiographs suggested a likely connection between the defect in the sole and the damage to the pedal bone, maybe from trauma by a puncture injury or from a bacterial infection. He does not think the abscess is related to laminitis, and has a hard time believing my horse has laminitis as there is no laminar separation, no rotation, and no triggering factors for it, besides the very small statistical possibility of acute laminitis from the cortersteroid treatment. He suggests trauma to the sole likely caused the defect, bacteria entry, hoof pain, and the resulting abscess. The other vets at the practice who diagnosed laminitis, and oversaw his treatment in the horsepital for two weeks (who did not properly manage the abscess by not allowing it to drain properly thus allowing the resulting infection to take hold longer..) continue to say the laminitis diagnosis is correct.
As I wait for the MRI results to come back to see if the infection has reached the pedal bone, my question remains, does this horse have laminitis?
All signs for me point to no. On the first day it certainly looked that way, looking at the painful presentation. But putting it all together, a puncture and related abscess seems much more plausible, given the radiographs, the pain concentrated in the RF and clear lack of contributing factors. The farrier assessment and the orthopedic specialist's assessment seem sound. But the initial vets keep saying his pain is laminitis aggravated from the steroid treatment. They can't point to anything specific just a confluence of things together that would trigger acute laminitis, but it just seems so unlikely, when you count the small statistical likelihood and the absence of other laminitis signs. A seroma from laminitis would likely present elsewhere. The LF hoof pain and pulses my farrier suggests is due to taking more support from the painful opposite hoof-- solar bruising is visible there. I called the laminitis diagnosis into further question when the vets suggested putting regular keg shoes on him to improve his comfort -- which makes no sense at all for a laminitic horse-- 4 farriers were aghast at the suggestion.
If it is laminitis, what would be the definitive proof, if you have no rotation or no apparent inflammation/separation in the laminae? Is it possible to prove?
Acute Laminitis pain and a sole puncture wound, I imagine could present very similarly. But after two weeks in the hospital, wouldn't the difference been clear? It is frustrating to think that he was in the hospital for all that time with a wound and grumbling abscess brewing that was not treated aggressively or investigated properly, allowing infection to spread. He's now back in the hospital with a suspected infection in the bone. Despite the new radiographs, the initial vets attachment to the laminitis diagnosis continues. Why is this, is it denial, an attempt at self-preservation, or does admitting a changed diagnosis appear as a mistake, making them liable for something professionally? Or does my horse really have laminitis and I am the one that is refusing to admit reality and too ignorant to recognize laminitis when its staring me in front of the face? I've challenged myself on this final question and keep coming up with the same answer-- no, but I don't have a vet degree. And thats the difference-- the initial vets that diagnosed "laminitis" and oversaw his first two weeks in the hospital are some of the lead professors at one of the UK's top veterinary teaching hospitals.
I'm sad for all my horse has gone through. These past weeks have been awful and he's been so incredibly patient. I've trusted his care and welfare to these professionals, yet I am losing confidence. I feel the vets are not being transparent with me, or looking at all the facts of my horse's case. What am I not seeing here?
