WWYD - EMS and low grade laminitis

[MrsNorris]

Horse is 19, he's slightly overweight and has EMS. He's out overnight from 7pm til about 7:30am on a sparse field and muzzled, in all day on high fibre horsehage. He has been in a constant state of low grade laminitis since around the start of May, digital pulses palpable though not bounding, not showing obvious signs of laminitis but slightly footsore in front, some days better, some worse, no real pattern. Legs and sheath fill a lot whilst he's in, go down again when he's moving.

I cannot get any weight off him at the moment as I can't exercise him, and his insulin sensitivity and LGL is not going to improve until I can start exercising and get his weight down. Feels a bit like a catch 22.

He was last tested for PPID a few years ago and deemed not to have it after a prascend trial. Vet thinks it unlikely that he has developed it now, as he has been the same for a good few years with no deterioration. He has never had full-blown laminitis and his feet look perfect, none of the tell-tale signs.

He's on livery, so no option for a grass-free lifestyle at the moment, I have his stable or the field. There are about 11 horses on 8 acres though, so hardly any grass really, but still enough to trigger his response despite being muzzled most of the time.

Any ideas on what I can try next, bar 24/7 in his stable which would make him completely miserable. Thanks

 

[Michen]

I think 24/7 stabling sounds like your only option, and gradually increase turnout once he's sound and in work. Starting with an hour a day and building up?

 

[elsielouise]

You could try closing the hole of his muzzle for up to three hours at a time. He can then go out and mooch around with ha field mates but not eat. Then take it off for a few hours/ bring him in etc and repeat. We did this with ours on her only ever bout and she was certainly happier wandering around the field than stuck in. You can buy a leather pad from I think ' best friend' muzzles that just closes the hole.


Also perhaps 12 hours is just too long? Ours is fully recovered now but I never leave her out more than 8 hours and then yard her for the rest of the time. We have lots of very rich grass but ours seems to cope. She is also worked every day tho.

The management is intensive and a year on still is a consideration but it has improved. We put ours out at first with the hole closed for three hours and then yarded building up to the 7-8 hours. I roped in friends and family to bring her in and out/ remove pad etc.

I don't think there are any other choices if you can't dry track etc but for me it was and is about quality of life.

 

[be positive]

This article taken from another thread makes interesting reading, I have a mare in being treated for PSSM getting alcar and vit e daily and have noticed her rather lumpy crest has gone recently, they are suggesting using the same supplements for IR horses along with the usual management, it may be worth looking into it for yours, being in 24/7 is no life for any horse unless it is very short term and essential.

http://equine.uckele.com/Resources-Articles/cat/drkellon/post/ir-horse/

 

[WandaMare]

You could ask your vet about giving him Metformin, it helps to stabilise their insulin levels and can be useful for EMS horses. Its definitely worth a try, some people say no effect but it worked well for one of mine and others that I have read on here.

If he were mine I would do a few days in, not nice for them but even a few days would help. Then I would let him out for less hours Maybe a couple of hours in the morning and a couple of hours again in the evening and see how that goes. If he seems better then build it up to overnight again but maybe put him out as late as you can and bring him in early.

The only other thing I can think of is walking him in hand but I wouldn't do that until his symptoms have gone. I was told that even as little as 20 mins exercise a day helps to boost their metabolism which again helps to stabilise the insulin levels.

 

[MrsNorris]

I was afraid that might be the only real option Michen, but he gets so miserable in all the time, there's no-one else in at all so he'd be completely alone and the filling of his limbs and sheath must be pretty uncomfortable. He has had 2 periods where I kept him in for 48 hours in the last 3 weeks, but it's starting to make me seriously consider his quality of life. He has struggled with EMS/LGL for years now and I've never really managed to find a good solution as I am constrained by being a livery.
If I had my own land, he would be in a dry lot with no access to grass at all, but then what sort of life is that for an old boy who loves grass with his very being? I just don't know, sigh...

Thanks Wandamare, was hoping someone who had tried metformin might reply. My vet doesn't seem keen though as he has never had a full blown laminitis episode and vet says its not been scientifically shown to do anything. Think I will speak to him again though..

 

[Michen]

I feel for you. Mine spent two years on box rest for various things and he's back on it again after a shoeing disaster and so so unhappy. But if the box rest stabilises your boy and allows you to get him working and reduce the lami risk then it'll be worth it.

I was afraid that might be the only real option Michen, but he gets so miserable in all the time, there's no-one else in at all so he'd be completely alone and the filling of his limbs and sheath must be pretty uncomfortable. He has had 2 periods where I kept him in for 48 hours in the last 3 weeks, but it's starting to make me seriously consider his quality of life. He has struggled with EMS/LGL for years now and I've never really managed to find a good solution as I am constrained by being a livery.
If I had my own land, he would be in a dry lot with no access to grass at all, but then what sort of life is that for an old boy who loves grass with his very being? I just don't know, sigh...

 

[MrsNorris]

You could try closing the hole of his muzzle for up to three hours at a time. He can then go out and mooch around with ha field mates but not eat. Then take it off for a few hours/ bring him in etc and repeat. We did this with ours on her only ever bout and she was certainly happier wandering around the field than stuck in. You can buy a leather pad from I think ' best friend' muzzles that just closes the hole.


Also perhaps 12 hours is just too long? Ours is fully recovered now but I never leave her out more than 8 hours and then yard her for the rest of the time. We have lots of very rich grass but ours seems to cope. She is also worked every day tho.

The management is intensive and a year on still is a consideration but it has improved. We put ours out at first with the hole closed for three hours and then yarded building up to the 7-8 hours. I roped in friends and family to bring her in and out/ remove pad etc.

I don't think there are any other choices if you can't dry track etc but for me it was and is about quality of life.

Thanks elsielouise, never thought of closing off his muzzle for a short time, and to be honest I have no idea how he gets any grass with it on anyway as the field is practically bald! I turn him out overnight as I believe the sugar levels in the grass are lowest at night, but maybe it's just too long as you say. Think I might try keeping him in at night then, and giving him time out with a closed up muzzle in the day, I can go several times a day and give him a few shortish sessions out to stretch his legs.

 

[MrsNorris]

This article taken from another thread makes interesting reading, I have a mare in being treated for PSSM getting alcar and vit e daily and have noticed her rather lumpy crest has gone recently, they are suggesting using the same supplements for IR horses along with the usual management, it may be worth looking into it for yours, being in 24/7 is no life for any horse unless it is very short term and essential.

http://equine.uckele.com/Resources-Articles/cat/drkellon/post/ir-horse/

That's a very interesting read, thank you, have fed ALCAR before to a suspected EPSM case, will order some more today. He's already on equimins advanced which has 2000iu vit E I think, plus some extra linseed.

 

[elsielouise]

Thanks elsielouise, never thought of closing off his muzzle for a short time, and to be honest I have no idea how he gets any grass with it on anyway as the field is practically bald! I turn him out overnight as I believe the sugar levels in the grass are lowest at night, but maybe it's just too long as you say. Think I might try keeping him in at night then, and giving him time out with a closed up muzzle in the day, I can go several times a day and give him a few shortish sessions out to stretch his legs.

http://www.charliesproducts.co.uk/grazing-muzzles/173-grazing-muzzle-plug-0754888041234.html

I used one of these. I bought two muzzles though as it was a bit of a faff to put in and out if doing it several times a day. The other thing is that if the grass is very short it is likely stressed grass which I believe has more sugars in it. Not that you can do much about that but it may affect the length of time he can cope with.

Good luck

 

[abbieandfiona]

Mine is on metformin she has 2000mg each day and her weight is 158kg so not an overweight pony. Since being on metformin her levels are nearly normal. It's helped her to enable her body to use her insulin correctly. She is fed fast fibre and lives out 24 x 7 at the moment.

 

[FfionWinnie]

Could he be turned out in the arena over night?

My PSSM horse lives a grassless existence and has done for 18 months now. She would of course love to eat grass, she's a cob after all, but she is perfectly happy living like this and she has adlib forage. She's never stabled because of the PSSM either. Her area is not enormous but it is big enough (and things are placed to make her walk as much as possible) to keep her healthy and in full work.

It sounds like you might have to bite that bullet at least during the danger months.

 

[Micky]

Have a look at the laminitis site for invaluable info..personally I would have the vet out, metformin until she is sound and you can ride/exercise her (key to ems horses), box rest or limited turnout..soaked hay, low sugar/starch feed (below 10%) if need and maybe X Ray's to check no rotation in feet... Good luck

 

[MrsNorris]

Could he be turned out in the arena over night?

My PSSM horse lives a grassless existence and has done for 18 months now. She would of course love to eat grass, she's a cob after all, but she is perfectly happy living like this and she has adlib forage. She's never stabled because of the PSSM either. Her area is not enormous but it is big enough (and things are placed to make her walk as much as possible) to keep her healthy and in full work.

It sounds like you might have to bite that bullet at least during the danger months.

We don't have an arena sadly, we do have an area that I might be able to turn into something though, I'm chatting to the YM about it just now. It's about school sized, only partially fenced and a mass of rubbish, old haylage bales and docks at the moment, but it used to be a woodchip area apparently, so there may be some scope to make it a usable turnout area. It is very uneven though, it was basically a massive pile of hardcore which was leveled off and had woodchip dumped on top and a fence put around it many years ago. It is full of holes and deep ruts, and may be too dangerous if the horse decides to have a run around, I'm not sure.
I feel lots of backbreaking work coming on!!
Still, all in a good cause if I can do it for not too much money.

 

[FfionWinnie]

It sounds ideal with a bit of work!

 

[wyrdsister]

Good luck getting your turnout area sorted. My vet had reservations about using Metformin too, on the basis that it's not supposed to be effective for more than a few hours after it has been given, but we gave it a go anyway and he agreed that it made a huge difference to my EMS mare's quality of life. She was on it for about three years and we had her on 20 per day near the end (lost her in March due to a combination of issues). It made it possible to get weight off her and keep her turned out (muzzled) for at least part of each day and helped keep her levels stable).

 

[chaps89]

I don't have much advice other than what's been posted already but wanted to say you have my sympathies. We have too much grass at our yard, mine is in during the day with 1 slice of soaked hay and out muzzled at night, on 30 metformin a day and exercised daily and *still* gaining weight. I would never ever get a good-doer again after this experience, it is so extremely stressful.
Hopefully the woodchip area is a feasible option for you and you manage to get things back under control.

 

[Spot_the_Risk]

My young horse had toxic laminitis in April 2015, has had all the tests twice now and they've all come back clear. I too feel as if I'm in a catch 22 though, he needs more exercise but recently has been footy, and two days ago had raised DP in both fronts despite being muzzled when out. He now muzzled by day, out on long grass, and in a fenced off gravelled area with weighed soaked hay. He's isn't massively overweight, probably 3 or 3.5 at the most, and needs to be exercised for weight loss really... Yep, catch 22.

 

[MrsNorris]

Thanks everyone for all your advise and experiences, it's not easy managing these types and sometimes I get a bit disheartened by others trying to tell me I'm making a mountain out of a molehill because " well he doesn't have laminitis does he?" Groan..
Nice to know I'm not alone, though I wouldn't wish this on anyone, it's proper stressful at this time of year...

 

[Christmas Crumpet]

It's quite interesting what you say about him having been in a lgl state for a while. My good doer had quite detectable pulses a while back and I had 2 vets out to see him convinced he had lgl. Neither believed he did - he wasn't footy, didn't react to hoof testers etc and when they both came to see him, he didn't have pulses as it was first thing in the morning despite him being out all night. I pointed out that he did have detectable pulses when it warmed up during the day and he was standing in. His legs also fill a bit. And again they both said that pulses are variable due to many factors such as heat during the day etc, less or more movement. He comes in every morning and I cannot feel a pulse. Then it gets warmer and I can. Then when it cools down at night, I can't feel them again.

He is out in a paddock with crap grazing and a muzzle at night and in on 12 hour soaked hay during the day. I have given up worrying about it as he seems quite sound and think if he has pulses in the morning then I need to worry.

 

[Pearlsasinger]

I would swap the haylage for soaked hay and plain oat straw chaff, as well as following the other advice above

 

[debsflo]

I used Metformin on my mini plus she had several weeks in until I was happy she was completely sound and lost weight. I would change to soaked hay in a trickle net and muzzle. Mine is a year on and apart from a recent bid for freedom is on a bare paddock and doing well. Hard work though but now weaned off metformin.

 

[Spot_the_Risk]

Carolineb I spoke with my farrier when Tinner presented with raised DP's. He said it wasn't unexpected when he had been on grass, to check them when he came in, then again after 30 and 60 minutes, in that time they should have decrease.

I still don't think I should ride though, at the risk of hijacking the OP's thread does anyone have an opinion on that's?

 

[Christmas Crumpet]

Carolineb I spoke with my farrier when Tinner presented with raised DP's. He said it wasn't unexpected when he had been on grass, to check them when he came in, then again after 30 and 60 minutes, in that time they should have decrease.

I still don't think I should ride though, at the risk of hijacking the OP's thread does anyone have an opinion on that's?

Pulses are Wierd things!!! My horse's seem to be the wrong way round - he has none from late evening to early morning when he's out then they seem to appear during the day when he is standing in then disappear again when it's cooler. He is sound and barefoot at present. Another horse who is living here is much finer skinned than mine and you can feel pulses in his legs all the time.

Both vets told me not to get too hung up on the pulses as they are so variable - obviously bounding pulses were a red flag. I was mightily confused to say the least having always been told a strong pulse in more than one foot at any time meant laminitis. I have wondered whether there was some kind of delayed reaction to the grass which resulted in stronger pulses later in the day. But then again, you can feel our pulses more when it's hot weather.

 

[MrsNorris]

My vet has said check for pulses and if present after standing in or weather warming up, take him for a little walk in hand. If pulses go, it's no problem, if they are still there after the walk, it's a problem. So this is what I go on, he's also a bit footy, only noticeable over stoney ground and what a lot of people would consider normal, but it's not normal for him, think it's about really knowing what's normal for each individual. As for soaked hay vs haylage, the hi fibre horsehage has less than 5% sugar guaranteed, which I feel quite happy with, soaking hay can be a lot less predictable, and unless you have it analysed you don't really know what you're feeding, I'd rather not risk it.

 

[Boulty]

My brutally honest opinion if things aren't working and haven't been working for a while / aren't improving would be to move yards if you can do nothing to improve the situation at the current yard. I have done this quite a few times in the last few years to try and better meet the needs of my grass sensitive, laminitis prone PPID horse who hates being stabled and generally needs as much movement / turnout as possible. (Not saying that I'm succeeding going off latest laminitis scare, around the same timing as yours actually, but I'm trying to)

Does your YO appreciate how much you are struggling? Perhaps sit down for a chat and see what they would be willing to offer you. Before you do this walk around as much of the property as you have access to. Search for bits of land that are currently being wasted /sat doing nowt. Bonus points if they already have a surface of sorts (be that compacted mud, concrete or hardcore), some form of shelter or are partially fenced already. If you don't mention that you think you can do something with such things then it probably won't occur to your YO that it may suit (I've started building a partial track system where I am on a disused bit of land that YM was totally unaware could be used for this purpose until I asked). Is t/o shared or individual? Either way would your YO mind you fencing off a small area for him? A track around the perimeter or a horse-shoe shape if not would work best as that way you can put lots of small piles of hay/haylage and a few buckets of water at different points to make him keep moving about which would benefit him from a weight POV and also his feet.

I'd be wary of closing the muzzle in such a way so he can't eat. The stress response this will cause will not be helpful for his body and he will simply compensate by eating more when you open it up again for him.

Is he sound on soft surfaces such as the arena? If so I'd speak to your vet / farrier about doing inhand work on soft surfaces so that at least he's doing something.

If moving is an option you'd consider I'd say post on fb both on barefoot groups and local equestrian groups and also maybe on preloved as well and see where things lead. Sometimes this is the only way to discover little private yards if you don't happen to know the people who own / rent them! Also someone I was speaking to recently suggested phoning developers about land they may have stood empty and I've also had it suggested that estate agents can also be a good starting point for looking for these obscure sorts of land to rent.

 

[MrsNorris]

My brutally honest opinion if things aren't working and haven't been working for a while / aren't improving would be to move yards if you can do nothing to improve the situation at the current yard. I have done this quite a few times in the last few years to try and better meet the needs of my grass sensitive, laminitis prone PPID horse who hates being stabled and generally needs as much movement / turnout as possible. (Not saying that I'm succeeding going off latest laminitis scare, around the same timing as yours actually, but I'm trying to)

Does your YO appreciate how much you are struggling? Perhaps sit down for a chat and see what they would be willing to offer you. Before you do this walk around as much of the property as you have access to. Search for bits of land that are currently being wasted /sat doing nowt. Bonus points if they already have a surface of sorts (be that compacted mud, concrete or hardcore), some form of shelter or are partially fenced already. If you don't mention that you think you can do something with such things then it probably won't occur to your YO that it may suit (I've started building a partial track system where I am on a disused bit of land that YM was totally unaware could be used for this purpose until I asked). Is t/o shared or individual? Either way would your YO mind you fencing off a small area for him? A track around the perimeter or a horse-shoe shape if not would work best as that way you can put lots of small piles of hay/haylage and a few buckets of water at different points to make him keep moving about which would benefit him from a weight POV and also his feet.

I'd be wary of closing the muzzle in such a way so he can't eat. The stress response this will cause will not be helpful for his body and he will simply compensate by eating more when you open it up again for him.

Is he sound on soft surfaces such as the arena? If so I'd speak to your vet / farrier about doing inhand work on soft surfaces so that at least he's doing something.

If moving is an option you'd consider I'd say post on fb both on barefoot groups and local equestrian groups and also maybe on preloved as well and see where things lead. Sometimes this is the only way to discover little private yards if you don't happen to know the people who own / rent them! Also someone I was speaking to recently suggested phoning developers about land they may have stood empty and I've also had it suggested that estate agents can also be a good starting point for looking for these obscure sorts of land to rent.

Think I may have a little bit of wasted ground at the yard I can work with, posted about it earlier on, fingers crossed I can make something of it. Ym is aware of problems and helping as much as poss. Don't really want to move as this yard is lovely and very close to home, but may have to consider it if I can't get him right.

 

[Boulty]

Sorry missed your earlier post, have seen it now (been out judging all day and not long got back in... brain a bit fried!) Fingers crossed for you that you can make something of the waste ground (perhaps organise a cleaning up party with the promise of food and alcohol for helpers... cake is a wonderful motivator!)

 

[JulesRules]

I thoroughly recommend a track system if at all possible.

I am lucky enough to have a supportive yard owner who has allowed me to set up a track in my paddock.

I had a similar issue to you a couple of summers ago where I could not exercise my good doer ( who is normally worked hard in summer to keep the weight off) as she had a hock injury and needed steroid injections. We could not do steroid injections as she was too high risk with her EMS. Could not reduce the risk with weight loss due to hock injury meant no work. No win situation

In the end she naturally dropped weight over winter and she was tested at normal for insulin resistance so we could do the steroid injection.

She is currently kept on a track and is being worked as much as possible to keep the weight down.

My point is that EMS is reversible. If your boy has been diagnosed in the past but is now only condition scoring at 3 don't assume that he still has EMS. As others have said, pulses are notoriously unreliable. What do your vet and farrier say?

 

[_HP_]

Copied from The Laminitis Site...http://www.thelaminitissite.org/d.html

Most horses with laminitis will have a "bounding" digital pulse and this can be one of the best ways to monitor if a horse has laminitis (or another problem in the foot e.g. an abscess or bruising) or is at risk of developing laminitis. It is important to know what is normal for your horse so that you can tell what is not normal. If you get into the habit of checking the digital pulse every time you pick out the feet, you will quickly pick up changes and may be able to prevent or reduce the damage from laminitis. When people talk about "an increased digital pulse" they mean that it is more easily felt/stronger/more bounding than normal, not faster. Exercise, hard ground, heat and not wearing shoes are some factors which can contribute to a more bounding digital pulse and should be taken into account when monitoring the pulse and deciding whether there is a medical problem.


As for exercise...as long as there is no rotation and the horse is not showing signs of being sore on NO painkillers, I think exercise is OK...important even according to above site...as movement improves circulationhealingis good for healing


If you are worried, it may be an idea to x-ray to make sure there is nothing going on inside and go from there ,as rotation that has not been corrected properly from a previous bout can cause continuous low grade pain.
If the pulses come and go then its likely to be EMS related and a test can help you find out how sensitive to the grass your horse is and help decide when or how much grass to allow them.
Haylage can be safer than hay...mine are fine on high fibre haylage.
Agree that EMS is reversible with weight loss
Metaformin can be useful in horses that cannot exercise