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  Discussion on LAMINITIS IN A SHETLAND COMPANION PONY
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Member:
Astbury

Posted on Monday, Nov 20, 2006 - 4:42 pm:

Hi Doctor O again

Have come to the Horseadvice.com site again tonight not for Padraig (whom you may remember from my plea for help a couple of years ago now - - following his acute ataxic problem) but for Padraig's pony Gem (his field and travel Shetland companion for some 5 years now).

Gem has periodically suffered from fairly mild laminitis - despite always going out in a muzzle which allows only minimum grazing) and restricted grazing and this year - at last - we thought we had cracked it. No laminitis whatsoever. I had discovered a product from Equine America called Lamiguard and was convinced this was helping her, and indeed her farrier said her hoof wall was much better.

Last month, on October 19th, she was slightly slow on turnout to the field with Padraig and so I asked a friend at the yard to fetch her back in within the hour (Anyway, an hour later she was led "hobbling" back in.

I called the vet the following day, who recommended box rest and if no improvement to get him out. I also called out my farrier, who trimmed her feet (although they had only been trimmed some 5 weeks previously). She has been on box rest since that time, with just an occasional short walk out and despite initial apparent improvement, she has not really come back to what I would see as soundness - although there was fair improvement. Last week I called the vet again because I was concerned that she hadn't recovered and asked if he could come along and xray her - which he did - and the xrays are "unremarkable" showing possibly a very very slight movement "which would be expected of an pony which has suffered a few episodes of laminitis" but which required no radical remedial work. The vet suggested the pony's feet should be taken back further at the toe and lifted at the heel and the farrier came out again the following day and did this. The vet suggested a further week's box rest and then gentle walking.

Yesterday, I brought Gem out of her box and walked her gently - she wasnt too bad apart from being obviously a little footsore but her back legs were moving very oddly (almost like a stringhalt action). Anyway, this resolved after a little walking so I put it down to stiffness after prolonged confinement. Because of this, I moved Gem to a "crew yard" - still on shavings where she could move around a little - for a few hours, and the groom at our yard, moved her back to her stable when the "crew yard" was required again a few hours later.

Tonight I got down to the yard and Gem was down again and very reluctant to get up. I eventually persuaded her but she was obviously quite uncomfortable and I have given her a further sachet of bute. I stayed at the yard for 1.5 hours following which she seemed much better and so I have put a further bale of shavings down and settled her for the night.

Gem is only 13 years old and so I would have thought that Cushings was highly unlikely. There is no "curlyness" of her coat. She generally seems bright but I have noticed she is sweating around the flank area again this evening (pain response?) - which happened a couple of weeks ago.

I will call the vet again tomorrow but I guess my question is "Am I expecting a result too soon"?

The postings on your site have (as always) been really helpful and I wish all of those who have written in a positive outcome.

Thanks for any advice Dr O - although I think your site has answered most of my questions already.

Padraig is in very good health after a summer competing at unaffiliated level cross country "pairs" competitions, giving a friend - with a rather naughty pony - a "lead" around xc courses - a task he took very seriously! We are now doing some affiliated dressage - which sadly he isn't taking quite as seriously!

Cheers.

Jenny
Moderator:
DrO

Posted on Monday, Nov 20, 2006 - 7:49 pm:

Hello Jenny,
Wonderful to hear about Padraig. Since it seems reasonable steps have been taken it does seem you are going to have to wait a bit longer but a few questions to be sure:
1) What is the ponies overall body condition score?
2) What is the pony being fed exactly?
3) What is in the Lamiguard?

I agree your pony is unlikely to be Cushings but is very likely to be Equine Metabolic SynDrOme after all many breeds of ponies practically define the condition. For more on this see the Endocrine Disease Section.
DrO
PS You should not do all caps in the title Jenny it is considered shouting and some will not reply to it.
Member:
Astbury

Posted on Friday, Nov 24, 2006 - 5:44 pm:

Sorry Dr O and everyone - Had no idea about the implications of Caps. Doesn't have the same implication in the UK. Wasn't trying to shout - honestly folks! Wasn't even aware that the shift key was down. Sorry all. I feel very embarrassed.....

Anyway - I will go to the Endocrine Disease Section now. Vet came out again yesterday and thought that whilst the hind feet had obviously been free of laminitis in the past, there was obvious sensitivity now. We are having her tested for Cushings just in case this is an unusual early onset problem. He did mention Equine Metabolic SynDrOme but she is not fat (you can feel her ribs) although Simon (the vet) did comment that her neck was a little "cresty".
Simon did say that there could be fatty deposits which might not be obvious on clinical examination which could cause the ongoing problem. Will this become apparent with the testing for Cushings?

Thanks for your advice here Dr O which is much appreciated. Gem, Pad's pony is much loved by both Pad and me and my grandchildren, and she is a charming little person who just loves kids to play with her.

Best regards.

Jenny and Pad and Gem
Member:
Astbury

Posted on Friday, Nov 24, 2006 - 5:53 pm:

Sorry Dr O - am obviously losing it after a ridiculous week

Gem is being fed simply

1. Good quality hay (I queried with vet whether I should go for "poor" stuff which may contain less proteins but he said "no". The hay was cut in June/July this year and is the best crop we have ever had.

2 Two meals per day of a product called "Dengie Hi-Fi Light" which is recommended by the Laminitis Clinic in GB - only 1 handful per day. This is alfalfa chop with minimal molasses content.

3. 1 carrot and 1/3 apple in feed

3. Lamiguard - sorry - am at home and cannot access tub and so am not sure what is in this. I will write it down tomorrow and let you know. I know it contains certain vitamins and anti-oxidants plus biotin I think.

Thanks again for your help which is greatly appreciated.

Cheers.

Jenny

PS: Is there anyway I can change the caps heading message?
Member:
Quatro

Posted on Friday, Nov 24, 2006 - 7:06 pm:

Don't feel bad Jenny, I did not know about the caps either. See, we learn lots of things on this site. If you had not done that I may have made the same faux pas myself someday :0!
So happy to hear about Padraig doing well
suz
Member:
Astbury

Posted on Saturday, Nov 25, 2006 - 6:46 am:

Thanks Suz

Every time I open the site and see "Laminitis in a Shetland Companion Pony" glaring out at me I cringe!! Maybe Dr O can zap it..?

Thanks for your remark about Padraig. I am so lucky that he is now so fit and well. He is 20 this year and feeling like a 7 year old. As Dr O recommended a long time ago - I toast his good health every night!

I am just off to the yard and have written a note on my arm to remember to write down what is in Gem's Lamiguard. Head like a sieve...

Cheers.

Jenny
Moderator:
DrO

Posted on Saturday, Nov 25, 2006 - 5:36 pm:

Being able to feel the ribs could still be fat if not obese see the article in the nutrition section on judging condition and see if you can come up with a number. Until you get this under control you should cut out the apple and carrot, or at least limit it to a teaspoon daily and if a more apparent reason for the founder cannot be found using a stemmy hay would be reasonable at least until sound.
DrO
Member:
Astbury

Posted on Sunday, Nov 26, 2006 - 3:29 pm:

Thanks Dr O. Have read the weight/condition article and at yard tonight measured Gem's heart/girth and length - nothing, I am afraid, as scientifically accurate as a tape measure (well can you ever find one when you need it!) - used baler twine and then brought it home to measure against a ruler. (We in the UK are in the dark ages still you know).

Anyway - Heart Girth = 54 inches (sorry am too old for centimetres) and length = 50 inches. This revelation took me back immediately, because I couldn't figure out how my pony could be rounder than she is long. However, having squared the heart girth and multiplied by the length, then divided by 330, I have come up with a figure of 441.818 which I think from the "simple table" which followed indicates that she is not overweight. Is this right?

Will seek out stemmy hay tomorrow from other local farmers. We have some old hay at the farm but it is very poor quality and I would be reluctant to give it to her since a lot of it has some quite mouldy bits in it. Even the sheep are turning their noses up at it.

The Lamiguard is described on the tub as "a feed supplement for horses and ponies prone to laminitis". I have had Gem on it for around six months and my farrier had commented (before her laminitic phase) that her feet were in excellent condition. The analysis is
Protein - 14.0%
Oils and Fats 1.3%
Fibre - 7.0%
Ash - 10.0%
Vitamin E - 1.135/U/KG

Ingredients are Dextrose, Super Oxide Dismutase, DL-Methionine, Vitamin E, Biotin, Folic acid, Pyridoxine HC1, Ascorbic Acid, Sulphur, Ammonium Propionate (preservative), Natural and Synethesized flavouring.
Feeding directions were average pony: Loading Period - feed 14 grams for first 21 consecutive days and she has been on 14 grams per day since the laminitis started, having previously been on around 7 - 10 grams per day. This product is expensive at over GBP64 per 908 grams but given the fact that she was laminitis free all summer, and the vets comment, I thought it was money well spent.

This evening Gem seems quite happy and settled, but still moving very slowly in her box and I am not moving her out of her stable which has very deep shavings in it. I have reduced her to 3/4 sachet bute a day (the vet wants me to get her down to 1/2 a sachet a day), and if she is fairly content tomorrow will reduce again to 1/2 a sachet. She is still sweating around the flank area which is a little odd because it has been a horrible day here and quite cold.

Also I can hear her back legs clicking when she moves (which they don't normally). Possibly stiffness due to prolonged confinement. Not sure.

Will cut down carrots/apples even further. How much apple and carrot can you get on a teaspoon. Will have to use the blender...
Moderator:
DrO

Posted on Monday, Nov 27, 2006 - 8:38 am:

Yes moldy is not acceptable in any circumstance. We crossed paths on condition evaluation Jenny when I said numbers on condition Jenny, I am interested in the Henneke evaluation (1-9) of this horse and not its girth measurement.

Concerning the Lamiguard the first ingredient listed is sugar, this does not sound like a well thought out product for foundering horses to me. The second ingredient a enzyme cannot be delivered orally as the digestive system will completely break it down as it does any protein, its inclusion suggests, at the kindest, lack of knowledge of basic physiology. We do recommend appropriate doses of methionine and biotin so I would substitute a hoof growth promoter that does not use sugar and meets our specifications in the article on founder. There are many reputable products on the market.

A small 1 cm cube of either twice daily should suffice Jenny.
DrO
Member:
Astbury

Posted on Monday, Nov 27, 2006 - 1:59 pm:

Sorry Dr O - will read article further and find the Henneke evaluation.

Your comments re the Lamiguard are worrying - since I have been stuffing the highest dose recommended into her since the Laminitis started. I will substitute it for probably Biometh Z, a product I previously fed Padraig, which is vet recommended and contains Biotin, Methianine and zinc - but will check out its suitability for laminitics first of all.

Thanks for your help

Jenny Padraig and Gem
Member:
Astbury

Posted on Thursday, Dec 14, 2006 - 4:03 pm:

Hello Dr O and everyone.

I am cringeing once again at the Capitals....

Gem is still quite poorly. Vet came out again to take further bloods, phoned me tonight with results. He was concerned earlier with liver elevations. Retook bloods as a result.

This time he said bloods measured 3 things on liver function. 2 of which are elevated.

The functioning bile acids are within the normal range.

However, raised GGT (?) which are produced, I think from liver or pancreas.

However, vet says this latter reading can be found in overworked racehorses; can be a virus and some drugs can produce.

I asked whether the fact I had Gem on 3/4 sachet of bute a day might be a contributor to this. He wasn't sure.

Vet says only way to further investigate the liver readings is to scan or take a liver biopsy. However, he said the relevance of these findings is debatable.

When Vet last came he thought Gem was walking slightly on her toes, and has suggested I briefly walk her out tomorrow to see if this is true.

If she IS walking on toes (rather than flat, or heels) it could be that she is getting deep flexor tendon contracture - and a solution there could be to cut the tendon (which sounds rather dramatic to me?)

Vet has said another factor could be that she could have abscesses in both front feet - but said it is difficult to check a Shetland's feet with a hoof tester. We are going to try next time he comes. I will hold the foot and he can test...

Vet wants to remeasure the GGT in a month's time.

Possible way forward?

We are going to Xray Gem's feet again to detect any changes from the last xray.

We may possibly put "imprint" glue on shoes on to help her comfort - but obviously this will not address the cause - and she will still need to stay in box with deep shavings until all evidence of soreness gone.

Vet has offered referral to Laminitis Clinic - but not sure if they will do anything above what I am already doing. The website is www.laminitis.org and is run by Robert Eustace - but having looked at the site - the last information is some 4 years old - which I find a bit worrying.

On the feed front - having followed vets advice to contact a reputable feed company. I did so and bought their product "Safe and Sound" which is recommended for laminitics but was a bit worried to find clumps of molasses in it. I fed it once and then contacted Spillers - another reputable company - but again found that their product - approved by the Laminitis Trust - "Happy Hoof" still contains molasses. Scary? Suddenly had a sensible thought and went back to the company that have supplied product for my horse for several years now whose philosophy is to feed horses as close as possible to the natural state - i.e. no molasses and no grains etc.

Their adviser, has suggested firstly we need to remove the cause - she has been box rested for 8 week and is still not better so:

Hay? Summer hay - this year very high in sugar content.

- Soak Hay for 2 hours

Additionally need dietary modifications to repair feet but not overload, and to repair damaged liver.

Jane suggested I should soak hay for 2 hours
Feed Eclipse Recovery (will let you know contents once received).
and feed 1 lb Luciebix per day (freeze dried Lucerne).

She said once we get rid of the cause we could then feed
Garlic - which improves peripheral circulation (but not to feed while inflammation there).

Suggested I get a plain white salt lick.

ABSOLUTELY no carrots - as they contain sucrose
Can feed - in very small quantities - apples (as contain glucose/fructose)
And also suggested feed a whole swede - which she can play with
+ unmolassed beet pulp
I am already feeding a mineral/vitamin supplement

Adviser said I could also try nettles - ouch - wilted, thank goodness.

On return to turnout (I am just really hoping we get to that stage)

Jane said Sun makes sugar
When temperature above 43 degrees Fahrenheit, plant (i.e. grass) can turn sugar into fibre.

If below 43 degrees F. it cant

So - if we get a glorious sunny, cold day - I have to BEWARE - since this will make sugar in grass (I thought frost was the only problem....)

Jane suggested trying field with hedge - put electric fence few feet in from hedge - so that Gem can take more exercise - and Pad can still be with her. Also if Hedge creates shade, less rich grass.

Fingers crossed.

Dr O - checked "scale" on weight by asking several people at the yard - without discussing - what number they would put Gem on the scale - this was on average 5 (3 people) with 2 people saying 4.

Will update again shortly.
Moderator:
DrO

Posted on Friday, Dec 15, 2006 - 7:56 am:

So the ribs are easily seen? Why would such a pony need muzzling? A condition of 4 to 5 on the Henneke scale with chronic founder strongly suggests Cushing's despite the ponies age. I agree that with no other symptoms of liver disease the liver enzymes alone are not likely to be significant. If I understand this case right radiographs to see if there may be structural reasons for the pain and consider the use of pergolide would be the direction I would be going in, see the article on Cushings and Cushingnoid Horses for more.
DrO
Moderator:
DrO

Posted on Friday, Dec 15, 2006 - 9:30 am:

Oh, I forgot, concerning differentiating founder from bruising, I thought that was well handled in the Founder Overview, only to find it was not so I updated the diagnostic section to include it. Let me know if it does not help.
DrO
Member:
Tuckern

Posted on Friday, Dec 15, 2006 - 1:57 pm:

Jenny, is there any way you can post pictures of your pony's feet? Particularly pictures of the side of the hoof with the hoof on the ground, and pictures of the sole.

Thanks,
Nicole
Member:
Astbury

Posted on Sunday, Dec 17, 2006 - 1:28 pm:

Apologies for delay in coming back again. Your comment, Dr O, is interesting re Cushings. Would early stage Cushings not show in the diagnostic test which was carried out on Gem?

Re Gem's weight viz muzzle usage. Are you saying that a pony must be fat to get laminitis? I thought that whilst it was more prevalent in obese animals, it could still occur in those of normal weight.

I did used to only use the muzzle when conditions warranted it (i.e. spring grazing; autumn flush of grass etc) but having been caught out a couple of times, with Gem suffering minor bouts of laminitis - I took the decision that she would always wear a muzzle when grazing. Don't like the idea of it, although she can still get some grass and seemed to come to terms with it. The main disadvantage, of course, is that she can't have grooming sessions with other horses.

Nicole - re pictures of feet, will get some photos and post. What are your thoughts?
Moderator:
DrO

Posted on Monday, Dec 18, 2006 - 9:27 am:

The article on Cushings explains the limitations of the various tests Jenny. As for the causes of founder they are explained in the article Founder Overview. But as a way of further explanation, it should not be looked at as a disease with a single cause and Equine Cushings is a case where thin horses get chronic founder.
DrO
Member:
Astbury

Posted on Wednesday, Dec 20, 2006 - 3:59 pm:

Thanks Dr O - I see what you mean!

As current update - vet came out today and took further xrays to compare against previous.

Interestingly - since I set up the new "regime" a week ago - in terms of soaking the hay particularly, and putting Gem onto Pad's "Simple System" totally sugar free diet - Gem is FINALLY showing improvement. Within three days, she has gone from a situation where she was reluctant to move even in her very deeply wood shavings bedded stable, to walking out quite freely today from her stable to a concrete floored stable for xray purposes. We are still not out of the woods - she certainly is not completely sound - but is only showing slight/moderate lameness on the near fore leg now - and that really on on circling.

Am waiting for vet to call to advise on any changes on xray. I also held Gem's foot today so that Simon (the vet) could do a more accurate test in terms of hoof testers and the only "response" we got was around the toe of the near forefoot. Simon has said that before he visits again he will call me to ask me to bind her foot with wet gamgee to soften the toe so that he can check whether there is any abscess there.

Anyway - currently keeping fingers crossed for her. She has returned to her old self in terms of being alert, looking happy and stealing my hat off my head as I pass her stable (her idea of a joke - and no, I am not 3 feet tall, just bending over picking up a hoofpick!!). This may be simply a temporary improvement, but at present, I have a fairly good feeling about it. If there is deterioration, then I think I will ask vet to put Gem onto Pergolyd (?) to see if there is an improvement. At present, his view is still that the mare is suffering from EMS, and if resolution is obtained through dietary change, could this be the case?

Finally, after soaking our hay for some 2-3 hours, the water is a reddy/brown and smells very "fermenty".

Weather here AWFUL today. Thick fog - not helped by fact that my windscreen washer has sprung a leak and to make matters worse, I whacked myself in the eye with the buckle end of the rein this morning with result that I now can currently only see out of one eye. Happy Christmas all!!
Moderator:
DrO

Posted on Wednesday, Dec 20, 2006 - 7:37 pm:

Great to hear! Rereading all the posts, I think I am seeing this case a little clearer. Here we have a pony with a history of chronic recurring founder when on rich pasture, therefore the muzzle. The thin condition is because you work to maintain this condition(?). In spite of this we have had another bout. So this may be an EMS that is very sensitive to sugars and starches? Does this ring true?

Or on the other hand the dietary change could be just coincidence...hmmm....certainly we should not ignore the diet vs the improvement, and time will probably answer these questions. What we need to do now is see if there is anything else that should be addressed to decrease the episodes. Do the feet look good? I would love to see some good pictures taken from the side and close to the ground of these feet with the horse standing square and find out what the radiograph results are.
DrO
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