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Discussion on Laminitis or Absess? How do I treat...?
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Member:
erika
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Posted on Wednesday, Sep 30, 2009 - 7:24 pm:
Dr. O, I am having a bit of a quandary. My 20 year old American Saddlebred mare has sore feet, with the right front becoming markedly more sore in the past couple of days to the point that it is hard to tell if this is laminitis or an abscess, or something else.
Sugar is on 1.5mg Pergolide, recently increased from 1mg because of reappearing Cushing's symptoms like heavy drinking, urinating, depression, long early haircoat. She also has been on 1mg of Thyro-L for many years (I know, I know,... but vet insists). She has a body condition score of about 4. She is an easy keeper though, and I deliberately try to keep her on the lean side because she has a history of two episodes of fall acute laminitis. Sugar has also had Lyme's disease, treated twice with good results--for a while anyway.
Earlier this week, while on mature pasture, she began to have that delicate walk with reluctance to turn so I took her off the grass to my rather muddy dry lot. We've been soaking her hay, and she gets just a handful of Triple Crown Safe Starch to eat her Pergolide caps and Thyro-L in in the AM. After a few days of this, she seems markedly more lame on the right front. She was reluctant to pick up her LF (but this is not uncommon, she has a touch of arthritis in that right knee and it also seems a little puffy again). No noticeable pulses--but then she has never had a strong pulse related to any of her founder episodes. He front feet are slightly warmer than the back, but again, not markedly so.
Vet came out and agreed she looks sore on both fronts, but suspected an abscess in RF, hence the extra soreness. She used hoof testers and the mare reacted very clearly on the RF at a point about halfway down the hoof, midway between the frog and the outside wall. She attempted to find the source by paring the sole but didn't find anything--no bruise or track that appeared to lead to an abscess. Sugar has very thick soles and she didn't want to keep going deeper at that point. BTW, horse is barefoot for several years but her toes have lately worn quite a bit to where she is contacting the ground with the soles of her feet in the front.
So she prescribed 1g of bute/day, and had us pack the hoof with 50/50 of ichthamol ointment and epsom salts. We put a pad under that, covered with plastic wrap and booted it. She did not want us to soak the hoof in warm salts because she felt it was contraindicated in case of founder. We are changing this dressing until my farrier can get out here Friday afternoon to see if he can find an abscess.
SO, finally my question: Does this sound like a good protocol to you? I am just not sure whether it is a simple case of abscess, mild founder, or even a recurrence of the Lyme's! When I asked the vet about the Lyme's she said it's possible, but didn't address it further. Seemed to want to pursue the abscess possibility before all else. These are all similar signs to when Sugar had Lyme's before--lameness that shifted and mimicked founder sometimes, sometimes unilaterally lame. She's got that puffy knee again and weepy eyes, and just looks all-around miserable. I swear she looks more like 30 than 20, poor thing.
So I guess I am asking what would you do first, and what would you follow up with treatment-wise? thank you so much for reading this long saga!
Erika
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Member:
mrose
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Posted on Wednesday, Sep 30, 2009 - 7:56 pm:
Oh, Erika; I'm sorry about Sugar. Poor thing.
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Moderator:
DrO
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Posted on Thursday, Oct 1, 2009 - 9:37 am:
Erika, the problem is you don't have a firm diagnosis. The treatment is logical as part of the treatment for bruising of the sole.
For each of the rule outs you list we have articles describing clinical signs, diagnostic procedures, and proper treatment. The best suggestion I have is to carefully read those articles and decide if what you are doing makes good sense. If it doesn't you need another exam done. We do have an article on Lyme Disease that should go up today or tomorrow at the latest.
DrO
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Member:
erika
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Posted on Thursday, Oct 1, 2009 - 10:18 am:
Oh Dr. O, you know that after all these years I would always read your fine articles first. And I did--i practically have them memorized right now. But yes, I don't have a firm diagnosis. I guess that's what I'm in search of here. I got the feelimg my vet sort of shrugged and said "I don't know" after examining Sugar.
My puzzlement stems from the history of all these symptoms being a recurrent theme in Sugar's life for the past several years. They wax and wane, but never seem to be totally absent.
Would you agree to the protocol of treating for possible abscess first, then founder, and if no improvement test again for Lyme? Cornell U won't accept blood for ACTH testing until late October so I don't have a way of knowing if this is Cushing's related.
Please understand my desperation. Sugar has been such a generous horse for me, with the heart of a lion! I reluctantly had to retire my lifetime favorite horse because she's no longer able to leap tall buildings in a single bound, haha. If I don't get to the bottom of what is happening I fear I will be burying her. I feel like I owe her all the vet bills I can afford, but I need some direction here.
Can I ask what you would do next if she were your horse?
Thank you,
Erika
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Member:
scooter
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Posted on Thursday, Oct 1, 2009 - 10:44 am:
Erika as you know Sam just went through this. If you look at the pictures I posted on the pergolide thread, you can see I had his RR wrapped. It was the worse of the 4. I couldn't decide if it was an abscess or founder....so treated it as both ....Wrapped the worst hoof with epsom salt poultice, gave banamine paste, and stuck him in a deeply bedded stall until he improved, which didn't take long . Of course he hates stalls and I threatened him every day that the stall would be his life long home unless he started walking better (I think that worked more than anything )
I hope sugar improves SOON!
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Member:
pattyb
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Posted on Thursday, Oct 1, 2009 - 10:55 am:
Erika...please allow me to chime in as I have been in this very same boat in the past.
Years ago, my Cushing's horse came up lame with a history of one mild laminitis that happened a few years prior. The vet suspected but couldn't find an abscess and told me to soak it.....which really contorted my brain because of the mild laminitis possibility.....so, I soaked in a little cooler water than I would have otherwise.
What I found with her was that even on Bute, she continued to get worse...and that is what clued me that it was an abscess. Sure enough, by the time the vet came back out, the goo came shooting out once he found it. I also had a similar event when she had an abscess with two tracts....the vet only found one until she got worse again and came back out .
Any chance your vet or farrier has a laser thermometer? The can be helpful in finding the best place to dig for an abscess. I have one and love it for checking for laminitis....they're so sensitive, there's no guess work.
Good luck, I hope you get to the bottom of it soon.
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Member:
paardex
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Posted on Thursday, Oct 1, 2009 - 11:15 am:
Sorry to hear poorSugar is doing worse. Logically spoken though Erika as long as you don't have another firm diagnosis following your vets orders seems wise. As long as you yourself who knows her best don't really disagree, because in the end without medical 'proof' your knowledge of her will I think give her best shot at the right choice no matter what that will be.
Hope she feels better on some bute by now and what a shame we cannot help our best friends with a glass of wine fi.
Jos
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Member:
leslie1
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Posted on Thursday, Oct 1, 2009 - 11:57 am:
big huggs for you and sugar.
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Member:
marieanh
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Posted on Thursday, Oct 1, 2009 - 1:32 pm:
No advice-just lots of sympathy!
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Member:
erika
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Posted on Thursday, Oct 1, 2009 - 9:50 pm:
Thank you all of you wonderful women! I know that so many of you have been in my shoes with a wonderful horse. Your sympathy really helps.
Farrier is coming tomorrow afternoon to see if he can locate an abscess. Even if he does, I think there is still more to the problem. She has been walking gingerly on and off for quite a while. I guess I will take it one step at a time and rule out one problem after another until I get to the solution or have to give up.
I joined this site originally to get access to the veterinary articles and to the expert opinion of you, Dr. O. I have to say that the longer I am here, the more I value the input of the other members with their experiences. The collective resource of so many years of everyday hands-on knowledge often eclipses the professional advice I have been given. Yes, I am cranky and frustrated, but I want all of you to know how much I appreciate ANY input I can get that will help my horse.
I guess what I was hoping to get was an expert opinion on how to progress. Thank you all of you for your input.
Off to pour a glass of that wine, Jos!
Erika
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Member:
vickiann
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Posted on Thursday, Oct 1, 2009 - 10:02 pm:
Good luck with this, Erika.
What a frustrating situation.
A few years ago one of my boys was diagnosed with laminitis in one of his front feet and I won't belabor all that we went through but it turned out that he had an abscess in one foot though ultimately he looked like he had slight laminitis in all four feet.
After I took him to a veterinary hospital and nerve blocks were done they felt it was NOT laminitis and pared out the bad foot until the infection drained.
It took more than that though to get all of the infection out of the foot and eventually had some pop out at the coronet band.
For abscess problems, my farrier is opposed to paring them out because he feels it undermines too much of the foot and the infection may become more widespread and chronic.
A few months ago he came out and put a poultice on one of my horse's feet that had an abscess. The poultice was simply a paste (mustard or mayonaise consistency) of boric acid mixed with water on a smooth layer of cotton with the foot then wrapped with a combination of Vet wrap and duct tape. He told me to leave the wrap on until it fell off on its own.
Amazingly, this remedy worked like magic. My horse was sound within the 2 - 3 days it took for the wrap to fall off and it was possible to see how the boric acid had worked on the bottom of the foot to draw out the problem and then harden the sole.
I am not claiming this is a miracle cure though it worked in my most recent abscess circumstance and my farrier claims much success with this remedy.
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Moderator:
DrO
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Posted on Friday, Oct 2, 2009 - 7:15 am:
Erika, as there is nothing in your posts for us to hang a diagnosis on it is my expert opinion you can best help your horse by getting a good diagnosis.
I must comment on Vicki's farriers opinion on paring out abscesses and her recent treatment. How many hundreds of horses have I attended to that after days of agony so bad they will not put the foot down, I pare out an abscess and have the horse comfortable in 24 hours and riding sound in 12? How many dozens of horses have I attended that did not have a abscess pared out and graveled after a week or more of intense and then go through months of rehab because of the defect in the wall that reached the coronet. Then there are the really unfortunate few where the infection became so wide spread the hoof sluffed off. Your farrier could not be more wrong Vicki. I do not know what was wrong with your horse's foot but you should know you cannot draw infection through an intact sole with a boric acid poultice.
DrO
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Member:
erika
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Posted on Friday, Oct 2, 2009 - 10:15 am:
Thank you, Dr. O. My farrier is coming this afternoon to search for an abscess. After two or three days of bute and hoof packing, she is moving much better, but I know the instant to he bute is out of her system she will be walking on eggshells again. I am stymied about getting a further diagnosis since, as I said, my vet sort of shrugged her shoulders at the whole thing. Is it "kosher" to call in her associate for an opinion? I don't want to offend my vet since she is also a social friend, but she was on maternity leave for quite a while and doing small animals except for one day a week for horses. I'm not sure her head is so into horses to be keeping up on the latest. How else do you suggest getting a clear diagnosis?
Since there is so much more going on with this mare, even if there is an abscess, I think I will have more to deal with after it is cleared. She just looks like a sick and miserable horse--weepy eyes, hanging ears, lumpy body, swollen knee, etc!
I have been dealing with issues for years now that just seem to morph together and string along. I found a picture of Sugar from five years ago and forgot what a nice looking horse she used to be. The only time she has seemed even close to normal has been after the second IV treatment for suspected Lyme's. Even that didn't last long.
I wish I could figure out how to do photos with this computer. Every file is too large no matter what I try to reduce it. I would love to show you pix of her feet, body condition, and expression. I think that might better illustrate what I'm up against. I've had old horses--much older than Sugar, but never saw such deterioration so rapidly in a relatively young horse.
I will post again after the farrier. Thanks again everyone for you help and support.
Erika
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Member:
leslie1
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Posted on Friday, Oct 2, 2009 - 10:38 am:
I would think its ok to get a second opinion...seems like MD's expect it.
...Farriers, on the other hand, get offended lol.
Besides, Sugar needs it.
Do the best you can afford to do. And know we are here for you and sugar.
Big hugs
Leslie
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Member:
scooter
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Posted on Friday, Oct 2, 2009 - 11:02 am:
Erika, This fall is really hard on Sam too for some reason, he looked much like you describe sugar. The pergolide, stall rest, and banamine did help him tho.
If you want to e-mail me pics I would be glad to post them for you.
I agree with Leslie a second opinion wouldn't hurt and if you offend...Oh well...it's for sugars good.
I have a feeling tho that you may be dealing with cushings problem with the related laminitis. Sam was walking gingerly also...no pulses or heat, was way out of my experience with founder, but I believe it was.
Lock her butt in a deeply bedded stall, and try some banamine...can't hurt
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Member:
paardex
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Posted on Friday, Oct 2, 2009 - 12:49 pm:
Erika, get a second opinion. If your vet is sure of herself she won't mind if a second opinion helps and she is a good vet she won't mind. If you don't and loose your horse your socializing with the vet will be difficult because you will[perhaps not founded] wonder.
I never had a vet or a friend who did not respect my making sure if only for my own peace of mind.
If she does mind you can do without her. Sorry if I am not 'nuancee' enough or seem pushy but I feel strongly about this.
Jos
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Member:
canter
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Posted on Friday, Oct 2, 2009 - 12:54 pm:
Erika, Don't hesitate to call in another vet for a second opinion. A true professional will welcome the added perspective and insight. A vet, or doctor, or anything for that matter, that gets offended at a second opinion does not deserve your business...or friendship for that matter.
I hope you get to the bottom of Sugar's issues - for her sake and for yours.
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Member:
ajudson1
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Posted on Friday, Oct 2, 2009 - 1:59 pm:
Erika,
Email me the pics & I'll be glad to post them for you. I'd love to see her picture anyhow and was going to ask you to post one.
It's raining, windy, mid 40s, and posting pictures is more fun the cleaning the house, lol!
Ditto to what the others said about a 2nd opinion. It's YOUR horse, and this is not the time to be worried about what someone else will think.
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Member:
mrose
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Posted on Friday, Oct 2, 2009 - 2:39 pm:
Hi Erika. I so empathize with your problems with Sugar. It is so difficult when an animal you've had for a long time, who has been such a good friend for so long, had problems and you know they are starting on the "downhill slide." It isn't so much that you know they are someday going to die, you can accept that, it is after all a part of life; but what you can't accept is their pain, their depression, the feeling that things are right, when you think there is some way that you can help them. You want their last years to be as happy and painfree as you can make them. That is what they deserve.
It is so, so frustrating to know something is wrong with your horse and not know what it is. If you knew what it was,you would know how to deal with it, how to treat it; you could fix it.
Often it seems like there is more than one thing going on at a time; or the symptoms are so subtle that only someone who knows the horse well would even know something was wrong. You take the horse to the vet, and the vet doesn't even see anything wrong. (My vet says Beau looks good for her age, but she doesn't. I can see that.) I suspect that there is more than one thing going on with Sugar and this makes it hard to diagnoss.
Our vet is probably much like yours. He is a good man, a country vet who treats all animals, from cows and horses to mice. However he is severly limited by lack of state of the art equipment. He is also limited by so many years of dealing with a local mindset that tells him the bottom line is the dollar. He assumes you want to treat the animal in the cheapest way possible; if it doesn't make it,he'll compasionately put the animal out of it's misery. He might casually mention to you that you could take your horse to a certain clinic for more diagnositcs but won't push it. He seldom does bloodwork unless you ask for it. He is used to treating emergencies.
I have learned to read up on stuff and ask a lot of questions. I know I annoy the man to death. I have also learned that for certain things I'll have to take the horse to Las Vegas or California to find out what is really going on, or for treatment. If the horse can't make it that far, I'll ask our vet to do what he can then take the vet to another larger clinic. Our vet isn't insulted by my doing this, he approves.
I think in Sugar's case you know her and need to rely strongly on your instincts and what you think is best for the horse and best for your peace of mind. If you need to take her somewhere else, do it. Your vet, especially if she is a friend (as our vet is) should understand. She may even feel relieved.
With the runny eyes and other symptoms you mention I think there is a lot more going on than laminitis. Possilbly an abcess with infection that has affected the rest of her body, or lymes or another body wide inflamation/infection that is causing laminitis or some other problem with her feet. I think she should have blood work, maybe x-rays of her feet, and go from there. If you have someplace available that can do it, I think some types of sonograms will show where there is inflamation in the foot. Thermography will if that is availabale. Also, if she hasn't had it done, a general physical should be done when the vet does the bloodwork. This way you can see if she has a system wide infection and whether or not there is laminitis, abcess or possibly both. I think this would give you some direction with her.
Good luck. I'll be calling later to let you know about Sunday.
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Member:
paul303
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Posted on Friday, Oct 2, 2009 - 6:51 pm:
Did this with my appendix mare from last Christmas through last July. There was lameness that we couldn't pinpoint - mild at first...RF, LF, maybe rear involvement???? Then she was fine for a few days and we went - Phew! Then it was back again. Farrier tested and tweaked her shoes, yet she never showed any foot pain. By May, the intermittent lameness became constant and we began to cautiously bute her with minor success ( which caused an ulcer flare up ). The vet had checked her twice already and came back out to check again in early June. Although the mare's feet were cool, she looked badly foundered to the vet and the vet arranged for the farrier to meet her the next day so she could do some digital x-rays to check for what she felt was serious rotation. Nothing. Just the same "mild" navicular changes that had showed in x-rays taken 3 yrs ago. The vet's explanation was that some horses are babies and over sensitive to pain, and recommended wedge pads and bar shoes. We also decided, at this time, to do a blood draw, and check just about everything - including Lymes ( which she had 3yrs ago with similar symptoms ). That's what the tests came back - Lymes. After about 5 days on Doxy, she showed improvement....and just got better from there. The farrier was elated to be able to remove the bar shoes ( he's not a fan, besides her heels were beginning to look underrun after 2 bar shoe shoeings ). Also, in the middle of all this, I had a clover disaster in my pasture....it's on another thread. What a mess. Nothing like this is ever simple.
So....what I'm wondering is, maybe you could call your vet and ask her if she could make arrangements at Ringoes ( I don't think you're too far from there )for a good going over for your mare. This way, your enlisting her aid and alerting her upfront. I've had experiences with Ringoes 5 times now and have been consistently impressed. The equipment is there for all the tests your mare could need, and they can do it all at once, eliminating the chasing of one theory for a few weeks, and then another one for a few weeks....etc.
Just something to consider. Good luck with whatever you decide. I know how upsetting it is when you have no solid diagnosis.
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Member:
erika
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Posted on Friday, Oct 2, 2009 - 10:48 pm:
Well well well, aren't we all kindred spirits?!
Here's the story as of now and a glass of Jos wine...Farrier found absolutely no sign of abscess. Sugar was walking better, not great, but not favoring any foot. He did his usual trim (although he has only been trimming this horse two cycles, so don't blame him for the long term probs) and even though I asked him to back up her toes vertically, he didn't seem to grasp the concept. So short of grabbing the rasp out of his hands, I explained what I wanted as clearly as I could and didn't get the full result I would have liked. To his credit, he did realize he needed to reduce her heels and shorten the toe, but he didn't get the "vertical backup" that I tried to get. When the pics are up I think you'll understand what I mean. But, I think he did improve things.
Since he didn't think there was an abscess involved (not sure I did either), he felt I should keep her on the founder diet she has been on (soaked hay, just enough low-starch concentrate to get her meds in) and see if that fixes things.
Sara and Lee, you are so in my head! I think there is something systemic going on. I don't believe this is a simple founder or trim issue. When you see the pics, you will think "what an ugly, lumpy-looking mare!". Then if I can scan a picture from a few years ago --before the Lyme's you will know why I always heard "what a pretty mare!
Angie, by now you have gotten my photos. Sorry to put the burden on you, but you did offer!! Email me for a frame by frame explanation. I'll be hunting in the AM, so it might be night before I can tell you much. Thanks for your kind offer to post for this illiterate!
Lee, Ringoes isn't that far. What is the name of the facility? I'll call them to see what can be done. Like you, I am suspecting Lymes. This is so similar to the last time we dealt with it. Cushingoid horses are prone to it and other infectious diseases, I'm told, and it just seems like such a repeat of our past experiences. I'm frustrated as to why it seems to be a last resort diagnosis when it is so rampant here!
So, more to come when poor Angie sorts through her email. When she recovers from the shock of the pics of Sugars hooves, we'll see if we can get somewhere! Again, such gratitude cannot be expressed for the insight and encouragement I find here!
Erika
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Member:
jowidner
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Posted on Saturday, Oct 3, 2009 - 12:32 am:
Hi Erika. I just read through this thread.
Given Sugar's history and symptoms, I also vote for a complete work-up at an equine clinic. The history of Lyme's is a real red flag for me. Its such a sneaky disease and can so easily go underground only to crop up again. It seems logical to me that the stress of a chronic inflammatory disease like Lyme's could be precipitating other issues.
In regards to your vet, I think I'd just say something to the effect of, "I'm just so worried about Sugar, I've decided to have a complete work-up at (fill in the blank). As your friend who knows how attached you are to Sugar she should understand. And as Sara said, she may well be relieved to have the responsibility shifted to an equine specialist.
Best wishes. Sugar is a lucky horse to have someone like you looking after her health and well-being.
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Member:
erika
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Posted on Saturday, Oct 3, 2009 - 8:07 am:
Lee, is the Ringoes place New Bolton? Or is that one in PA? Does one need a referral or do you just make an appointment?
After (not) sleeping on it, I think my next step is to call the associate of my vet and hope she will do a phone consult on Monday. I'll see what she says and if I don't get much, I will try the equine center evaluation. My regular vet is due to return in two weeks to follow up and draw blood for the Cushings. I will have her test for Lyme's again if we decide to wait that long. If things get worse or don't improve on the spartan diet I won't wait that long.
Meanwhile, I'll try to find a pre-Lymes picture to contrast with the ones I took yesterday. When Angie recovers from the ones I sent her, you can compare.
Erika
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Member:
rtrotter
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Posted on Saturday, Oct 3, 2009 - 9:58 am:
Erika,
I beleive the name of the vet clinic in Ringoes is called Mid-atlantic, I have never used them but I hear really good things about them.
As far as the Lyme's goes. This is a very tricky kind of disease to diagnose in horses and even though your horse may be positive for it, it does not necessarily mean that is what is causing her symptoms. There may be other infections that would be sensitive to the antibiotics that would result in an obvious lessening of symptoms.
Over the past 10 or so years, every dog I had has come back positive for Lymes, we treated with Doxy, waited six months and treated again. Only one had arthritic like symptoms and she was older. The others were younger dogs and did not show any symptoms at all. I routinely have them checked and they always come back positive. However, whatever test the vet uses can tell if it is an ongoing current infection or an antibody reaction. We treat accordingly, both of my current dogs have not had a current infection in three years and do not show any signs of the disease. My dogs are never off of my property, so they most likely picked it up at home.
My 19 year old gelding has been in my backyard, in the same tickfilled environment( very wooded) is healthy, has never shown any symptoms and would most probably test positive, if I tested him. I am sure at sometime in his life living where he does, he most probably contracted the disease, but he seems to be immune to it.
In some of my reading on this because I too had a case of Riccicittia ( sp?) a few years ago about the same time the dogs had Lymes, the bacteria that causes the disease is different in different species, yet causes similar titer reactions when positive. Also, I think there are different markers and one has to have a certain amount of positive markers for it to be considered true Lymes disease.
I think Dr. O just revised the latest research on Lymes disease in Horses, so I'm going to go read it and see what it has to say.
Rachelle
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Member:
mrose
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Posted on Saturday, Oct 3, 2009 - 10:01 am:
Erika, re:loading photos: Do you have Paint on your computer? If so, it's easy to resiz photos, even if it isn't the most efficient method. Open Paint. Click on file and open a photo file. Then, click on "edit" and then "resize" A box will open asking if you want to resize by 100%; you put in whatever figure you want. I usually put in 50% at first. Then save to desktop. Click on the photo on the desktop with the right button of your mouse and then click on "properties" and it will tell you how large the photo is. It will probably still be too large, and you'll have to repeat the process. As the photo gets down to close to the 64kb that HA allows, you can reduce it by 90 or 95% so as to make it as large as possible to allowable size.
I use Adobe normally, which has a faster more efficient way of resizing, but most Windows based computers come with Paint, so give it a try. If you're on a Mac, sorry. This will be of no help!
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:07 am:
Well, this is weird..I put the pictures in their own folder in Picasa, and typed a number on each for easy reference for you, Erika, to refer to them with your comments, and ta da! It's going to post right from the folder I saved them in without resizing! You made my job easier by sending them sized already!
So, here is number one of Sugar
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:08 am:
Number two, front feet?
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:10 am:
number 3 LH? I see a tail!
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:11 am:
4)
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:12 am:
5)
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:13 am:
6)
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:14 am:
7)
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Member:
ajudson1
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Posted on Saturday, Oct 3, 2009 - 10:24 am:
Erika,
Does Sugar have any swelling starting under her ears and going down around her throat latch? I ask because I think Willow looks so similar to Sugar, except for the hoofs. I asked about the swelling a couple of years ago, my vet insisted it was "trauma" for getting hung up with her halter on...not possible!
I just looked at a picture of her from last fall, and she has went down hill this last year. I am curious to see a "before" of Sugar. I need some ideas what to insist my vet check for; your answer may give my 20 year old mare a few more years of quality life.
I know you won't mind the brief interruption since I uploaded all your pictures,
Beautiful horse btw, but those hoofs make me cringe!
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Member:
erika
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Posted on Saturday, Oct 3, 2009 - 2:43 pm:
Thank you Angie, photoloader extraordinaire!
I'll try to address pictures and questions, hope I get them all...
Rachelle, I know all too well about the Lyme's hiding and the showing positive without infection. But Cushing's horses are often immune compromised and I think it allows them to get a full-blown infection that a normal horse would fight off. Whether it was LYme's before, or something else, the antibiotics made a tremendous difference in Sugar--for a while, anyway!
Sara, no, I don't have paint on this. No windows--it's a Mac. I have no idea how the pics came to Angie already sized because they certainly weren't even close on my computer!
Angie, no, she doesn't have any swelling there, only on her neck and around the tail--those Cushing's lumps.
Okay, photos. First one is lumpy Sugar, looking depressed and hairy, belly sagging and ribs showing. All the rest are front feet only, the first four are pre-trim (five weeks out, farrier said they had grown quite a bit in that time), the remainder are post-trim. I asked him to back her toe vertically so as not to leave any to break off, but either I wasn't articulate enough, or he disagreed. He said she needed more toe, and after a discussion, I deferred to him. No abscess was found and she was walking sound although still from the bute the day before, I imagine.
I see only one of the bottom views made it. You can see a lot of separation at the white line. The other foot was similar in that respect. One foot was noticeably rounder and wider than the other. This farrier is only doing her for the second time.
I asked him if he thought x-rays would be helpful, but he felt he could see where her coffin bone would be judging from the top inch of the hoof from the coronet. To his credit, he said he agreed with keeping her barefoot, and he felt that slowly he could bring her feet into better shape.
So from my perspective, I deduce that there has been some ongoing low grade laminitis for quite some time to see that separation and dishing. Apparently she is chronic with it and I have only been aware when it flares up. So I am thinking no more grass for this girl. We are still soaking her hay--it is really nice, fragrant hay, but I bet it is just loaded with sugars and starch.
My next step is to wean her off the bute to see if she is still sore.
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Member:
leslie1
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Posted on Saturday, Oct 3, 2009 - 5:23 pm:
hmmmm, also remember nav synDrOme usually has one foot smaller than the other and it can come and go. Not saying thats what she has, but Im not sure why she would have the smaller foot?
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Member:
scooter
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Posted on Saturday, Oct 3, 2009 - 6:04 pm:
Erika, I don't know if you follow hoof threads but her hooves look very much like Hanks did, with some seedy toe and maybe WLD thrown in there.
I know Angie and Rachelle will disagree but when Hanks hooves were in that state he was never "sound" he had good days and bad days...but never 100% until I put the routed out WW shoe and equipak CS on him...with a good trim. The change was dramatic to say the least his attitude changed, he didn't act as if he were in pain all the time. This could be part of her depression. He only had to stay in that package for 2 shoeings to get him going in the right direction. He would get sore when we were bringing his toes back and IMHO he needed them. It looks like from that pretty remarkable ring half way down her hoof and where it begins to distort she had a "bout of founder" probably last spring and some mild laminitis in between. Looks so much like Hanks hoof did. I am all for barefoot and don't want to start an argument about that, it was my goal all along, we just needed some protection on those ouchy feet for awhile. The old Macs with comfort pads worked well too, but they did turn his hoof to mush, and they can't be left on 24/7. If you prefer bare foot perhaps something like the equicast would work well, but I don't know if de-rotation can be done with them or not, I suppose it would depend on your farriers skills and the amount of rotation.
If you get another opinion or even have your regular vet out I would include X-rays of her hooves in the diagnostics. Her hooves have to be making her uncomfortable. she could be thin soled too, and with rotation her CB could be awful close to the ground.
As Dr.O. said in another thread x-rays can tell you a lot and you would have them for reference in the future.
The de-rotation article in here is great and I highly recommend it FWIW
I hope Sugar is feeling better, she is a pretty girl even in old age There's something about old mares I love, they are just so smart and patient.
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Member:
paul303
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Posted on Sunday, Oct 4, 2009 - 1:38 am:
Ringoes Veterinary Clinic
554 State Highway 31
Ringoes, NJ 609 397-0078
Mid Atlantic Equine Medical
40 Frontage Rd.
Ringoes, NJ 908 788-7776
I believe you can call for an appointment at either one, yourself. The only reason I suggested getting a referral from your vet was to involve her in case she gets her feathers ruffled easily.
Mid Atlantic is extraordinary also. I've been there too. My vet tends to think that Mid Atlantic is the one for lameness issues. She takes her race horses there. However, I took my neighbor's horse there last fall for removal of the third eyelid due to a cancerous lesion. That was quick, neat, matter-of-fact, and cost $235. The horse was sent home the same day with eyeDrOps and antibiotics ( included in the price ). Recovery was routine.
Yeah, New Bolton is in Pa. Hate to sound like a broken record, but they are wonderful also. But too far from you, I think. Had to take my 38 year old there in 2000 when he was suffering from what turned out to be 2 large lipomas (fatty tissue tumors ) that were strangulating his intestines. They diagnosed quickly, kept him pain free, and euthanized quietly. They were, indeed, wonderful. When we tried to pay, they sent us home, saying that "now is not the time to be worried about the bill", and that "they would bill us later." The bill came weeks later, along with a beautiful gift box containing his halter, a tail braid, and a beautiful hand written note of sympathy.
Mid Atlantic diagnosed my appendix mare's ulcers and Lymes....when we thought she was lame.
Either place is well equipped to 'cut to the chase' and diagnose Sugar quickly. They both are reasonable in their charges, also. It's so good to get a solid diagnosis quickly, and it saves the money you are spending casting about for an answer.
If you want to know more, just Google both those places.
Her feet really don't look that great, but it doesn't look like your farrier could take those toes back any farther. Believe me, I'm no foot expert, but possibly hot shoeing and rockering the toe might be a possibility.
Crossing my fingers, Erika. Give the old gal a kiss from me.
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Member:
erika
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Posted on Sunday, Oct 4, 2009 - 8:39 am:
Leslie, the horse didn't react at the heels with hoof testers, nobody has brought up navicular as a possible contributor, but I will be sure to ask about it next visit. The bottom view hoof is the rounder, wider of the two. Farrier thought the difference might be from years of a "handed" farrier. He said he has seen a lot of horses whose feet change from a farrier being better on one side than another. Other than that I don't now what caused that.
Yes, Diane, I read all the hoof threads and I have considered many of the possibilities I've read about, as well as the treatments. Sugar is already on a laminitis diet, wears pads and boots or wraps, and the war is on to find out what is causing the whole-body synDrOme. You're right that she may simply be depressed from the pain in her feet, but we are addressing that the best we can with bute as well as physical supports.
Lee, thanks for that info. I'll be making some phone calls Monday to investigate. Sugar thanks you for all the advice and attention from all you Nicker Sibs!
Off to hunter pace. Sister visiting from Virginia. Grateful for friends who don't mind guest riders so sister can ride, Haha! Busy weekend of hunting, pacing , eating and drinking!! I'm tired just thinking about heading out for another day--but FUN!!!
Will check in later...
Erika
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Member:
leslie1
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Posted on Sunday, Oct 4, 2009 - 9:14 am:
Erika
Thats great news that no one has brought up Nav. Ill be so glad for Sugar when it gets worked out
Have fun at the pace!
Cheerios
Leslie
For future reference...Pumpkin didnt react to hoof testers either, I dont believe all will test positive.
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Moderator:
DrO
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Posted on Sunday, Oct 4, 2009 - 11:21 am:
Erika,
The photos are pretty good but we need more of the leg to judge foot balance. With the horse standing square:
1) A straight on frontal shot taken from about the level of the knees that includes the cannon, pastern, and hoof only. If the feet point significantly different directions one of each leg is warranted.
2) A lateral shot of each leg from the side again that includes the cannon, pastern, foot.
Though we cannot judge balance yet, your foot is still dysfunctional with entirely too much flare at the toe and quarters and the solar shot suggests the heels have shifted forward. The change in angle of the wall near the top also suggests that the coffin bone has rotated in the hoof capsule. So besides the conformation shots above I would suggest you have a good set of hoof radiographs so that you can correctly position the coffin bone and rule out other causes of lameness.
DrO
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Member:
erika
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Posted on Monday, Oct 5, 2009 - 8:42 am:
Okay, I have asked the vet to bring her x-ray equipment when she comes back in a couple of weeks. My gut said x-rays would be helpful here too. Thanks. Also will get shots of her legs. I think in the first whole-body picture above you can see the swelling in her RF knee, also. Don't know if that is part of the equation yet.
Angie, I got your private email about rasping regularly. I think you gave me very good advice and others might benefit from reading it so feel free to post it here if you are comfortable doing so.
I do have a Rider's Rasp. I showed it to the farrier and he thought it would be a good thing to use to just run around the hoof once in a while to keep it rounded. I can see from my own photos that the flares have really gotten out of hand. I had this problem a couple of years ago when Cleo had the hoof crack and I did get a rasp and start working on it. I just can't help but wonder why the pros don't seem to notice these things!
Sugar has been off the bute for a bit now, and seems to be more comfortable in the foot department. She also went without the pads and boots yesterday and seems okay. Not obviously sore in her regular environment, although I haven't taken her out to hard pavement yet to see how good it is. Weekend was too busy to get everything done.
Still has puffy knee, weepy eyes, etc. After talking with various horse owners this weekend the general consensus is to test again for Lyme's when the vet comes back. SO many here have been diagnosed with it (many different vets--so it's not just one on a mission, LOL) that it seems to be the first thing that pops to everyone's mind when one describes a depressed and painful horse.
So, the latest plan:
Requesting radiographs of hooves; whole-leg photos; blood tests for ACTH and Lyme's; frequent rasping to control flare; continued laminitis diet. Hope and pray for improvement! If solution isn't found with all that, then a call to a clinic for evaluation is in order.
Erika
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Member:
vickiann
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Posted on Monday, Oct 5, 2009 - 5:22 pm:
Dr. O,
I understand your skepticism about using Boric Acid, and am not personally arguing against paring out abscesses, especially when remembering one that Lance had many years ago that I soaked two or more times daily for too many weeks (also wrapped with Icthammol) as he suffered horribly, but at that time soaking is what I was told to do by the Veterinarian and farrier, neither of which is in business in my area any longer. Since then I've had abscesses pared out a couple of times and one of those times it later also came out at the Coronet band.
My farrier had me do a soak for a limited number of times with Boric Acid and water after my Veterinarian had pared out an abscess a few years ago. During this most recent abscess Perry's sole was so soft that it gave with finger pressure and was painful, so perhaps that is not an "intact foot."
Boric Acid is used successfully for many purposes for man and animal, for infections and fungal problems in all parts of the body, including eyes, and for drawing out infections.
After first suggesting using it as a soak, my farrier began experimenting making the poultices after noticing that commercial foot poultice products primarily contain it as a main ingredient.
Here is information about a pad made by 3-M composed of Boric Acid and Tragacanth and one of the uses is for drawing abscesses (see below information):
Animalintex Poultice Pad 8x16 in.
Manufacturer: 3M
Manufacturer Model No: 1395P
Animalintex poultice is a ready-to-use poultice that comes in a pad not a bucket.
- Ideal for cuts, wounds, abscesses, inflammation, skin disorders and hoof conditions.
- Use as a hot poultice for abscess, boils, infected and dirty wounds, cracked heels, thorns, laminitis, seedy toe, corns.
- Use as a cold poultice for strains, sprains, sore shins, splints, bruises, capped hocks/elbows.
- Use as a dry dressing over open wounds or for pressure padding.
- Available in 2 sizes: 8" x 16" pad (can be cut to any size) and pre-cut hoof shape.
* Animalintex is a registered trademark of Robinson Animal Health, England
Best of luck with figuring out the answers to all of your horse's problems, Erika. It appears that you are dealing with quite a number of issues.
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Moderator:
DrO
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Posted on Tuesday, Oct 6, 2009 - 8:56 am:
Erika, though I am uncertain what the indication for the ACTH and Lyme titer is for careful evaluation of the feet and correct trimming will optimize the chance your horse will go as sound as possible.
Vicki, while poulticing abscesses of the skin is a time honored way to bring them to a head and getting them to drain, the skin has a completely different consistency than the hoof wall. The hoof wall is not susceptible to necrosis by the purulent material like the skin is and therefore poulticing the sole or wall to get the abscess to rupture will only result in a gravel and can be avoided by proper paring out of the abscess ventrally. Poulticing after it is open and draining may be of benefit however.
DrO
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Member:
erika
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Posted on Tuesday, Oct 6, 2009 - 9:12 am:
Dr. O, the reason I wanted the other blood tests is because Sugar seems to have more going on than just the feet. I understand that depression could be a result of pain in her feet, but she also has that big, soft knee again (without heat) and weepy eyes, hard lumps of fat, and all-over body soreness and tenderness. Some of which sounds like the Pergolide might need increasing, and some of which is very like when she had the sky-high Lyme titers.
I understand that fixing the feet is job #1, but I still think there is more to the picture than just poor trimming. So I want the tests just to ease my own mind.
I have a call in to the vet and awaiting a return call as to when she is coming to do the x-rays, etc.
The first time she came, she was doing fall shots, Potomac, flu, rhino. We didn't give them to Sugar because of her condition. Do you think it's safe to give them next time she's here?
Thanks,
Erika
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Member:
vickiann
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Posted on Tuesday, Oct 6, 2009 - 11:28 am:
Thanks, Dr. O.
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Member:
erika
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Posted on Friday, Oct 9, 2009 - 7:22 pm:
Angie will be proud to know that I have been using my Rider's Rasp every few days to control flare on Sugar's feet. It sure is easier than a regular rasp! No new pics yet, husband has the camera in FL. Vet coming on the 20th.
I came across this picture of Sugar a few years ago on her last hunter pace, ridden by a little mosquito of a girl, my friend's daughter. Big difference from the photo above!
https://mkphotography.org/SprVlyJune2006/dsc_0013.htm
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Member:
scooter
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Posted on Friday, Oct 9, 2009 - 7:52 pm:
Erika don't you just love that riders rasp. I don't know if you read my most recent thread about Hanks hooves, but the travelers rasp is very nice too.
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Member:
mrose
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Posted on Saturday, Oct 10, 2009 - 12:14 am:
Erika, you are right; she doesn't look like the same horse. Poor girl. And, poor you. I hope you are able to get to the bottom of this and help her. You may wind up just treating each symptom as a separate issue as the only way to deal with it all. I'm glad you're getting a work up done. IMHO there is from the looks of her more going on than just feet. I read you've upped her pergolide; how long ago did you do that? Also, what is she eating?
After doing a lot of reading, I've added flax seed meal and extra biotin to Beau's diet, on top of the Eq.Senior. I'm looking for a source of whey as I've read that older horses don't digest proteins well sometimes and that they really perk up with added easily digestable protein, like whey. Just increasing her senior, plus the flax and biotin has improved her some imo over how she looked a couple of weeks ago. I've just started her on pergolide, but she not been on it long enough to make any difference-just a couple of days. You've probably read them, but in case you haven't, there's a lot of good books and article on the internet on feeding senior horses. Sugar just really reminds me of Beau, except luckily Beau's never had foot problems.
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Member:
ajudson1
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Posted on Saturday, Oct 10, 2009 - 7:25 am:
I am proud of you Erika! I wish every horse owner would get in the habit of keeping hoofs beveled/mustang rolled on a weekly or bi-weekly basis. Once you get in the routine, it is sooo easy.
WOW, what a difference in Sugar's appearance from a few years ago. I hope you get answers soon.
Sara,
Would feeding colostrum be a practical option? A short term boost to the immune system? I got that prescribed to me years ago to fight CFS, I think that would be a good source of protein too?
There are many types of protein products for humans now, whey, soy, and I think pea? and Hemp? Just thinking of different options for cost comparision.
Wonder if there have been any studies done on those things?
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Member:
scooter
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Posted on Saturday, Oct 10, 2009 - 7:40 am:
I don't know if you have any ration balancers available, but the one I give my horses is 30% protein and high in minerals and vitamins. My horses love it and it is fairly low in NSC's. Most horse feed brands have them now including Purina which most people have available to them..
Makes feeding much simpler
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Member:
erika
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Posted on Saturday, Oct 10, 2009 - 7:58 am:
Thanks for the suggestions, and the confirmation that I'm not crazy when I say there is more to this puzzle than trim alone. Diane, do you have a name or brand to the balancer? Sugar has been living on soaked hay for a few weeks now and I think long term she will need more than that.
Off to opening day of formal hunting season. Hope my britches stick to my saddle!
Erika
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Moderator:
DrO
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Posted on Saturday, Oct 10, 2009 - 10:32 am:
Erika, what do you expect to learn from the horse's serum ACTH value, particularly since it has been taken in the fall? For more on this see the article on Cushing's.
I know this sounds "wrong" but I am trying to shock a little bit of sense into you and it is nothing I have not said to you in the past in more gentle terms: testing for thyroid hormones, Lymes, and ACTH and treating as though these tests "diagnose some disease", it is not surprising you are confused what to do with this horse.
DrO
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Member:
mrose
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Posted on Saturday, Oct 10, 2009 - 11:15 am:
Dr.O, would you please humor a foggy brained middle-aged lady that needs more coffee and explain in a little more detail your last statment? Thanks.
Also, do you have any comments on the feeding of whey or protein supplements? Is feeding Eq. Senior in label recommended amounts make feeding such supplements unnecessary?
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Member:
lilo
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Posted on Saturday, Oct 10, 2009 - 11:38 am:
Erika - I use Purina's "Natures Essentials" 32 (formerly known as "born to win". It has 32% protein, few calories and lots of vitamins and minerals. For my oldster (23 yr old mare) I add Purina Senior - but the younger gelding just gets the Natures Essentials 32.
Lilo
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Member:
mrose
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Posted on Saturday, Oct 10, 2009 - 11:53 am:
Lilo, I've never heard of this product but am going to look into it for Beau. Thanks.
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Member:
scooter
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Posted on Saturday, Oct 10, 2009 - 12:14 pm:
Erika I use buckeyes Gro N win
https://www.buckeyenutrition.com/equine/GNW%20product%20manual.pdf
Purina has one
https://horse.purinamills.com/products/Enrich32.asp
And here are some others...whatever may be available to you
Buckeye Gro N WIn or ALf Gro N Win
https://www.buckeyenutrition.com/dealers.html
Tribute feeds Essential K
https://www.kalmbachfeeds.com/Dealers.php?zipcode=16143
Front Runner 30% or 10% Supplment
https://www.frontrunnerhorse.com/
McCauley's M30
https://www.mccauleybros.com/contact/dealer_locator.cfm
Kent Horsego12 or Horsego32
https://www.kentequine.com/Results.aspx
LMF SuperSupplement
https://lmffeeds.com/cart/index.php?m...products_id=10
Pennifield All Phase
https://www.pennfield.com/equinefeed/phaseFeeds.cfm
Progressive Pro Advantage grass or alfalfa formula
https://prognutrition.com/DealerLocator.htm
Purina Enrich32 or Enrich12
https://horse.purinamills.com/dealerlocator/
Seminal Equalizer
https://www.seminolefeed.com/ProductS.../Equalizer.mht
Triple Crown TC12% or TC30% supplement
https://www.triplecrownfeed.com/distributors.php
Brookes Feed All Phase
https://www.brooksfeeds.com/product04a.html
ADM Allaince Nutrition Gro STrong
https://www.admani.com/AllianceEquine...lsVitamins.htm
TDI-30
https://www.tdihorsefeeds.com/product.asp#TDI-30
Kalmbach Feeds https://www.kalmbachfeeds.com/Dealers.php
32% Horse Supplement Pels
34% Horse Supplement Pels
35% Horse Supplement Pels
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Member:
erika
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Posted on Saturday, Oct 10, 2009 - 8:57 pm:
Dr. O, the test for ACTH level was suggested by my own vet, not by me. I personally don't think it will tell us a thing due to the season, but sometimes we clients have to "play along" with our vets or there is a loss of cooperation and good will, do you catch my drift?
I don't believe I ever said I wanted to test her thyroid. If I did, I must have mistyped.
As for Lyme's testing, you ask what I expect to get from it? The last time the test was suggested--by my vet--we were dealing with very similar symptoms. Whatever the reason, Sugar improved greatly with treatment. My vet will not treat Sugar without the test first. Again, I sometimes have to go with the flow, Dr. O. I am not sure how kindly my vet would take it if I give her directives because of an article I read online.
You keep telling me I need a diagnosis. How would you suggest getting a diagnosis from the vet I hire if not by going along with her suggestions?
Like Sara W, I need some clarification of your comments. Are you saying do nothing? I don't believe that is an option.
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Moderator:
DrO
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Posted on Sunday, Oct 11, 2009 - 10:07 am:
Sara, these tests have little to no capability of diagnosing problems that actually cause clinical signs in horses.
As to protein supplementation, anytime the regular diet does not provide the NRC recommended amounts of protein for the horse's stage of life protein supplementation is logical. However you have to consider more than the concentrate fed you must also consider the forage when figuring protein in the diet. If protein supplementation is warranted I suspect there are equally good but much cheaper ways to provide it than by buying whey but I could be wrong as I have not priced it. For more on all this see the "Protein" subtopic of Horse Care » Equine Nutrition, Horse Feeds, Feeding » Equine Nutrition an Overview of Feeding Horses.
Erika, the reason I bring up thyroid testing is in your profile you have Sugar on Thyro-L, I presumed you tested before supplementation.
OK where to start this...a little old and a little new seem best...
Members must take nothing said here for granted, it is guaranteed there will be mistakes on this site. You should independently research everything written here before acting on it and that certainly includes discussing it with your own vet. This is so important that it is written into the membership rules. On the other side of this evaluation of information this site provides is that what you read here in the articles is also what your veterinarian is reading in her books and journals published today and what she is hearing at the conferences she goes to because that is where this information comes from: the finest equine veterinary and scientific journals and equine conferences from around the world. Written and interpreted by an experienced equine veterinarian in an attempt to make it relevant and readable for equestrians.
We provide a form method in every article to conduct this independent research and to review of the basis for the statements made. If there is something you have a question about or need more than the article go to the "More Info" topic at the bottom of every article and push the Pubmed button. It will automatically deliver a review of every piece of peer reviewed research on the pages topic published from that moment and back through the past 40 years. Though how the research was preformed and results interpreted is often difficult to understand the conclusions presented at the bottom are usually very easy to understand. You can copy off the ones that seem significant and present it to me or your veterinarian if we need more evidence of something you believe.
You say "I cannot do nothing"...but doing nothing is "always" better than doing the wrong thing. Unfortunately that is a hard lesson for equine veterinarians as clients expect a prompt diagnosis and treatment. Doing nothing is not my recommendation however. My recommendation is that you primarily use clinical signs and not laboratory work to be the primary drive to for a diagnosis and treatment of your horse.
If you would like to try something do this for me:
List, using just a word or two, each symptom your horse has right now. Now list abnormal clinical exam findings. Lastly list your horse's vital signs. Also place in the list the medications your horse is on, dosage rate, and date started. Keep the list simple and succinct providing no explanations for the items on the list.
DrO
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Member:
erika
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Posted on Sunday, Oct 11, 2009 - 10:22 am:
Okay, will do. I'll work on it this afternoon and try to post soon. I realize that with all the reading you have to do to locate that info, it is easy to miscommunicate.
Thank you,
Erika
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Member:
mrose
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Posted on Sunday, Oct 11, 2009 - 11:52 am:
Dr.O, I got the idea of feeding whey to senior horses from a book I read, Senior Horse Care,by Karen Hayes, DVM, which states that many seniors have trouble making use of protein in their feed, which can result in loss of muscle, and that by adding milk or egg proteins, which are rich in lysine, will help them. It's not that there isn't sufficinet protein in the feed, but that the horse can't digest it and make use of it properly. I've had this book awhile so don't know if this is still accepted theory or not.
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Member:
erika
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Posted on Sunday, Oct 11, 2009 - 8:17 pm:
Dr. O, I will do my best to list without embellishment. Here goes:
SYMPTOMS:
off and on lameness, sometimes bilateral, sometimes RF only
right front knee puffy, no heat or tenderness
weepy eyes
depressed attitude
"touchy" skin
sore, tender body areas--especially over back/loins
rough, standing coat
lumpy, hard crest
reluctant to pick up feet for cleaning/trimming
EXAM RESULTS:
"pottery" walk
reacted to hoof testers RF hoof
no abscess found
no strong digital pulse
slight heat in both front hooves
heart/temp/breathing normal
body score 4
MEDICATIONS:
1g. Thyro-L daily (prescribed 10yrs ago after acute laminitis)
1.5mg. Pergolide daily (prescribed about a year ago, increased about a month ago from 1mg. daily )
1g. bute daily for four days
recommended drylot, soaked grass hay only, until vet's return.
Vet will return for x-rays Oct.20
Thanks,
Erika
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Member:
scooter
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Posted on Monday, Oct 12, 2009 - 8:20 am:
Erika forgot all my words of wisdom from the other day since I was Banned from your post
All I can say for sure is sometimes things appear to be something it isn't...Sams tumors for instance!
Good Luck figuring it out!
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Moderator:
DrO
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Posted on Monday, Oct 12, 2009 - 8:36 am:
And your horse's vital signs Ericka? You will find a description of them at Diseases of Horses » First Aid » Taking Temperature, Pulse, and Respiration.
Sara, protein digestion and metabolism is an incredibly complicated subject and the amount we don't know about horses is huge. As to the statement about some specific poorer digestibility of protein, there is no work documenting a significant loss of protein digestibility in older horses. Currently the reason older horses are considered to have more problem with weight and condition is multifactorial. Concerning lower digestibility, the older horse with teeth problems does have trouble with digestibility but not with protein alone. Poor mastication does not free up and expose plant tissues to digestive chemicals so there is probably lower digestibility of all classes of nutrients. Another big factor is the hormonal effects of Cushing's disease. Excessive glucocorticoids cause a catabolic muscle wasting that even very high protein diets will not prevent.
Because of the general observation that weight loss is common in older horses all reasonable diets for older horses, including the one I recommend, already have increased energy and crude protein recommendations. Older horse feeds are processed to increase mastication and digestibility. While crude protein can be a crude measure of protein availability, it is the way the research has been carried out and builds into the numbers the difference between crude and digestible protein. Using crude protein values for formulating horse feedstuffs has worked surprisingly well as demonstrated by all the fleshy horses we see.
I do not know of any work that whey is a superior form of feed when compared to more commonly available protein supplements, though I suspect it is far more expensive. The only work in horses I can find is comparing regular diets to casein and whey based diets in suckling foals. This research found in the whey diet a decrease in arginine and ornithine in the foals blood suggesting a limiting amino acid. Overall the foals did the same.
Let me ask you Sara, what form of whey do you feed, how much do you feed daily (by weight), and how much does it cost? If you are uncertain about the weight take the weight of the package and divide it by the approximate days it lasts.
DrO
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Member:
erika
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Posted on Monday, Oct 12, 2009 - 9:22 am:
"heart/temp/breathing normal" as reported by vet during exam. I don't have a stethescope, so going on her findings.
Erika
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Moderator:
DrO
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Posted on Monday, Oct 12, 2009 - 10:49 am:
OK we will assume normal TPR. How about gum color and sclera?
The image you post above does not show a body condition of 4 but instead a solid 5 to me, what is the basis for your evaluation of 4?
Have you had a fecal performed just prior to a regular deworming and what were the results?
Now let's look at your horses diet. List all foodstuffs, weights fed daily, type and quality of the forage. If pasture is part of the horses daily routine tell us composition, quality, and hours on it.
Again let's keep is short and simple.
DrO
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Member:
mrose
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Posted on Monday, Oct 12, 2009 - 10:56 am:
Dr.O, I haven't started on the whey as I can't find it locally without ordering it. I've been trying to figure out if it would help or not. After your explanation, I think she's getting enough protein with her Senior and since we just started her on pergolide, I'm going to see how she does after being on that for a month.
Thanks for explaning so throughly. In trying to educate myself I sometimes just get more confused.
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Member:
erika
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Posted on Monday, Oct 12, 2009 - 9:30 pm:
"4 Moderately thin A negative crease along its back. The outline of the ribs can be seen. Fat is palpable around the tailhead."
As you said recently in another thread, Dr. O., it is very hard to determine body score from a photo, so in person: Sugar's ribs are clearly visible under all that coat. She has a slightly raised backbone--no crease down the back, very little flesh behind the withers. Lumpy, but small fat deposits by tail and hard crest fat on thin neck.
Temp today was 100.5.
Her gums are pink with reasonably quick refill when pressed upon.
Sugar has fairly dark sclera with some visible blood vessels in the lighter areas, no evident jaundice.
We had fecals done in the early spring on all three horses before worming. All three had low levels of eggs (was not given numbers, but told it was good.)
They were last wormed Sept 1 with Quest.
As noted above, she is on drylot with free choice excellent quality grass hay, soaked 1/2 hour before feeding. Estimated by my barn help to be about half of a forty-fifty pound bale a day.
She also gets one small handful of moistened Safe Choice in the AM to feed her the pergolide caps and Thyro-L. She eats this out of hand to insure that she eats the meds.
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Moderator:
DrO
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Posted on Tuesday, Oct 13, 2009 - 6:35 am:
I can see a small amount of the edge of 4 ribs and if the rest of the exposed ribs is covered up by hair, 4 is a good evaluation. The butt looks pretty good but as we all have said here photos are deceiving.
Concerning the diet I do have a few more questions: I do not see a reference to a mineral salt. Is she getting a mineral supplement? Also how long has she been on a hay only diet and how long have you been soaking it? What type hay are you using?
DrO
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Member:
ajudson1
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Posted on Tuesday, Oct 13, 2009 - 8:29 am:
Erika,
Just curious, why don't you up the Safe Choice a bit considering she is, I think, a bit thin? I have been told by Nutrena rep that it is very safe to feed in larger amounts. I know you want to keep weight off to prevent laminitis, correct? But perhaps she is not getting enough nutrients from just the hay?
Just my opinion of course, yet I have to wonder if more SC plus a good vitamin & mineral supp wouldn't help. (we know it helps us)
Is lack of selenium an issue in your area?
Wait to see what your vet and DrO come up with first of course. I am just thinking Willow perked up so much with adding a good vit/min supplement with added Selenium...although now she is back to being "DrOopy" it seems, and like Sugar, ribby but seems to have some fat at tail head, etc.
I am a supplement nut some what, at least for myself, so my mind goes to that for critters too.
Oh oh, guess what? Sticky typing, part 2 needed, lol!!!
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Member:
erika
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Posted on Tuesday, Oct 13, 2009 - 8:47 am:
Sugar has a high tail set and level croup, perhaps giving the illusion of more butt than she's got. Slight "poverty line" viewed from rear.
Yes, all the pastures and paddocks have trace mineral salt blocks. No further supplements.
My first post on Sept 30 states that Sugar had been on mature grass pasture until a few days earlier, so I estimate she was taken off the grass around Sept 26. That is when I started soaking the hay.
The hay looks to be timothy, It is not fully booted out to see a lot of seed heads.
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Member:
erika
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Posted on Tuesday, Oct 13, 2009 - 9:13 am:
Angie, orders are to keep Sugar on the lean side because of past laminitis history. I don't think 4-5 is unhealthy, do you? She normally does get a little more Safe Choice in winter, but when she was on good pasture it would have been a recipe for blowing up. I have very rich river valley soil that grows abundant grass.
She is getting so little now because of possible current episode of founder. But yes, I think she will need a diet tweak going forward. That's why I asked Diane about ration balancers.
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Member:
ajudson1
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Posted on Tuesday, Oct 13, 2009 - 9:34 am:
No, I don't think that's unhealthy. In fact, I wish my guys looked to be 4-5s.
I was thinking more like lacking something in the diet, like if we eat really lo-cal it's hard to get every vitamin and mineral we need. I also think with any health issues, maybe the body isn't able to utilize what is fed, like what Sara is saying with the protein.
I also feed very little SafeChoice just enough to add supps to, and I always wonder how much I would have to feed to meet the %'s they list on the bag.
FYI, Sugar seems built like Willow..low back, ribs obvious. Willow seems well padded in other areas, it's hard, IMO, to figure out what is "healthy" weight in that case.
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Member:
scooter
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Posted on Tuesday, Oct 13, 2009 - 4:29 pm:
Erika it seems being out on the mature grass was the turning point for Sugar and she started having lamintis. AS you know horses with CD and or IR like to do things we don't expect. About the same time you posted about Sugar, Sam and Hank had a "flare up" on dead brownish looking grass....Sam was much worse, I suspect because of the CD.
Sorting out which is the CD symptoms and the IR symptoms is difficult to say the least, but since you know Sugar is IR and has a tendency to founder in the fall I would highly suspect that is where this is coming from. It took Sam a good while to get over that laminitis episode, and like Sugar it did not "present normally" he didn't really have pulses, one leg was worse than the other (I suspected an abscess too.) or he fell in a hole or something! His fetlocks were very swollen in back and sore to the touch...don't think lyme disease didn't cross my mind, we are very endemic for it around here too, I did question my vet about it like Dr.O. tho he says he has never seen a case of it in horses.
My vet just brought it home for me and said you have an IR/CD horse that ate too much grass PERIOD. If you would like to treat him with Doxy go ahead, I'll sell it to you, but that's not the problem.(gotta love him some days)
SOOO that's when his butt went in the stall on deep bedding and the banamine began, thankfully that did it for us along with the pergolide.
IMHO I think getting her hooves x-rayed and in better condition, keeping her diet under control and pain relief when needed is a start of rule outs. If that don't help move on to the next thing at least that way you know what her problem is/was, if you treat for lymes, cushings/IR ect. all in one pot it leaves you guessing. I know you keep up on this stuff on the yahoo groups, but Safechoice is not a good choice for an IR horse...of course a handful is not going to hurt anything, but I would be leary of giving her the recommended amounts, which would be about 6lbs. to get their recommended amount to receive the proper nutrients. The recommended amounts for the ration balancers is only 1# per 1000#'s of horse for the same thing but better IMO and their NSC's are guaranteed.
Good luck, I hope you figure it all out, I think it is quite a balancing act, but doable, they like to throw us a curb ball when we start to relax a little!
How is she doing now?
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Moderator:
DrO
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Posted on Wednesday, Oct 14, 2009 - 10:29 am:
OK Erika,
Let's create a problem list trying to group symptoms together that are likely to have common causes. I am going to change the description somewhat and you let me know if something does not seem right.
Problem 1: Generalized poor doing of unknown cause as indicated by: - weepy eyes
- depressed attitude
- overall sensitivity to touch and deep palpation
- rough, standing coat
Problem 2: Episodic bilateral or generalized lameness on unknown cause as indicated by:- off and on lameness, sometimes bilateral,
- "pottery" walk
Problem 3: Episodic R fore lameness of unknown cause as indicated by:- A sometimes RF only lameness
Problem 4: Puffy Knee of unknown cause
Note the problem lists are not written in stone and as diagnostics are performed may, and probably will, change. This beginning is only a logical way to approach the problems you list using the information that I remember you have posted. Would you agree with the problem lists, grouping, or are there any mistakes you think I have made?
DrO
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Member:
erika
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Posted on Thursday, Oct 15, 2009 - 10:04 am:
The only omission I see is the renewed puffiness of her RF knee. It is soft, doesn't seem painful to touch, but odd looking. It was big like this before when we check for Lyme's (actually it was one of the things that made me think this is more than just fall laminits). There is still reluctance to stand on RF when LF is lifted. She once fell on that knee when I didn't give in to her wanting the other foot back!
On recent observation: yesterday evening Sugar looked to be walking pretty well so I got on her to ride her around the pasture at a walk just to see how she went. She didn't walk lame, but when I mounted (bareback) even though I used a mounting block and eased myself onto her back as gently as I could, she still sank noticeably when I got on. Didn't seem to inhibit her movement though, once we got out walking. She marched forward without apparent difficulty.
Whether this is an improvement or just a "good day", I'm not sure. Thanks
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Member:
erika
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Posted on Friday, Oct 16, 2009 - 10:57 am:
Seems that even though I posted last night, my thread is missing from today's discussions.
How about I just take this up with my own vet when she returns. I feel like this is a case for an in-person check.
Thanks anyway.
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Member:
erika
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Posted on Tuesday, Oct 20, 2009 - 2:35 pm:
In case anyone was following this thread with interest, I wanted to post the latest.
Vet was here this AM. X-rays of Sugar's feet were excellent. Meaning no rotation, nice thick soles, thick walls, no bony lesions or apparent degenerations. In fact Dr. Turk exclaimed that they looked really great, especially for "an old gal with so many miles on her".
Because the RF knee was still swollen, she also x-rayed that, both standing and flexed, and found the same result--remarkably clean and lacking in any obvious arthritis or spurs.
On lameness exam, now Sugar was showing slight lameness on the LF ( last time it was RF). No obvious reason could be found other than slight bruising near toe, which she deduced was from the long toe and resulting late breakover. Toes are dubbed back much more than in the photos above, I have been diligently shaving a little every few days. Farrier returns in 2 weeks for pro trim.
Vet took blood to be sent to Cornell labs; did a phone consult with their Lyme expert who said they would look for increased titers and if present, the next step would be to sample both the synovial fluid of the big knee, as well as a tissue sample from the lining of the joint capsule to look for evidence of Lyme there. Evidently there is a new DNA test that has been more successful at determining Lyme's by this method.
Overhearing and having explained the conversation between my vet and Cornell, the continued shifting lameness, lack of obvious laminitic changes, the big knee without bony changes, and general sensitivity all point to suspected Lyme's.
Again, when I questioned what I've read about horses not contracting Lyme's, it was explained to me that immunosuppressed horses can get diseases that normal horses would have no problem shrugging off. Being PPID is akin to having long-term steroid treatment, which suppresses immune function.
They will send me a CD of the X-rays soon. Should know blood results by the end of the week. Will update pictures of hooves and legs when I get a helper here to assist.
Erika
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Member:
ajudson1
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Posted on Tuesday, Oct 20, 2009 - 5:08 pm:
Thanks for a well written update. Looking forward to results from blood work and updated photos.
Ang
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Member:
mrose
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Posted on Tuesday, Oct 20, 2009 - 6:08 pm:
It makes sense that if the immunse system is taxed from any reason, the horse would be more suseptible to conditions/deseases that wouldn't normally affect it. I'll be interested to see what the blood work says. I'm glad her feet are o.k. At least that's one less thing to worry about. I suspect she may have more than one thing going on when you look at her "list of complaints" especially if her immune system is depressed.
Beau also has the weepy eys and the lids are sometimes puffy. I took it to be a sign the wind, pollen or flies were bothering her and keep her fly mask on during the day and washed out her eyes with saline in the evening. I wonder if the Cushings makes her more susceptable to those things? I hope all Sugar's problems are minor and that you are able to get them figured out. The general sensitivity makes you think it's systematic doesn't it?
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Member:
vickiann
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Posted on Tuesday, Oct 20, 2009 - 8:40 pm:
You make very interesting observations about the immune systems of horses.
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Member:
paardex
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Posted on Tuesday, Oct 20, 2009 - 10:02 pm:
So glad you ruled out a few unpleasant possibilities. I guess Sugars diet now can be upgraded too? That will probably make her happier which for 'an old gal with so many miles on her' is nice!
Don't forget to update!
Jos
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Member:
paul303
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Posted on Tuesday, Oct 20, 2009 - 11:45 pm:
Thanks so much, Erika. I'm really anxious to see how this turns out. So glad to hear the x-ray results were OK. Things are getting narrowed down.
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Moderator:
DrO
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Posted on Wednesday, Oct 21, 2009 - 7:19 am:
Ericka, the first step to the diagnosis of a cause of lameness is to localize where the lameness is coming from. Taking and reading radiographs of a unlocalized lameness is both nonspecific and not sensitive for finding lameness causing disease. For more on this see Diseases of Horses » Lameness » Localizing Lameness in the Horse.
As to the tissue biopsy method of diagnosis we discuss it in the article on Lyme Disease.
DrO
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Member:
erika
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Posted on Wednesday, Oct 21, 2009 - 8:22 am:
On Oct. 4, you wrote,"I would suggest you have a good set of hoof radiographs so that you can correctly position the coffin bone and rule out other causes of lameness.
DrO"
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Moderator:
DrO
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Posted on Thursday, Oct 22, 2009 - 7:46 am:
That would be correct if you know that you know you have a undiagnosed foot lameness Erika as you indicate in your first post. It seems since that time it has become less certain where the lameness is coming from as I outlined in my next to last post.
DrO
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Member:
erika
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Posted on Thursday, Oct 22, 2009 - 10:09 am:
Well, this is getting difficulter and difficulter, isn't it?
Yes, that is the problem, each time the lameness presents a little differently. And often in a different part of the horse.
This is the main reason we are going to pursue the Lyme connection a little further. We have located points that seemed to be the area of concern, but they just keep changing. This last visit, the LF toe reacted to hoof testers. Last time, RF hoof. Before that--bilateral. One time, RF knee after flexion, etc. Never (or rarely) the same place, but never totally sound. I'm beginning to think the only way to find out conclusively is to teach Sugar to talk!
Please understand, Dr. O, I am not being deliberately obtuse to what you are saying. But I have a husband who is still not 100% after Lyme's, and more than one friend who is dealing with devastating complications from it. I've had two dogs get it; and Sugar, having had similar symptoms in the past, responded positively to treatment before. Two friends' horses were successfully treated with Lyme protocol. Can you see why the Lyme possibility is sounding more like a "horse" than a "zebra" ?
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Moderator:
DrO
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Posted on Thursday, Oct 22, 2009 - 11:42 am:
I understand that humans and dogs get Lyme disease and have significant clinical signs Erika however we have not developed similar information on the horse. Concerning your horse in particular, even if we assume horse's develop polyarthritis from Lyme disease, I have trouble seeing what lameness localized to the sole has to do with Lyme disease.
You and your veterinarian will have to determine the best way to proceed and if this is what you are thinking that is OK but from the information so far provided the logic escapes me. But I hope this works well for you and that you get your horse well.
DrO
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Member:
erika
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Posted on Thursday, Oct 22, 2009 - 12:02 pm:
Thank you very much, Dr. O, I hope we figure it out too. I appreciate what you have to say, and I do understand what you are saying.
I'm not sure if the sole lameness hasn't mimicked laminitis. That was one of the symptoms Sugar displayed previously. I think the x-rays pretty much ruled that out this time, anyway. Fact is, we're stumped. I'm hoping Cornell has some interesting findings from the blood, or else a complete rule-out.
I hope you don't mind if I continue to update as we go along, in case we do eventually come to a conclusion. I think perhaps someone else might benefit if and when we do have answers. Sometimes I worry about this getting tedious...no intent to annoy, and apologies to anyone who is tired of hearing our saga.
Erika
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Member:
scooter
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Posted on Friday, Oct 23, 2009 - 8:13 am:
Erika I hope you continue to update, Sam is very much like Sugar. I would have sworn when we had his hooves x-rayed he would have significant rotation, but he didn't which was good, but confusing! He also had a thick sole and everything looked good as far as the radiograph's. When he gets "sore" it does seem to be many things including his hooves.
I did suspect lyme disease, but never treated for it, with the addition of pergolide his "soreness" has disappeared and he really looks good at this point. His fetlocks remain slightly swollen, but not painful to touch anymore.
My brother had Lyme disease also and it is a devastating disease. I don't know if horses get it, but there are many people that treat for it and have good results. Whether it is the doxy taking away inflammation somewhere or actually curing Lyme disease has yet to be proven I guess. There are many vets and teaching schools that do believe Lyme disease does effect horses, time will tell as more research is continued.
So please do keep us updated on your findings.
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Member:
erika
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Posted on Tuesday, Oct 27, 2009 - 9:11 pm:
Okay, I update today with a significant helping of crow...
Got lab results back from Cornell and Sugar is the picture of health according to her blood.
Insulin and glucose well within normal range, ACTH also normal, Thyroid normal, and TA-DA!! Dr.O will love this one: Lyme titers only around 120, therefore most likely not the issue. She told me over the phone while I was driving home today (I know,I know) so I don't have numbers yet, but she is mailing me the report and the DVD of X-rays.
After being dry lotted for some time, and I have been rasping away to get those hooves out of the embarrassment category, things seem to be improving. Sugar's attitude has been brightening. I haven't had a chance to trot her out to see if there is any more lameness yet. Maybe tomorrow depending on weather. Hopefully just bruises and stretched white line were the culprits and I am hoping that careful rasping is helping.
Doc still wants her on dry lot, even though my barn helper is dying to get her out on the grass with the others, I think we'll leave her right there for the time being! Why mess with a good thing? We have slowly weaned her off the soaked hay and begun giving dry hay. So far so good.
So I am having crow for dinner. Sometimes a mom's" instinct can be wrong and just good prudent care can make a difference. We'll see... hope it holds. Looking forward to being able to at least a brisk trail walk to help manage IR and weight, which is creeping up since she's in a small paddock alone. Not much exercise now, which I feel would benefit her when she is able.
Hope this continues in the right direction. Will continue to update as we progress. BTW, I may have "wasted"some money in some people's eyes, but the testing did go a long way in reassuring me, so it was worth a few hundred for rule-outs.
Thanks,
erika
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Member:
scooter
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Posted on Tuesday, Oct 27, 2009 - 9:31 pm:
Glad to hear it wasn't anything serious Erika . Sam is back out running around again in the pasture, I bet Sugar will be soon too....watch that grass tho!
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Member:
paul303
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Posted on Tuesday, Oct 27, 2009 - 11:33 pm:
Wasted some money for peace of mind? I don't think so, Erika. After all, why do we get spring and fall vetting? Why vaccinate? Why do fecal checks? Why do any of the "well" horse checks? It's so that we know that we are trying to do the best we can for our equine friends. No, Erika, that is far from wasted money.
There is nothing sweeter than a little peace of mind.........For horses are large animals, and when they encounter catastrophe....those catastrophies can be big....
vaccinations....................$$$$$$
Various blood tests.............$$$$$$$
Peace of mind...................priceless.
For however long it lasts.....
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Member:
jowidner
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Posted on Wednesday, Oct 28, 2009 - 12:04 am:
I'm really glad to hear the good news Erika, and I hope that Sugar continues to feel better.
Lee, "for however long it lasts..." Yes, peace of mind is priceless! And as all horse owners know, a temporary state until the next crisis looms! Thanks goodness we have Horse Advice, each other, and Dr. O to get us though the latter!
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Member:
canter
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Posted on Wednesday, Oct 28, 2009 - 7:03 am:
I hope Sugar continues to feel better Erika. And to my mind, spending money on our furry friends is never a waste. Lee got it just right...prioeless!
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Member:
ajudson1
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Posted on Wednesday, Oct 28, 2009 - 7:48 am:
It was nice to read such good news this morning! Now, hoofs, hoofs, hoofs...keep after them, great hoof form goes a long way to a horses comfort, the while you tweak diet.
P.S., if you decide to post pictures, would you please start a part 2? Sticky typing for me...sorry.
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Moderator:
DrO
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Posted on Wednesday, Oct 28, 2009 - 8:18 am:
Erika, you still miss my point: If these tests had come back positive, current equine veterinary science strongly supports that it would not have any meaning in relation to the symptoms you are seeing.
Normal healthy horses can have "elevated levels" on these tests. And horses with elevated levels on these tests have no more problems with illness than those with normal levels. In scientific parlance these tests are neither sensitive nor specific for any particular disease.
I am also confused by the responses of relief above. Getting back normals on these or any tests does not change the horse's symptoms. There is no laboratory test or groups of laboratory tests that can proclaim a healthy normal horse. We diagnose and treat horses not laboratory tests.
Complete exams, accurately defining clinical signs, creating problem lists modified by signalment and history, developing diagnostics that rules in and out listed items, that is how health problems are solved so as to yield correct answers.
DrO
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Member:
erika
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Posted on Wednesday, Oct 28, 2009 - 9:07 am:
Thanks for the words of support, everyone. Yes, even tests that give no answers help me with peace of mind.
We did a lot of dietary changes simply by pulling her off the fall grass. Soaking the hay probably helped with the initial symptoms of bilateral sore feet. I am willing to wager that she had low-grade laminitis at that point but catching it early helped.
Dr. O, I understand what you are saying. Still I am glad to see that her Lyme titers were a fraction of what they were a couple of years ago when treatment for that successfully helped.
And Dr. O the relief comes from the understanding that at least her cushings and IR are under better control than at times in the past. The blood sugar/insulin/ACTH, etc. did help me see that we are at least on the right track with feed.That is if I can keep my barn guy from sneaking her grass!
Many cushings owners speak of "DDT" as the best maintenance. That's what I am working on. Diagnosis, Diet, Trim, is what it stands for. Sugar was already diagnosed with Cushings. We are doing our best with diet and trim. My big worry now is what happens when I go to Florida for the winter. She will only get her five week trims and by a guy who I can't get to dubb the toes back enough! Maybe I'll teach my boarder to do the maintenance (she's a dog groomer!) for a break in her board.
Any way, tests or not, I am relieved. Will check current soundness tomorrow when the weather clears up.
Sure Angie, new pix will go in part 2.
Erika
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Moderator:
DrO
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Posted on Thursday, Oct 29, 2009 - 9:00 am:
As covered in the Cushing's article ACTH, insulin, and glucose values do correlate well with severity of the Cushing's and there is a normal large daily and seasonal variation in these numbers so comparing one test result to another is fraught with error. I do think a carefully conducted fasting glucose study can help define insulin resistance, a problem many horses with Cushing's have. But as a reliable indicator of Cushings severity I think it overstates what can be learned from these tests.
The way you tell is whether your horses clinical signs of Cushings are better or worse.
DrO
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