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  Discussion on Hoof Lameness advice
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Member:
jessblue

Posted on Friday, Mar 15, 2013 - 9:02 am:

Hi I recently posted about my horse who had a violent inflammatory reaction to procaine penicillin injections. Having just recovered, finally, from that he now has developed lameness to offside foreleg!! Unbelievably. He was recently at hospital following FUO which was why he had the penicillin injections. He was shod the day he got sick, so went nowhere other than hospital after shoeing. 2 weeks later when he came home he had this very painful rump then flank, then stifle then gaskin and was treated with more bute/metacam and doxycycline. This finally nailed the inflammation issue. Whilst walking him out daily, I had noticed he was a little choppy on turning, not every stride not every time, now and then as if trodden on a stone, especially on up or down slope. I didnt know if this was becasue he was sore behind. I actually though it was his near fore but my vet came out and said no it was off fore (opposite diagonal to the affected hindlimb by the way) Anyway, when he finished the doxy and painkillers 2 days later he was noticeably lame. Even on a circle on the lunge with the off fore on the inside he was lame. Quite uncomfortable to turn on the hard consistently. Vet examined both fronts and found digital pulse heat in hoof and sensitivity to hoof testers on outside near the heel to hoof testers. Pared the foot and poulticed in case of abscess. Nothing significant to report, some blackish discharge from 3 areas on poultice and a little bit of slime fron side of frog, but vet thinks this is not pus just the hoof getting cleaned out by the poultice. 3 days later he still has the digital pulse. Less heat if any and less sensitive to hoof testers. Vet says he is much less lame and to put shoe back on in 2 days. I am a little concerned as he has had these 3 things happen one after the other and I am not sure there is some sort of link. I wondered if he could have drug induced laminitis as he has been seen standing pointing the bad foot. Also, initially i was sure he was lame on the other leg? But admittedly I am no lameness expert. It just seems incredible that this is a separate issue after all hes been through. Could the drugs he received at RVC possibly cause laminitis?? He had procaine penicillin gentamycin, bute, gastrogard, metacam, doxycycline. Then added to feed succeed, probiotics naff pink powder to try and keep his gut healthy with all the drugs. It seems strange becasue he was slighly off when he returned from hospital and the lameness became worse when he stopped the antiinflammatories and antibiotics, which makes me think the drugs may have been masking this for a while.

Any advice helpful as I am back to worrying myself sick again. I have a bad feeling this will be another mystery illness that isnt going to go away quickly!
Moderator:
DrO

Posted on Saturday, Mar 16, 2013 - 8:32 am:

Hello Jessica,
Without knowing what is causing the lameness it is impossible to conjecture a cause. None of those drugs are known to cause laminitis but sick horses can acquire laminitis for a number of reasons. For more on diagnosing lameness, including what a foundering horse looks like, see the article HorseAdvice.com » Diseases of Horses » Lameness » Localizing Lameness in the Horse.
DrO
Member:
jessblue

Posted on Monday, Mar 18, 2013 - 11:10 pm:

Hi again and thanks for reply. The latest situation here is that it does seem it may be a laminitc flare due to his fever and resulting treatment causing toxins being released into the hindgut. Not able to confirm this obviously but he is still sore both fronts. heat in hooves and sore on turning, but not really lame in walk in straight line. Vet a little confused as he isnt sensitive to hoof testers currently and usually they would be around the toe area. So my vet thinks if its lami its very mild. He is actually landing slightly toe first if anything. One question I have please. My vet has ordered a glucose uptake test (i believe thats what it is called) I have to starve him then give him a massive bag of glucose with breakfast then blood is taken. My concern is that if we are trying to remove the sugar from his diet right now to reduce the inflammation and get the lami under control before further damage is done. Is it a good idea to give him what looks like a weeks worth of sugar in one go to go through his already delicate hindgut at this point in time?? I am worried it may cause the lami to flare even more. I dont want to question my vets advice without cause, but its just bothering me that we should maybe wait until he is stable and do this test later to rule in or out his insulin resistance. He took blood today for cushings. Also just to advise I spoke to the hospital that cared for him with his original FUO. They told me that laminitis was on their list originally and that they checked his feet for activity everyday but nothing showed!! My vet said no way laminits could have caused his fever of 40 deg plus for a week! He said they must have meant they were looking for laminits to develop as a complication of treatment etc. Thats not what she said to me though! I wish they had told me this as I would have been able to act more quickly when seeing signs of discomfort as I did early on!! I am seriously confused here and just dont want to miss anything. I appreciate you not having a lot to go on here but would value your advice and comments re the glucose test at this time. I am not sure it will change treatment currently and would probably rather do it later if that wouldnt be detrimental. Many thanks.
Moderator:
DrO

Posted on Tuesday, Mar 19, 2013 - 5:54 pm:

Though I cannot find a case of laminitis induced by a glucose tolerance test, I too would be reluctant to do a glucose tolerance test. It may be that the rapidly digestible sugar does not make it to the large bowel but this is uncertain.

Sugars that reach the large bowel cause a increase in the bacteria that release toxins that are believed to be a common cause of founder. You can experimentally cause a horse to founder by overloading carbohydrates, though a carb that is likely to reach the large bowel is used.
DrO
Member:
jessblue

Posted on Wednesday, Mar 20, 2013 - 2:32 pm:

Thank you Dr O, That is very useful information. I did discuss this with my vet and although he also said there were no documented cases of founder being made worse by the glucose tolerance test, but it was something we could do at a later date, as we were trying to cut his sugars and starches in order to get the founder to subside. I am interested to try and figure out why my horse has developed laminitis. I strongly suspect it was due to the toxic episodes he experienced along with the other circumstances of being starved for 3 days while at hospital, then gastric ulcers being found on scope, then receiving gastrogard for ulcers, rendering the balance of acid going through the hind gut very changeable through this time. Then large doses of antibiotics etc. I am interested in your opinion of whether the glucose tolerance test is of much value if done outside a hospital environment? I understand when done in hospital the glucose is tubed in after fasting for 12 hrs. Then bloods are monitored every hour for several hours to see how the horse responds. If we do this test at home will it still give accurate results? Obviously fasting when a horse is at a yard away from my home could be a bit hit and miss and bedding would have to be removed as he would eat this if hungry. Also, if the horse is found to be insulin resistant, what difference would this make to his every day life? Obviously one would take care having had an episode of laminitis with diet/grass etc anyway. Also, if we are to assume his laminitis was related to the fever/toxic episodes etc, why would we expect him to be insulin resistant? Can we not put his laminitis down to the other circumstances rather than a possible metabolic imbalance. Sorry for rambling, just trying to fully understand where my vet is going with this. By the way no rotation of pedal bones on x ray and bloodwork all completely normal. Hooves much cooler now and no digital pulses. Still a little sore on turns though.
Moderator:
DrO

Posted on Saturday, Mar 23, 2013 - 8:39 am:

Jessica, there are several tests that are performed in several ways for IR and EMS. We have a detailed discussion about this in the article at: HorseAdvice.com » Diseases of Horses » Endocrine System » Equine Metabolic SynDrOme and Insulin Resistance » Research Summary: Seasonal effects on IR testing. I think it will clear up several of your questions.
DrO
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