Founder/Laminitis- Looking for Advice

[myvanya]

This is pretty long, but here goes…

My mare was diagnosed with Laminitis on one front hoof about 3 months ago; she is 21, IR, Cushing’s, and has struggled with Navicular pain her whole life, though since I have owned her and got her in better farrier care the navicular issues were well controlled.

We took x-rays and they showed about 3 degrees of rotation and a little sinking. My farrier worked from those x-rays to modify her shoeing, she was on stall rest for a few weeks and on a two week course of Equioxx, we also put her on Thyro-L and resumed Cyproheptadine (she doesn’t tolerate Prascend). She has been on a low starch diet for years, and I switched to an even lower starch feed (the former feed was about 14% NSC and the new one is 8%). She lives in a 14 x 30 sand paddock; we added more sand and put shavings in as well under her shelter where she stands the most. She responded well and seemed to be improving so after she had been doing ok off of Equioxx for a month hand walking was added in slowly, and eventually walking under saddle. I was given some soft ride boots and they seemed to help her as well.

Then 2.5 weeks ago she had another laminitis flare up. We put her on twice daily oral banamine, increased the Thyro-L dosage, added in gabapentin, and pentoxifylline. Took new x-rays and the sinking seemed to be gone but the rotation had increased quite a bit and is now more like 10 degrees. Her sole depth was good and the vet said her shoeing looked ideal for her situation, my farrier redid her feet using the new x-rays and that seemed to help a little and there was slight improvement. After a week and the improvement we had seen, we tried to switch her from the Banamine to Equioxx. She did okay for about 48 hours and then got worse again, so we put her back on Banamine for another five days at a full dose for her weight, and then transitioned down to a half dose, still twice a day. She seemed to be holding steady or slightly improving for a few days again and we went off gabapentin as planned. Then she got worse again. We added the gabapentin back in, and she is continuing on the half dose of banamine twice a day as my vet is concerned about doing the higher dose longer and risk if kidney problems. My farrier will be out again today or tomorrow to see if she can get her any more comfortable. We have also been icing her once a day for at least 30 minutes using gel packs as my farrier doesn’t want her standing in water and I can’t get to the barn more than once a day. I have also been applying liniment or poultice (alternatingly) to her coronary band area. She is still pretty sore.

Here’s where I am hoping for input…

I am deeply concerned about her quality of life at this point. I am a firm believer that it is better to euthanize a day too soon than too late. But it’s still heartbreaking and I also don’t want to give up on her if this is something she can reasonably expect to recover from, even if just to soundness in the walk. I also do have to balance this with finances too, as much as I hate that money plays into it. I was unemployed for about 6 months, which I had savings to handle, but now even after being back in work for 4 months I only have a couple thousand available for this. My vet is aware and has said that she supports me either way with trying to continue treatment or euthanasia. She thinks there may be a chance of recovery perhaps since it is only in one hoof, but can’t say for sure either way. She has said I can consult with an equine podiatrist in the area or possibly do surgery to cut the tendon involved in the rotation process. So… thoughts? Advice? If this was your horse, what would you do? I know asking for advice from strangers is not a replacement for continuing to work with my vet and farrier, but I want to gain as many perspectives as I can to make sure I am not overreacting or missing something.

[Scribbler]

Most of the medicines you are naming are pain killers. They won’t affect the rotation one way or another.

The fact that the coffin bone is still sinking suggests you have not yet got a handle on the metabolic or hoof angle issues.

What is the sugar level in the hay? What feed is she on? I would suggest putting her on tested low sugar hay (below 10%), no bagged feed at all, and get her a good vitamin mineral supplement with therapeutic doses of copper and zinc, like California Trace, which you can feed in a mash of hay cubes or pellets. No grain at all.

I also recommend the ECIR FB group, I think it’s called horse nutrition.

Also the Hoof Rehab FB group connected to Pete Ramey.

Keep in mind:

Painkillers only mask the pain. They are necessary at times but they will not fix the problem.

Correct mineral nutrition will regrow better quality hoof over time. Low sugar hay will stop diet caused laminitis episodes. Hay can be as high as 25% NSC and I have seen horses get obese and founder on hay only diets.

Correct trims for angles including a short toe plus padded boots to allow movement are your best hope for encouraging the hoof to remodel.

With these kinds of issues the owner really has to self educate fast and be proactive which I can see you are starting, which is great. It’s not the kind of problem like stitching up a wound that the vet can just do for you. You need to think about the whole horse.

[myvanya]

Thanks, @Scribbler
I should have included…she is on Bermuda hay for two feedings and alfalfa for one. I don’t have hay analysis available for them as she is boarded and buying all of her hay really isn’t am option. She has to be on some feed to get her meds and supplements. Currently getting Cyproheptadine, and Levothyroxine for the metabolic issues, as well as Platinum GI, Platinum electrolytes, Platinum metabolic, Platinum Otho-Chom II HA, Smartpak SmartLamina, and Smartpak Chasteberry. She is a very picky eater so doing just hay pellets or beet pulp aren’t an option if I want her to take any meds or supplements; I have her on the lowest NSC feeds I could get my hands on that she would eat. She is definitely not obese or even overweight. She was being worked consistently until Covid happened. I am high risk so I couldn’t go to the barn for a month or so, but then was getting her back in work when all this started. She still got light work as well as turnout during the time I could not go to the barn. She did not gain weight during that time either.

The vet agrees that her trimming and shoeing is correct, hoof angles are good and her toes are short.

I have had a Cushing’s horse in the past that lived into his 30s, so I am familiar with the protocols for that and have been following them with her for years now.

[walkinthewalk]

Exactly what IS her trimming and shoeing protocol?

Respectully, it sounds as if you are “throwing the kitchen sink at her, by feeding too many things that claim to help metabolic issues.

I would get her completely off all of that and also anything that is a feed or ration balancer.

I would feed her a condensed, soy-free, no added iron vitamin/mineral supplement. It only takes three ounces for the horse to receive the nutrition they need.

I feed HorseTech’s HighPoint for grass fed horses. They make a meal form and a pellet form. I might ask them for a sample of the pellets to see if she will eat them. If she doesn’t, buy the meal add some water and syringe down her particular self.

Most people would have PTS’s my foundered horse years ago — BEFORE he fractured his sacrum for the second time. I just had new e-rays done and his coffin bones are still at a dangerous position, after all these years.

I have a therapeutic farrier who has him in:
Natural Balance PLR steel shoes. She hot shoes him to cauterize the whitelines and uses copper nails.
Castle Brand plastic wedges with a frog pad. The rear of the wedge is 3/8”.
VetTec’s EquiThane CS is poured liberally onto his soles.

His hind hooves are bare but it’s still a three hour process just to reset.

A sports medicine vet from another county did the X-rays because none of the local mobile vets have portable equipment and I am not asking this 25 hr old guy to get up on a trailer with a twice fractured back.

Given all that, the sports medicine vet was astounded not only at how good this horse looks but how good he moves, given the amount of rotation he lives with. The horse has a spot of arthritis at the top of the P3 and a spot at the coronet band, on the same hoof. When I dug out his 2013 x-rays, those spots have barely enlarged - barely.

I say all this because the crux of the issues with your horse will come down to how much micro-managing you are able to do and how much money you are able to spend on quality help.

I am retired but hypertensive Type A DH still works full time. That allows me to spend every stinkin’ rotten penny of my retirement on my last two horses. If I couldn’t do that, I would have had to PTS my foundered horse several years ago.

Your horse’s diet could use a total revamp as, IMHO, you are killing it with too much stuff and stuff that doesn’t work for seriously metabolic horses. I would also question the vet. I have learned the hard way, even some so-called lameness vets don’t have all the answers but they are still a lot better than your regular vet shooting from the hip.

Its even worse with farriers. Lots of good farriers out there if the horse does not have special needs hooves. It took me a few years to find the farrier I have now. She has been performing miracles on this horse 3-1/2 years, without benefit of x-rays. The only flaw the sports medicine vet and a farrier who studied under Bowker could find, was the RF was just a tiny bit too far forward, and that will be corrected when she resets this horse this weekend.

Best wishes in whatever you do:)

[myvanya]

@walkinthewalk thanks for your input.

She had been on most of the supplements for a long time prior to this and had done very well. I added in the two Smartpak supplements for the Laminitis as there doesn’t seem to be anything in them that could hurt and it could help. I will take your feed advice under consideration, I used HorseTech supplements in the past but switched to Platinum as we were competing and wanted the quality control they offer. She is not an easy keeper though and is extremely picky so I will have evaluate that further, but she isn’t getting much fees beyond hay and what she gets is less than the 10% NSC recommended by my vet. The vet is happy with her current diet for what it’s worth. I am new to the State I live in, but chose this vet clinic based their extremely good reputation. My horse has been seen by multiple vets at this clinic and all seemed to know their stuff. I am open to getting more vet opinions…but I don’t have unlimited finances.

My farrier is ELPO certified and has the CLS certification. I use her as she was recommended by my farrier in Colorado who had made this horse and others I have had sounder than ever should have been possible for them. The current farrier had been maintaining the progress of the former farrier very well. All that to say, based on everything I know, as well as the multiple vets that have seen my horse…I have a good farrier. I will probably consult the equine podiatrist recommended by my vet as well though.

My horse is in a fairly wide steel shoe with wedge pad that includes frog support, she has some form of packing under the pad as well, but I honestly don’t know all the brands. Prior to this she was in EDSS Freedom Shoes with some form of packing; since being in them she was the soundest she had ever been and her gaits were much improved. The vet also approved of how she was shod before this.

My biggest concern is whether I can get her through this acute phase. I wish I had more time and money to spend on my horse, but I work full time and have my own chronic health issues complicating things. I have tried very hard to make sure I have quality help though.

As far as the concerns with her diet, what exactly are you thinking she is getting too much of?

[walkinthewalk]

It sounds as if you and your professional caregivers honestly do have a good handle on her palliative care:)

As far as the supplements, I am for “less is more”:):). It seems like she is getting too many things. Also, often what worked THEN may not work NOW:)

I have tweeked Joker’s diet a few times since 2012 and I’m probably not done yet:(

According to the x-rays two weeks ago, my horse only has about 50% of the sole depth he should have and he is still rotated a lot more than three degrees. The vet who x-rayed him said that’s a concern but not as big as it would be, due to the package the farrier has on him.

I never had my horse on Thyro-L. The lameness vet, in 2012, put him on Hot Hoof I instead. I syringed it down him 2X/day for three years. He lost 100+ pounds and has kept it off without having to wear a muzzle.

My hay is locally grown orchard/mix and consistently tests somewhere in the 8% range for NSC. The time of day that hay is cut is crucial to the end starch value.

My horse’s current diet is:

HorseTech HighPoint for grass fed horses. I like this because it has all three amino acids:)
HorseTech “GutWerks pre-probiotic
HorseTech Natural Vitamin E 5000 without selenium
HorseTech BioFlax 20
Cosequine ASU-Plus, mostly for his fractured sacrum, but the arthritis on his P3 & coronet band has barely changed since 2013.

All that mixed in 1/2 to 3/4 measuring cup of Standlee Timothy pellets and I get away with a 50:50 mix of pure apple juice & water to hold everything together.

I have also been feeding him 1500 mg of pure human L-Citrulline from “Source Naturals”, cheapest on Amazon.

Between his twice broken back, still very rotated coffin bones and now Cushings, the vision of this horse sounds like he should join his ancestors “yesterday”.

Here is his 25 year old self, after he shed out, spring of this year:). He is a fighter, bar none. FWIW, he receives 1/2 mg Prascend daily but I break that 1/2 mg into two doses.

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I will give him a regimen of Egusin twice yearly, when I have to de-worm him, to buffer his stomach from the worm meds, as he ended up with ulcers from all the Previcox he was on when he foundered in 2012. If I could give Egusin 15 stars, I would. It’s bloody expensive but it seems to do the job on gastric and hind gut issues:)

[myvanya]

Thanks for the additional info @walkinthewalk .

My big concern is the level of pain she is still in even with the current care. Her x-rays don’t look super bad and she has plenty of sole, so everyone involved so far is a bit surprised that she isn’t showing improvement. I desperately wish I could find something that would get her comfortable so I can focus on rehabbing, gently adding in exercise, and making changes to her management for the long run.

She is getting a bit more as far as vitamins and minerals than what you are doing, but aside from that our regimens aren’t all that different. I did add in the Smartpak supplements after some research, but otherwise she is basically getting GI and multivitamin/multimineral, chromium, magnesium, and joint stuff. And she is on electrolytes as she is sensitive to heat, sweats well, and absolutely refuses to use a salt lick. The electrolytes are as plain as possible and don’t have added sugar or anything like that. I also give her omeprazole any time she is under stress. She sheds out well, but I body clip her because, being half draft and a quarter Morgan, her coat is always super dense and until this she was in consistent work so clipping helped her stay cooler.

[walkinthewalk]

I re-read your first post. I did. It see the second rotation of about ten degrees. That’s about where my horse is.

you also mention navicular. That much rotation would have to affect the navicular issue. I think that would be my first question to your vet.

I get what you are saying. It’s tough enough to manage a horse like this, if there is some fins cushion and our health is relatively good. You also are in a boarding situation, while my horse is home - another huge piece of the micro-managing formula.

I have never had to deal with navicular so have nothing to offer except my sincere sympathy and that I surely would ask the vet how the new degree of rotation affects the navicular issue and your horse’s level of comfort:). The answer may play a huge role in your decision.

[EmilyM]

I’m sorry this is happening. One of my nice hunters had laminitis this spring despite being in a muzzle. He turns out to have EMS.
he sunk a little but the hospital failed to tell me that until discharge three weeks later after a 7k bill. I would have euthanized had I know even though it’s mild. He is sound now but hasn’t been turned out since June per The hospital discharge instructions. I too worry about quality of his life because he can never eat another blade of grass. And he loved his turnout. I will make him a sand paddock.
I was told to soak hay for him for the rest of his life. Feed ration balancer. No grass. He’s on Thyro l and metformin. Have you tried metformin?

In your situation w a 21 year old horse that has ongoing struggles I think euthanasia is a perfectly acceptable option. Laminitis is a painful disease.

best of luck.

[dotneko]

Are you soaking the hay? That also reduces the sugar. Feed her much less. No grain, soaked hay. You havent got hold of her metabolic issues yet.

[MsM]

It is okay to call it too much for her to go through at this point. IMO, if I couldnt quickly get her reasonably comfortable without extreme measures, I dont think her quality of life is adequate. With animals with multiple problems you start adding this and that to combat problems and no one thing seems like it should cause the end. But then you stop and look at the overall situation and realize how much you are doing and that it is still not enough.

If you are looking at a longer uncomfortable “recovery” perhaps even with a painful procedure, you have to think very hard if the result is worth the pain and distress to the animal during it. And then how comfortable will she be with how much medication and for how long? And at what cost financially and emotionally to you?

I dont think it is cruel to try to get her through this latest crisis, but if it were me, I would get the best pain relief possible for a short time and let her go sooner rather than later.

[Gainer]

I’m sorry if I missed it, but is she on Prascend for the Cushings? It appears as if you’re only feeding supplements for the metabolic issues and that may not be good enough. Does she wear a muzzle when out? I have a gelding that, although he has never tested positive for Cushings, had all the symptoms. Fought laminitis constantly in spite of his wearing a muzzle, only getting soaked hay, etc. etc. Put him on Prascend and haven’t had another bout of laminitis in 5 years.

If I missed something, I’m sorry. I’m at work and just buzzed through the thread.

[Scribbler]

I’d also get rid of the alfalfa.

[BAC]

@MsM

I dont think it is cruel to try to get her through this latest crisis, but if it were me, I would get the best pain relief possible for a short time and let her go sooner rather than later.

I agree with MsM. Considering her age and other health issues I think you need to consider euthanasia. I’m so sorry you and your mare are going through this.

[myvanya]

Thanks so much for the responses so far everyone. Currently waiting to see if my farrier will have any more success in getting her more comfortable today. I will call the equine podiatrist on Monday unless a miracle occurs between now and then. Last night when I iced her she seemed more off on the left, which is radiographically normal; the last few days the right, which has rotation, was still worst. It’s heartbreaking to go through so I really appreciate everyone’s input. This mare is so special; it would take a while to fully explain why, but suffice it to say that my chief goal is to provide for her in the best way I possibly can whatever that is, and I wish very much I had unlimited resources to do so. Though I have only owned her for a few years, I have known her and loved her her whole life. Even thinking about a world without her in it is gutting and I appreciate everyone’s helpful and kind responses to help me figure out the best options for her.

And to answer questions/respond to specifics…
@EmilyM we haven’t tried Metformin yet. I can ask the vet about that the next time I talk to her. Thanks for the suggestion!
@Gainer she could not tolerate Prascend so she is on Cyproheptadine for Cushing’s instead. I have unfortunately had terrible luck with Prascend, though I know it’s a literal life saver for many horses. My sister’s horse is on it and doing great. It caused my gelding that I grew up with to go off feed and then colic multiple times so it wasn’t an option for him, then with this mare I saw similar symptoms starting even on a half dose of it and couldn’t risk it getting worse. So…we have been doing our best with Cyproheptadine, supplements, and diet. She is never turned out on grass. Her paddock and turnout when she gets it is sand. When she was in work I would allow her a couple bites of grass occasionally but she hasn’t had any grazing or fresh grass since well before this started.
@dotneko I am going to try to work with the barn owner to set up something for soaking hay, but have not been able to get that figured out logistically yet. Her diet is reduced to the maximum limits of reduction recommended by the vet and for what is needed to get her medications into her. She is definitely not overweight at all but we are still reducing as much as the vet feels safe doing.

[ThreeWishes]

If you don’t test it you HAVE to soak her hay. I know it’s tedious and hard. But it is her entire diet really. And her laminitis will never settle until you do. Shoeing, supplements, icing won’t do anything if what is sustaining her is triggering a bad cascade of events. Been there done that. Sending all my good thoughts.

[walkinthewalk]

I hope the farrier can find a method to make her more comfortable:)

The left, which is the good hoof, is likely starting to suffer because she is relying more on it.

If we have a sore leg or foot, we tend to put more weight on the good leg. If we have to do that long enough, pretty soon the good leg is bad from overuse.

Best wishes for a good outcome with the farrier:)

[SharonA]

I am so sorry for what the two of you are going through, OP. It’s very clear that you’re caring and involved. Your horse is lucky to have you on her team.

I would, if it were me, let her go. Even if she recovers from this episode, I think it’s going to be hard to keep her comfortable going forward. I guess I feel like we all can go along coping with small injuries and metabolic issues while we’re young and even well into middle-age, but there comes a point in our aging when the body can’t compensate anymore, and things start to hurt and to start compounding each other. I feel like it possibly could be a gift to her to send her on before the laminitis or the navicular gets worse, and before the pain in her feet starts affecting her joints, her back, her neck, etc.

Regardless, trust your own instincts. You know her better than anyone else.

[myvanya]

Thanks for the advice, support, ideas, and thoughts everyone.

Unfortunately, as much as I wanted to get her through this, I can’t put her through more pain. As much as it breaks my heart and leaves a gaping hole in my life, I have to give her the gift of freedom from pain. I know the impact chronic pain has on my own life and I know horses experience pain differently and probably more acutely than we do.

She was happy tonight, but in pain. So we appreciated the happy moments together, she got lots of treats, and she got some time with her “cousin” (my sister’s horse). I am absolutely gutted, but I know this is the right thing to do. Sorry if this is a bit discombobulated…but I really am thankful for the help everyone gave.

[quietann]

This is heartbreaking, but thank you for doing right by her.