How long before laminitis pain is under control?

[Gwyneth]

My horse (with cushing’s) just suffered from a laminitis episode on the 22nd. This is the first time she’s been laminetic. X-rays showed mild rotation, and the farrier was out yesterday (23rd) to retrim her to account for that. Blood work revealed that she is also insulin resistant. The vet wants to start her on Levothyroxine which I’m going to pick up today (blood work showed that ACTH levels are well controlled on her current dose of Prascend).

She is getting Equioxx (which she was on before this for some arthritic pain), and is now on additional pain meds (acetaminophen). I’ve ordered the Easyboot Clouds for her (no where in my country had the Softride boots available in her size), but they haven’t arrived yet.

I’ve been icing her front hooves several times a day, but even with that and the pain medications she is still in pain. For people who have gone through a laminitis episode with your horse, how long did it take from the initial symptoms until your horse was more comfortable? My mare is in a deeply bedded stall and is happily eating, but she’s still quite tender. She rarely does the standard “laminitis stance” (usually stands squarely), but she’s constantly shifting her weight side to side and just hobbles around whenever she moves. It’s really heartbreaking to watch (even though I know it can get so much worse than what she has). Should I have noticed an improvement by now (2 days)?

[StormyDay]

It really depends on the horse. My mare was attempting to canter in her tiny little turnout a week after, and was non-reactive to hoof testers at 3 weeks out. I’ve also met horses who needed several months to feel better.

At two days, I wouldn’t be worrying too much. My vet told me it could be up to a week before I saw improvement. My only suggestion is make sure any hay/grain is low in sugar. Soak the hay, cut any grain. What we would consider a regular low sugar diet can be enough sugar to prolong the laminitis

Though you can’t see it, your horse has a wound. His laminae are torn and stretched, and just like any wound it can take a long time to heal. The smaller the wound, the less time. Some horses have a really high pain tolerance, others have a really low one.

I’ve used both soft rides and easy boot clouds and I prefer the clouds. More durable, and the soft foam inside is about the same as the soft rides.

[NaturallyHappy]

We had one that took quite a bit of time; he’s sound and in work now. We were told to ease up on pain medication to encourage him to lay down. So, we went back and forth on dosages of bute. It broke my heart to watch. We also used the Wolf Medical Boots. Good luck - I know it’s just terrible.

[ravenclaw]

Two days is a little soon to expect improvement. Up to a week sounds about right. With my horse, it wasn’t always a steady improvement. Some days he would look better and some days he would look more sore again.

Until the Easyboots arrive, you can go to Lowe’s or another home improvement store. Get a sheet of foam board insulation and make your own pads for your horse’s feet (trace around your horse’s feet). The foam board will compress so you will need multiple layers. Duct tape the pads to your horse’s feet.

[2DogsFarm]

Initial episode for my mini was 2yrs ago.
No rotation, put on Thyro-L (same med as yours) & feed switched from whole oats to TC Sr.
He got banamine P.O. for 2 weeks - 2X daily 1st week, then once daily.
By the end of week 2 he was noticeably more comfortable & back to use (I drive him) in a month.
He had a flare that Fall, but recovered in a week.
Hooves grew funky in front, but farrier did a great job trimming to accommodate & feet now look normal.
{KnockWood} he’s been free of any recurrence since then.
Still on the Thyro-L & TC Sr, muzzled 9h daily.

Hope your girl recovers as well!

[ThreeWishes]

Good idea! I have also used those little foam gardening mats meant to be knelt on in a pinch to apply to ouchy hooves

[S1969]

@Gwyneth

Should I have noticed an improvement by now (2 days)?

Well, not if the source of the laminitis hasn’t changed.

If the reason for the laminitis is the IR, there is no reason to believe it will go away until that is under control.

I’m not sure how long that will take. So, if the vet believes the Cushings is under control, I’d definitely be changing her diet asap to try to control the IR.

[ravenclaw]

@ThreeWishes

Good idea!

My vet told me about doing this.

[walkinthewalk]

As others have said, it depends on the horse and also degree of rotation.

My horse severely foundered in 2012 and was in pain for weeks, even though he was on pain medication. It was bad enough I talked to the lameness vet about PTS’ng him. The vet said the horse had a lot of Will & Fight and to give him a chance. We agreed on six months and if there was no improvement, I would do the thing I did not want to do.

Here we are approaching 2022. That horse had a laminitic setback in 2015, I managed to find a certified therapeutic farrier who has been managing his hooves ever since. Were it not for this horse’s other health issues, he would be rideable for occasional very short hacks up and down my road.

My horse has been in IR remission since 2015, but he is now Cushings and was diagnosed with Low Ringbone in one of those foundered hooves in 2019.

Treating Founder and it’s residual effects requires a LOT of patience and being astute in knowing your horse. It is also labor intensive and expensive.

Best wishes in a full recovery for your horse:)

[horsepoor]

@ravenclaw

Until the Easyboots arrive, you can go to Lowe’s or another home improvement store. Get a sheet of foam board insulation and make your own pads for your horse’s feet (trace around your horse’s feet). The foam board will compress so you will need multiple layers. Duct tape the pads to your horse’s feet.

This! I’d be making sure to provide some support like this til you get the boots. It can make a big difference I have found.

As others have said, it can take a bit of time to get them comfortable. I’ve had vets suggest adding ace on a regular schedule as it can help blood flow (and has the added benefit of quieting them), so that might be something to ask your vet about.

It is really hard to watch them in pain, I know, I’ve been there. Your vet should be able to help you assess things even if just over the phone, to know if things are ok or if you need to do more to help your horse through it.

[PNWSunnyDay]

What diet was she on and what changes has the vet suggested in response to the IR diagnosis?

[Calvincrowe]

Curious about diet as well-- that needs to change ASAP. My gelding is also Cushings and IR, and has had three laminitis episodes over 3 years, all from different “causes” but all boil down to access to grass in too great an amount. I third the idea of making her foam ‘boots’ until the softrides arrive (and those will make a HUGE difference in her comfort level, if my gelding is any indication! I wish vets would stock SoftRides in various sizes that they could loan out to laminitis cases).

Two days is probably too soon-- she’s in a lot of pain and it is not a quick to go away problem. You are doing the right things, take comfort in that, and follow your vet’s recommendations. It is so scary when this happens, take heart that she’ll get better and you are in good company with all of us who’ve been there. Hugs!

[Gwyneth]

I have been duct taping the hardware/ insulation foam to her front feet since yesterday, and that seems to help a bit.

She gets Teff hay (tested 6% sugar), that I’ve since been soaking as well. She gets just a couple of handfuls of molasses free (and rinsed) beet pulp to eat her meds, and that’s it. She’s always been an easy keeper and is prone to getting colic when on grass so she hasn’t had pasture turnout in years.

The vet suspects that it was her high insulin levels that caused the laminitis and not diet related (this also coincided with a really cold spell in the weather, so that might be related too?). Since it mostly seems to be connected to her insulin levels, there doesn’t seem to be that much I can do to change in her environment. She’s started on the Levothyroxine now, but I know that can take a few weeks/ months to cause any improvement.

She’s 20, and has been retired for a few years (she was my first pony, so I outgrew her quite a while ago). I’m just trying to find something else that I can do for her so I don’t feel quite so helpless… But now that she’s on her new meds it seems like we just have to wait and see?

[Showbizz]

After two months of watching our pony suffer on max pain meds and NSAIDS, I had her PTS even though vet wanted to go 6 more months. Farrier was on board with me and it was SO HARD to see her SUFFER every day. I don’t regret my decision. Hopefully yours feels much better soon!

[StormyDay]

If you are worried her pain is very bad, you can request the vet to do a nerve block on her. They use something that’s longer lasting than the lameness exam ones. It’s not always recommended because there’s a chance the horse will feel so good that it starts wanting to run around, but if you think the chance of that happening is low have your vet do them.

If the pain isn’t gone in a week or so, you could also request giving something like methadone, or another opioid. However, with the recent opioid crisis some vets are very leery to give such things out.

[JB]

@Gwyneth

She gets Teff hay (tested 6% sugar),

What are the ESC, WSC, and starch values?

@Gwyneth

The vet suspects that it was her high insulin levels that caused the laminitis and not diet related (this also coincided with a really cold spell in the weather, so that might be related too?).

If this is cold-induced laminitis, that can be really, really hard to get under control. I would (also) be wrapping her legs with the best standing wraps you can find, assuming you know how to wrap legs really well

But if her insulin levels are high, that’s also a problem. The Levo shouldn’t take weeks to make any improvement though.

[Gwyneth]

@StormyDay

If you are worried her pain is very bad, you can request the vet to do a nerve block on her. They use something that’s longer lasting than the lameness exam ones. It’s not always recommended because there’s a chance the horse will feel so good that it starts wanting to run around, but if you think the chance of that happening is low have your vet do them.

It’s hard to say how bad the pain is. She rarely dose the stereotypical leaning her weight back on her haunches stance. When she’s standing she’s usually just slightly weaving her weight from side to side, but she’s quite resistant to move, and when she does walk around in her stall, she’s very shuffly and limpy.
I think I’ll give her a couple more days and if I don’t see any improvement I’ll ask the vet about a nerve block.

[Gwyneth]

@JB

What are the ESC, WSC, and starch values?

Starch: 1.2
WSC: 5.0
ESC 4.7

@JB

If this is cold-induced laminitis, that can be really, really hard to get under control. I would (also) be wrapping her legs with the best standing wraps you can find, assuming you know how to wrap legs really well

But if her insulin levels are high, that’s also a problem. The Levo shouldn’t take weeks to make any improvement though.

I’ll look into wrapping her legs. I only have horse sized standing wraps, but I might be able to cut them down to her size (she’s a pony).

I’m glad to hear the Levothyroxine won’t take weeks to take effect. I read that it usually takes a month or more for symptoms to start to resolve? Or does it just mean that it will start to lower the insulin levels before that, but it might take 1+ months before outward changes become apparent (lessening of fat pads)?

[walkinthewalk]

When my foundered horse had torn tendons, thanks to a farrier, the lameness vet had me quilt him and wrap standing wraps over the quilts. It really made a difference in keeping his legs warm and the circulation going in his hooves.

There is a right way and a wrong way to put quilts and wraps on a horse. There are a couple of good videos by veterinarians on YouTube.

Here is a website for pony sized wraps, etc. I don’t know a thing about them, maybe someone else does:)

Pony & Horse Standing Wraps 4'' & 5'' Widths

[StormyDay]

Neither did my mare. My vet actually thought she had an abscess when I first called her out.

If you are concerned, there’s a lot of pain meds you could discuss with your vet. The methadone as previously said, lidocaine injections, lidocaine patches (they are super strength, goes right above the heel bulb) and morphine injections, some people use gabapentin as it can stop nerve pain. The morphine definitely will require a vet to do it it, but from what I’ve heard it last 24h so you could see if the vet could do it on her rounds.

And if she doesn’t respond well to any of it for several months, you can nerve… it’s not always recommended for laminitis cases, but as long as you keep a good track of her blood levels, control her diet, and don’t ride her, it should stop her pain for a few years. I did know a person who did it with her horse. He got another 5ish years before he was finally PTS, and he couldn’t feel a thing down there. He was a very happy horse for that time.