Did we establish if this was cold-induced or IR? I’ve lost that detail in the thread.
IR caused. Her insulin levels were through the roof (so high that the machine actually topped out on its max reading). But apparently cold weather causes insulin levels to spike, so it is a bit related to the cold. This episode coincided with record breaking freezing temperatures in our area, so it definitely seems like the cold had something to do with it even thought the vet is classifying it as IR caused.
2 Likes
Yes, I asked the vet about that, and they just said that NSAIDs are the most widely recommended pain drug and that they didn’t want to introduce too many new medications at once.
I’ve read that Metformin can help with relieving nerve pain, so maybe that will help with making my pony more comfortable.
1 Like
How often should I be taking her boots off/ looking at her feet? She really doesn’t like to pick up her right front hoof (oddly enough, her right front has more rotation than her left, so it’s odd that she doesn’t want to completely weight-bare on the foot with less rotation) so I don’t want to make her do it more than necessary.
@Gwyneth
I removed them about every other day, to clean out the debris and apply Gold Bond powder-- but he was in a small paddock with access to a sand pile which was fluffed (it was summer) and cleaned several times a day. He (and vet) loved the sand pile as he could adjust the sand to his comfort under his feet, and lying in it was ideal as it conformed to his body and made it easy to get up and down.
You’ll get very quick at removing them-- just make sure you mark Left and Right on the boots as their feet aren’t the same size/shape. The pads will also need to be replaced as they are smooshed by the horse’s weight. I used Valley Vet to order my replacement pads. I now have two types/sizes on hand.
I was hesitant to post this at first as I think it might be controversial, but a vet local to me is having excellent success with Botox injections as pain management therapy for acute laminitis. And in the rehab phase I believe. It maybe a more experimental type thing. Not sure. I can give you that vets contact details by PM if you’re interested in reaching out to him for a phone consult or something.
I don’t know anything else about it. It’s not my regular vet. I heard about it from a trainer and my farrier (that works with the vet doing the Botox).
2 Likes
Interesting! I looked it up and that technique seems to have been around for about ~10yrs. Just with looking it up quickly, it appears to be more toxic for horses and has potential to result in an overdose. It might be worth looking into again if no improvement is noticed, but I’ll probably leave it for now.
Pony (her nickname is literally “Pony”) actually seems a bit better today! Metformin usually takes ~3 days to take effect, so I doubt it’s done anything for her yet. I’m thinking the boots are offering her some relief; she’s hardly been shifting her weight from side to side. Although she still doesn’t really want to move about in her stall, she did wander up to the wheelbarrow while I was in there and gave a halfhearted attempt to tip it over/ push out the stall door, so hopefully that means she’s feeling a bit better if she thought exploring might be a good idea.
6 Likes
Glad to hear Pony is feeling a bit better.
I don’t know much about the Botox. I do personally know two horses that have had the Botox and they didn’t OD and perish so I guess that’s a win for that vet. I don’t use that particular vet (unrelated reasons) or I’d try to find out more deets just to know.
1 Like
The boots were a game changer for my boy’s comfort from the get go! I’m glad Pony is perking up a bit. I know my guy also got a bit depressed from the confinement of the stall (he’s used to 24/7 big paddock access and his buddy by his side), which made everything worse. Fingers crossed you are on the road to recovery!
The use of botox is very interesting!
Apologies for hijacking your post with another question, I hope that’s okay. What is the pathway that leads an insulin-resistant horse to laminitis? I have a science background and understand insulin resistance, and have a general understanding of what laminitis is and that IR/EMS horses are at-risk. But I think I’m missing the pathway and WHY/HOW that works. It’s because of the subsequent higher levels of circulating glucose? But, then what?
From my understanding, it’s the high insulin levels (and not glucose directly) that causes laminitis. The presence of glucose causes more insulin to be released, but glucose levels don’t always have to be high to cause laminitis/ high insulin (my pony’s glucose levels were fine).
It seems like the exact reason for why high insulin causes laminitis isn’t 100% known, but the best explanation is that insulin activates the “insulin-like growth factor receptors” in the hoof. When insulin levels get too high, they appear to trigger these receptors which results in rapid hoof growth (which is partially why heels tend to grow so quickly in acute episodes) and causes fast proliferation of the laminae cells which makes the coffin bone rotate.
If anyone has anything to add/ correct, please do!
3 Likes
My one mini (Cooper) has laminitis flareups. He was good for 2 years, but this winter it came on again. No changes in anything, but he did develop his crest again, which is a big warning to me. After reading this thread I was reminded he did better with leg wraps and his boots for warmth besides the extra deep bedding and stall rest. Within hours he was moving around, and this morning was pawing for his food. I did have to cut down leg wraps for his front legs, but am experimenting with leg wraps past his hocks in the back as he’s also got a very sticky stifle. What I think happened is he fell in mud - I usually keep the two boys in the barn loose during the mud season which has really been bad this year, but I was late getting them set up - and hurt his stifle/hips/back again, causing him to put his weight on his front legs, then it got cold and he had a cold weather flareup. Picture for cuteness! And yes, the wraps stay up on his hind legs even with him rolling and laying down, but I do reset them twice a day.
1 Like
Sorry to hear your boy is going through a flare up! Hopefully the acute episode doesn’t last too long.
Do you have him on any medications?
I’ve never had a horse with laminitis before, so seeing it first hand really makes me see how devastating it can be…
My pony seems better with wearing leg wraps too (the smallest size of the Back on Track quick wraps fit her).
1 Like
Pony update: She’s certainly starting to feel better now. She’s been on the Metformin for 3 days, so the neuropathic analgesia effects of it should be starting to work now (interesting that it has neuroprotective properties).
The vet did say it would be good to wean her off of the pain meds if possible, because since she is so small and is on the max dose of Metformin and Levothyroxine (in addition to the pergolide), the vet was worried that it might be a lot on her kidneys and liver. I took her off of the bute yesterday, and I haven’t noticed her pain increasing (if anything, she’s actually more comfortable now).
She rarely shifts her weight from side to side, and isn’t wanting to lay down as much now either (the vet said that, while we want to encourage them to lay down to take the weight off their feet, excessive laying down is a sign that the pain is uncontrolled).
I want to recheck her insulin levels in about a week to get an idea of how well the Metformin is working. Fingers crossed we continue to improve from here!
11 Likes
Great news! Thanks for the update.
1 Like
It does just take time. My boy has been off meds for two weeks, and has again started his pawing for breakfast/supper. He still gets leg wraps and boots when running loose in the barn area (he finally felt good enough to want to do that). It’s so easy to get frustrated (not laminitis again!) but to remember to have patience and let the healing happen.
1 Like
Another update: It’s been just over a month since my pony presented with laminitis, and she’s thankfully doing so much better!
I did end up changing to a new vet as I just wasn’t happy with my old vet’s response or attitude (I thought some of her responses were inappropriate/ unprofessional - such as laughing or giggling at my concern or questions). I changed to the vet who I use for my competition horse (my coach wants all of her students to use her vet, who is considered the best equine vet in the area), so I know him quite well.
He wanted to discontinue the Levothyroxine as he didn’t think it would be helpful in our case. He said Levothyroxine doesn’t “spot remove” fat - it just speeds up the metabolism and makes the horse lose weight everywhere. I’ve been so careful with her weight the last few years and made sure that she is showing just a bit of ribs as I didn’t want her to put more weight on over her crest. The vet said that continuing to use Levothyroxine would just cause her to lose too much overall body fat because she was currently in a good condition. And since her thyroid levels were normal, he saw no point in continuing it. So we’ve been slowly tapering it off (she’ll be completely off it in another week). I have noticed that she’s lost a bit of weight, and I’d now consider her underweight, so I’m happy to be stopping the Levothyroxine if it’ll only continue to make her skinnier.
Pony has been on metformin for exactly a month now, and is showing really good improvement on it! The second test of her insulin levels came back completely normal! It’s so incredible that her first test showed levels of over 2700 pmol/L, and this last one came in at 93 pmol/L.
She shows very little soreness now (on no pain medications), and the follow up x-rays shows that the farrier is on the right track with trimming. She’s started limited turnout in boots and is very happy to be out of her stall.
When I first started the metformin I did have some issues with it causing a chemical-like burn on the side of her lips (but not inside her mouth). I’ve since been putting a barrier of vaseline on her lips before syringing it and then wiping any metformin off that got on her lips. This has completely stopped the burns, but the hair right around her lips still hasn’t grown back, so I know it must still be causing some irritation.
I’ve talked to a local pharmacy who specializes in veterinary medicine, and they said that they could compound the metformin as a liquid in a base of oil, and that should help with the issue. So I’ll probably try that and see how it goes.
But so far, things are looking up! I’m so thankful that she seems to have pulled through this episode. The longterm plan is frequent re-checks on her insulin to make sure that the metformin is staying effective for her, and come cold days, making sure she is blanketed and has wraps on her legs. Fingers crossed the plan works, and that I’ll have at least a couple more years with my senior girl.
12 Likes
Thanks for the update. What great progress you’ve made! Prayers and good thoughts for continued healing.
2 Likes
@Gwyneth
This thread has been so very informative for those of us with IR horses. Thank you for sharing openly and honestly about your experiences. Thank you to those who contributed, as well. I am also a bit unhappy with my vet practice’s response to my gelding’s laminitis episodes. Unfortunately, finding an equine vet who is taking new patients here is near impossible. So happy your pony is improving! Yay!
3 Likes
