Update p122: good news/bad news. Is this founder? Xrays included

[SusanO]

I guess this is something you need to have a discussion with your vet - Is he seeing an acute case of laminitis or are her problems a chronic case of founder, which may have happened a while in the past? Usually you do not see bony changes on radiographs during an acute attack unless it is really bad or the horse has foundered in the past and is having a flair-up. Maybe he thinks this rotation/sinking is something that happened in the past and that is why is not as concerned about it. Have you x-rayed her feet in the past so you have something to compare the current radiographs to? Even if she is not in an acute attack of laminitis those bony changes to her feet can be painful and can stay painful.

You are not a bad owner to put limits on what you can spend for veterinary procedures. And surely not a bad owner to balance the cost of procedures versus her prognosis. Sometimes, no matter how much money we can throw at a medical crisis in an animal, all that money can’t fix the animal.

[IPEsq]

I have a metabolic horse (thankfully no laminitis). I learned today that Renovo is a better product than the other biologics (we have used ProStride and IRAP on my horse for various things) because there is a new study about to be published that shows that blood from metabolic horses doesn’t contain the same amount of some of those healing factors that we are looking for compared to a non-metabolic horse. So knowing that may guide you toward a better option for the stifle than if you choose blindly.

Additionally, you should find out if your horse has changes in the front feet due to a metabolic issue because if she needs medication to help control insulin or help with foot pain, for example, this is an additional management issue on top of the better diet protocol. And not easy for a hard keeper type. Metformin needs to be given and then no meal for 30 minutes. Pain and inflammation control drugs aren’t great for the gut. Things like Thyro-L up their metabolism and hunger. Alternative drugs like canagliflozin and related drugs do help control insulin and can be effective for laminitis pain. But you can’t mix it with NSAIDs. And if already a hard keeper (versus the easy keeper overweight metabolic horse), they will need to eat a lot more to maintain healthy condition on these drugs. But of course that should still be low sugar food options. These are the horses who are IR / EMS despite not being too fat. Canagliflozin costs me over $500 for 21 days from the local pharmacy. I can get it for $300 for 90 days ordering the brand made in India. There is another drug in the class that is available for a little less money here.

If the founder is from a mechanical problem primarily instead, then it seems like it’s dependent on getting the very best outcome on the stifle plus finding the magic farrier solution. And would it be good to have MRI imaging or even CT of the feet to see what else is going on in there for a young horse to be having these problems?

I’m not trying to be an alarmist. Just that there may need to be some more homework done before you make decisions if you want her to try to have a shot at a job. And to understand if the management picture is even possible for you.

[Peggy]

@IPEsq

I learned today that Renovo is a better product than the other biologics (we have used ProStride and IRAP on my horse for various things) because there is a new study about to be published that shows that blood from metabolic horses doesn’t contain the same amount of some of those healing factors that we are looking for compared to a non-metabolic horse.

That is super interesting. I know you ideally don’t want to pull blood for those two (or ACS) if the horse is stressed bc there will he fewer healing factors in the blood. Look forward to seeing the study.

[Virginia_Horse_Mom]

@IPEsq

Additionally, you should find out if your horse has changes in the front feet due to a metabolic issue because if she needs medication to help control insulin or help with foot pain, for example, this is an additional management issue on top of the better diet protocol. And not easy for a hard keeper type. Metformin needs to be given and then no meal for 30 minutes. Pain and inflammation control drugs aren’t great for the gut. Things like Thyro-L up their metabolism and hunger. Alternative drugs like canagliflozin and related drugs do help control insulin and can be effective for laminitis pain. But you can’t mix it with NSAIDs. And if already a hard keeper (versus the easy keeper overweight metabolic horse), they will need to eat a lot more to maintain healthy condition on these drugs. But of course that should still be low sugar food options. These are the horses who are IR / EMS despite not being too fat. Canagliflozin costs me over $500 for 21 days from the local pharmacy. I can get it for $300 for 90 days ordering the brand made in India. There is another drug in the class that is available for a little less money here.

Both of mine were easy keepers. One was in the very beginning stages of a metabolic disorder, and the other was just old and left on spring grass too long one night with a muzzle she figured out how to push to the side and eat freely.

My insulin dysregulation horse was brought back within normal ranges with a super careful diet for months, and the metaborol supplement. I but that was pretty expensive. I think $90 for a thirty day supply? I can’t remember. Our next option would have been Thyro-L if metaborol and careful management of diet hadn’t worked
.

Your comment about the blood from metabolic horses being deficient in healing factors is super interesting, and how that might be a consideration when it comes to choosing a biologic. I will say, my horse was always a bit tight in her body even before the laminitic episode… even with a great fitness regimen, plenty of turnout, bodywork, and well fitted saddles and riding 6 days a week. She was very fit when the episode happened. After we started the metaborol and got her levels within normal ranges and returned her to work a few months after the laminitic episode? She was much less tight in her body. Just interesting.

Managing a hard keeper that is also metabolic sounds VERY challenging. And expensive.

[TWH_Girl]

@IPEsq

I have a metabolic horse (thankfully no laminitis). I learned today that Renovo is a better product than the other biologics (we have used ProStride and IRAP on my horse for various things) because there is a new study about to be published that shows that blood from metabolic horses doesn’t contain the same amount of some of those healing factors that we are looking for compared to a non-metabolic horse. So knowing that may guide you toward a better option for the stifle than if you choose blindly.

I’ve long suspected this. Also consider that older horses have less potent anti inflammatory factors. It’s a catch 22 because steroids may also not be appropriate for older and/or metabolic horses.

I do believe there are also some studies supporting Noltrex/Arthramid hydrogels for meniscus issues too so that could be an option. This is specific to Athramid-

Novel treatment of stifle lameness in a horse - Arthramid Vet NZ

[sascha]

The skin. Right where leg meets hoof.

[alteredcarbon]

@SusanO

I guess this is something you need to have a discussion with your vet - Is he seeing an acute case of laminitis or are her problems a chronic case of founder, which may have happened a while in the past?

Neither. I guess it isn’t bad enough? I keep getting the “I’ve seen SO much worse” line which I understand but also the horse doesn’t know that. I elected to bute her which the vet said probably wouldn’t hurt and should help the stifle. I’m emailing my other vet practice to ask about feet and stifle but I will say my team in real life is much less concerned about the feet than I am.

I don’t have any previous xrays of the feet unfortunately.

[alteredcarbon]

@IPEsq

If the founder is from a mechanical problem primarily instead, then it seems like it’s dependent on getting the very best outcome on the stifle plus finding the magic farrier solution. And would it be good to have MRI imaging or even CT of the feet to see what else is going on in there for a young horse to be having these problems?

My vet and farrier are leaning this way, mechanical vs metabolic if there’s anything going on at all besides thin soles. I guess it’s not unheard of for a 6 year old TB that isn’t fat and recently raced with all that high octane feed to also be metabolic but it seems unlikely? I can pull blood though I don’t think those tests are expensive?

I flat out can’t afford an MRI or CT, I think. Not if I want to also treat the stifle to the best of my ability.

[alteredcarbon]

I saw the arthramid article but couldn’t find a ton of information not published directly by the company. It really is hard to sift through all the marketing out there when the research is skimpy on even the most common horse problems…

[knic]

It’s really unlikely this is a metabolic issue in a 6 yo OTTB. You could do bloodwork to double check.

She probably needs shoes, pads etc to address the thin soles and angles. Is there a reason you have her barefoot?

[alteredcarbon]

She’s been in boots pretty much from the start. She’s barefoot because we couldn’t keep a shoe on her and she was ripping off hoof wall every 3 days. She really was comfortable up until the last month or so - stifle and some footiness both show up in my notes around the same time.

And here is also where it gets difficult. I don’t have a ton of farrier access out here but I am starting to suspect I need to switch. Finding someone to come out here for a couple trims and whatever this one horse needs is difficult unless they’re already out here. It is likely I’ll need to take all of my horses TO someone else, which isn’t simple when I work outside the home with limited PTO and have retired horses that haven’t hauled in forever. Right now I speed out of work on farrier day and meet them at the barn. Obviously I’ll do what it takes but I wish it was as simple as just finding a new farrier.

[knic]

Farrier access stuff is tough :/. Which higher maintenance farrier than your area supports plus the stifle doesn’t sound great for the long term. I feel for you

[alteredcarbon]

It’s frustrating. I never realized how impactful farrier access could be but I am learning fast that it’s essential. You’d think it would be vet access but with luck you don’t see them as much as the farrier! Anyway I started reaching out to see if there is someone else. My research says the NPA behind should’ve been addressed already and my pictures say she didn’t arrive bullnosed like this.

[Libby2563]

@alteredcarbon

These are her front feet xrays, the vet just said to have my farrier look at them, but that they could be rotation or could just be thin soles?

This is strange and unhelpful. Yes, a good farrier should be able to read films, but that’s really the vet’s job. I’m upset for you that you’re not getting better, clearer professional guidance about the feet.

[RhythmNCruise]

Maybe I’m just not skilled enough at reading the x-rays, but I don’t really see much in the way of rotation? That first one of the LF LOOKS like rotation, but as later explained, it’s because of the thing she was standing on. The RF and other LF don’t show much rotation that I can see, but maybe I’m wrong.

I have one with thin soles. He went so lame a few years ago that I was convinced he was foundering. Nope. He actually was dealing with hock and stifle issues. Adequan and Equioxx were the answer to his woes. He still has delicate tootsies and does best in hoof boots when being ridden, but with Durasole’s help he manages just fine in his day-to-day barefoot.

[Virginia_Horse_Mom]

@Libby2563

@alteredcarbon

These are her front feet xrays, the vet just said to have my farrier look at them, but that they could be rotation or could just be thin soles?

This is strange and unhelpful. Yes, a good farrier should be able to read films, but that’s really the vet’s job. I’m upset for you that you’re not getting better, clearer professional guidance about the feet.

Very strange from a vet. Laminitis is something I take super seriously, and prioritize mitigating immediately. It’s really painful for them.

I can appreciate that the stifle issue is bad… but I don’t understand prioritizing that over laminitis? Maybe we are missing some important details about the situation.

[alteredcarbon]

I’m honestly hoping the reason my vet and farrier aren’t as concerned is because it’s “just” thin soles. I mean thin soles aren’t something to write off but it seems that if you take the weird X-ray out of the equation we have less of an alarming picture. She’s sore in boots on gravel though… so I don’t know.

She’s on half a gram of bute twice a day while I make decisions and talk to people, but that was for the stifle rather than the feet.

[alteredcarbon]

If there are important details missing, they’re missing for me too 🥲. I’ve pretty much laid it all out.

[IPEsq]

The most accurate test you will want to do for EMS / IR / ID is the Karo syrup test. You draw baseline blood ideally after they have had hay only for at least 4 hours (but complete fasting no longer required), and then you administer a lot of Karo syrup and take blood again at 30, 60 and 90 minutes. You see how high insulin spikes and how it comes down over that period (or if it doesn’t).

I am interested in reading the study also. My vet was doing a routine soundness check on the horse, and we were talking about how his last treatment with ProStride for some arthritis was a bit underwhelming compared to previous treatments, and the topic came up. He has never tolerated triamcinolone (which is the worst for spiking insulin among the steroids we use for joints), but before his extended layup his body condition was generally ok. He was in full blown fatty mcfatterson insulin dysregulation when that last ProStride blood draw was done. I wonder if the healing factors can change in the same horse depending on whether their metabolic syndrome is controlled or not. Like, would ProStride work well for him again now that he’s lost over 100lbs and his insulin is doing better off the medication?

[IPEsq]

Then perhaps you should start with some nerve blocks in the front feet (off Bute) to determine how much pain is in the feet. That’s relatively inexpensive. Take X-rays of the hind feet too since you suspect NPA.