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The Laminitis Site

Early symptoms of PPID

7/21/2013

0 Comments

 
The seasonal rise in POMC hormones, the hormones affected by PPID (Cushing's disease) tends to start around late July/early August and last until late October or into November - this affects all horses, but particularly horses with PPID, and the seasonal rise can be a good time to diagnose horses in the early stages of PPID.

In the first of a series of articles that we'll be running on PPID over the next few weeks, here's a short video in which Dr Hal Schott describes some of the early signs of PPID. These include:
- change in behaviour/attitude/performance - the horse may become more lethargic or dull, less enthusiastic about work;
- muscle loss along top line or rump, you may notice the saddle doesn't fit quite so well;
- you may notice long guard hairs on the back of the legs, under the jaw or along the jugular groove. The long shaggy coat associated with PPID is usually late to develop and indicates advanced PPID;
- the horse may drink and urinate more - horses can become diabetic in the early stages;
- you may notice that the horse is sore footed, or it may develop obvious laminitis - laminitis could be due to PPID or EMS, but any laminitis, and particularly first time laminitis between August and October, could be a symptom of PPID.

More information about the early and advanced symptoms of PPID here.
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Don't raise the heel!

7/20/2013

5 Comments

 
It seems that some people still believe that raising the heels of a laminitic horse will 
Picture
A palmar angle of 19 degrees - this is not healthy!
reduce the pull of the deep digital flexor tendon (DDFT) and thereby prevent rotation. Devices can be bought and fitted that will increase the palmar angle by as much as 18 degrees - that's much the same as the palmar angle in this x-ray - I struggle to believe that anyone can look at that and think it is healthy! Arguments about the effect, if any, of the DDFT in laminitis have raged for years. There is research to support surgically cutting the DDFT, a procedure known as tenotomy, but this research is usually from back in the days when horses with more than 11 or so degrees rotation were considered to have a poor prognosis (that is definitely not the case!), and reference is rarely (never?) made to a correct realigning trim having been carried out before the surgery. And it has to be said that if you look hard enough, you can find research supporting just about anything! 
Besides, surely tendons don't contract - wouldn't it be the muscle, if anything, that was affected - and wouldn't artificially raising the heel actually be likely to cause the muscle fibres to shorten - the very last thing we want - as recent research found in women who wear high heels a lot (High heels "shrink calf muscle fibres").

Dr Debra Taylor and Pete and Ivy Ramey address the role of the DDFT in their Hoof Rehabilitation Protocol article: "our therapy of laminitic horses is based on the concept that tension of the deep digital flexor tendon cannot result in stress to the laminae if the toe wall is not allowed to bear weight at impact, stance or during breakover. While tension of the deep digital flexor does exert a rotational force on P3, this force cannot oppose the laminae if the hoof wall remains out of contact with the ground." 
Pete Ramey elaborates on p 349 of Care and Rehabilitation of the Equine Foot (2011) - "if the sole at the toe is in ground contact, and the toe wall is out of ground contact"..., "force applied from the DDFT can have little or no effect on lamellar attachment." He reminds us that the sole must be padded, and goes on to say that whilst elevating the heels may temporarily reduce tension in the DDFT while the horse is standing, tension may actually be increased when the horse is moving, and that any relief will be transient anyway as the flexor muscle will quickly adapt. Pete says that in all the presentations he has seen where raising the heel has been advocated, he has never yet seen a hoof restored to health. And finally - sorry to quote you again, Pete, but this is so important (and why IMO anyone involved with laminitis rehab should buy Pete's book!) - "I believe that DDFT tension concerns have held back the veterinary and farrier world, preventing rotation reversal by leading people to stand P3 up on its tip and ultimately destroying the foot."
Picture
The ECIR group has this to say about raising the heel (www.ecirhorse.org - ddt-trim):
"There is really no proof anywhere that raising the heel does anything to prevent rotation. The theory of DDFT pull also fails to explain why horses with the most extensive damage sink or how sinkers can have a perfectly aligned bone column with no rotation at all. In fact, some sinkers are more ground parallel than before the laminitis. Raising the heel has negative effects long term by increasing the pressure on the tip of the coffin bone and accelerating bone loss." 

We now know thanks to research by Melody de Laat  (Insulin-Induced Laminitis - An investigation of the disease mechanism in horses 2011) and others that during endocrine laminitis (~90% of all laminitis cases), the laminar cells stretch, and it is likely that this weakening of the connection between the hoof wall and the coffin/pedal bone leads to laminar failure and rotation and/or sinking, exacerbated by the the horse's weight and perhaps poor foot balance. 
Picture

Hundreds of horses have been restored to health and returned to work following rotation by following the ECIR group's realigning trim - simply realigning the hoof to the pedal/coffin bone, with a palmar angle of usually no more than 5 degrees - and not a heel wedge in sight. 

The Laminitis Site has had the same excellent results in tens of horses - the x-ray above is of Sorrel, who was back in work within 8 months of a correct realigning trim (carried out according to emailed instructions!), after 7 years of laminitis - read her story here.
We have recently heard of a horse with laminitis, no rotation seen on initial x-rays, heel wedges fitted, then further x-rays revealed rotation - hopefully a correct realigning trim and barefoot rehab will restore this horse to full health - and hopefully this article will prevent this happening to other horses.

See more under DDFT. 
5 Comments
    Articles

    ​Laminitis, EMS or PPID - start here​
    ​Who said "stop the carrots"?
    ​Pituitary stress hormones
    ​Should pergolide be increased for the seasonal rise?
    ​
    Are you using illegal supplements?
    ​Body Condition Scoring
    ​
    Pituitary Pars Intermedia Dysfunction
    Equine Metabolic Syndrome and insulin dysregulation
    TTouch for laminitics 1
    Laminitis and the Feet

    La fourbure et le pied
    Laminitis, EMS and PPID
    Testing Insulin
    Cold Weather 
    Laminitis Rehabilitation – The Owner's Perspective
    Casareño's recovery
    P3 - the pedal/coffin bone/third phalanx
    Vit C and PPID

    Vetcare Webinars Andy Durham 2013
    Movement - good or bad?
    Pulsatility of ACTH
    Starting pergolide/Prascend
    ​
    Managing horses with PPID - Marian Little & Dianne McFarlane
    Is it PPID or is it EMS? 
    FAQ: Rehabilitating the feet after laminitis
    Diet for weight loss
    Please report adverse reactions to Prascend
    Splitting Prascend tablets
    Measuring Collateral Grooves
    General Laminitis Quiz
    Body Condition Scoring Video
    Video comparing PPID symptoms and normal aging
    McFarlane 2011 Equine PPID
    Pharmacokinetics of Pergolide Mesylate in Horses - Rendle et al. 2013.
    EVA foam pads

    Rehabilitating the Laminitic Foot - Scott Morrison DVM
    Anaemia and Iron Supplements
    Early symptoms of PPID.
    Don't raise the heel!
    The Laminitis Site is now a charitable company!
    Izmir returns to work after laminitis in all 4 feet.
    Trimming the laminitic horse.
    A balanced foot.
    The circumflex artery and solar corium necrosis.
    What do you know about PPID?
    Laminitis myths.
    Frosty grass = high sugar!
    There are no magic potions!
    Is injected pergolide more effective than oral?
    ​
    Risk Factors for Equine Metabolic Syndrome - Dr Nichol Schultz
    Fly free Homey pony.
    Sorrel's doing great!
    Celebrating Homer's results!
    The Horse.com Ask the vet live: PPID.
    If the bone moves - move it back!
    Always get a diagnosis!
    Horses with laminitis need pampering!
    Autumn is the best time to 
    test for PPID.

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Disclaimer: The information, suggestions and links (hereafter referred to as “information”) contained in this website are provided for information purposes only and should not be relied upon nor replace professional veterinary advice.  Information is non-veterinary, is based as far as possible on current research, does not constitute advice or diagnosis, and should be discussed in full with all relevant vets and hoofcare or other professionals.  No responsibility is taken for the accuracy or suitability of information contained in this website, and no liability accepted for damages of any kind arising from use, reference to or reliance on any information contained in this website.  If you suspect your horse has laminitis or is ill, please consult your vet. 
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