RosieWhen we were asked to come and look at Rosie, her owner reported she was not herself, uncomfortable, lying down far more than normal, lethargic and depressed.
It was May, rain and sun had caused an explosion of lush grass, Rosie was 16, not in work, a cob who lives on fresh air, and had had 24/7 access to unlimited grass. We hardly needed to see her to know she had laminitis! But 2 vets had made 3 visits in the previous 6 days, and laminitis had apparently not been diagnosed. From outside of the shelter where she was thankfully contained (her owner having had a hunch that it was laminitis), we could see that she was paddling with all 4 feet, hardly moving - if she moved at all she shuffled backwards and forwards, turning was clearly painful. Her head was low, her eyes dull, she was clearly in pain, and her pulse rate varied between 52 and 60 bpm. She had bounding digital pulses in all 4 fetlocks/pasterns, but her feet and coronets were not warm (heat in the feet is an unreliable sign). Her stance was normal (we have found a normal stance common in horses that have all 4 feet affected by laminitis), but her quarter muscles were tense. She was given Bute immediately. |
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1. Classic dip between cresty neck and withers.
2. Large crest along top of neck, largest in the middle of the neck and falling away to either end. 3. Lack of shoulder definition. |
She was very overweight - body condition score (BCS) 7/8 out of 9, with a large neck crest (left) and fat in the hollows above the eyes (supraorbital fossae) (right), a crease down her back (above right), fat pads behind the saddle area (below), and it was difficult to feel her ribs.
Fat pads behind the saddle area
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Filled supraorbital fossae
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Rosie's feet were due for trimming (laminitis is generally worse when feet are not correctly balanced), with high heels which were preventing the frogs from bearing weight, and causing all her weight to be born on the walls. Pads were improvised from foam swimming pool toys cut up with a hacksaw and bandaged onto the back half of her feet with Vetwrap (Duck tape could also be used) to fill the gap between her heels and frogs and increase the weight-bearing area at the back of the foot. Although she was able to pick her feet up if we timed the "ask" with her paddling, she was unable to hold her feet up for more than a few moments, so applying the pads was a 2 person job and she was allowed to put her feet down when she asked. The pads brought her immediate relief, she reduced the frequency of her paddling and started to move around a little more and nibble at hay (the horse must be monitored when any device is applied to the foot to ensure that it increases rather than decreases comfort). Although at this point it was difficult to thoroughly inspect her feet, hoof rings, a less than tight white line, redness in the walls and flaring suggested that this wasn't her first experience of laminitis, although it was the first that had caused enough pain to be noticed (see Chronic laminitis for signs of changes in the feet due to laminitis).
Rosie had to be moved home to a stable. A deep bed of straw (which was replaced with sawdust ASAP for better support and less calories) was prepared, hay soaked, and a trailer with a low ramp was driven right up to her door so that she had the shortest possible distance to walk. She travelled the short distance to the stable with her companion, foot pads in place.
A diet of 1.5% of her current bodyweight in soaked hay (she weighed just over 400 kg so just over 6 kg DM hay) was recommended as she needed to lose weight, with a low calorie balancer for minerals and protein, linseed, salt, and magnesium oxide in case that would help reduce her neck crest, and a low sugar/starch chaff (Dengie HiFi Molasses Free) and/or a handful of rinsed and soaked sugar beet to carry her minerals. Absolutely no grass, carrots or sugary treats of any sort. Her feed and water were kept close to her and offered above ground level where possible to reduce the pressure on her front feet, her companion was close by but unable to make her move, and we hoped that she would lie down for long periods, which she did.
Rosie had to be moved home to a stable. A deep bed of straw (which was replaced with sawdust ASAP for better support and less calories) was prepared, hay soaked, and a trailer with a low ramp was driven right up to her door so that she had the shortest possible distance to walk. She travelled the short distance to the stable with her companion, foot pads in place.
A diet of 1.5% of her current bodyweight in soaked hay (she weighed just over 400 kg so just over 6 kg DM hay) was recommended as she needed to lose weight, with a low calorie balancer for minerals and protein, linseed, salt, and magnesium oxide in case that would help reduce her neck crest, and a low sugar/starch chaff (Dengie HiFi Molasses Free) and/or a handful of rinsed and soaked sugar beet to carry her minerals. Absolutely no grass, carrots or sugary treats of any sort. Her feed and water were kept close to her and offered above ground level where possible to reduce the pressure on her front feet, her companion was close by but unable to make her move, and we hoped that she would lie down for long periods, which she did.
Left fore - dorsal angle 14', palmar angle 13'. X-ray is not to scale but hoof:laminar measurements illustrate how dorsal wall at the bottom of the foot is wider than at the top - this is laminar wedge.
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X-rays were taken the same day and showed that all 4 feet had rotation of the pedal bone, with palmar angles ranging from 17' to 13' and dorsal angles from 14' to 9'. Unfortunately the dorsal hoof wall markers were not placed at the coronet so it was difficult to accurately assess distal descent (sinking), but there did not appear to be any significant sinking on any foot. She appeared to have reasonable sole depth.
The x-rays showed a laminar wedge on each foot and there were no indications of gas or haemorrhage, suggesting that the damage had occurred over a period of time, as is common with laminitis caused by insulin resistance. |
The current hoof which is "too far forwards", and suggested trim in red to bring the hoof further back under the horse and correctly realign the hoof to the pedal bone.
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How the hoof will look when correctly trimmed. The heels can be brought down in one or two trims (removing no more than 1cm heel height per trim), the toe can be beveled so that the new hoof wall growing down from the coronet will hug the pedal bone tightly. The sole depth under the tip of the pedal bone must be preserved to protect P3.
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The red line outlines the trim needed to realign the hoof to the pedal bone. The blue lines indicate (1) where breakover is currently (too far forwards, exerting separating forces on the weakened laminae), (2) or (3) are suggested breakovers (with the toe beveled). (4) is the current heel and extent of palmar weight bearing, and (5) is how the weight bearing surface will be extended back under the horse when the heel height is reduced. Note how the trim will move the hoof back under the horse - the hoof's current weightbearing surface is from 1 to 4, this will move back to 2/3 to 5.
Rosie's feet were trimmed the next morning, her heels brought down to make her frogs weightbearing and her toes shortened to bring breakover back. The foam supports were no longer needed and she was fairly comfortable on 2 g Bute confined in her deep sawdust-bedded stable. Her pulse was still hovering around 50 bpm and she was still paddling slightly.
The following day she was more comfortable still, her pulse down to 44 bpm. She should remain confined until she is showing no signs of pain without pain relief, and until her feet have been realigned. She will then be allowed to roam in a slightly larger space, with her feet well supported and protected. Her insulin and glucose should be tested, and although she is not showing any symptoms of PPID, as she is 16 years old and this is her first recognised episode of laminitis, we have suggested that she has ACTH tested to rule out PPID, but perhaps not until the seasonal rise for the best chance of a diagnostic result (as long as she continues to respond to current treatment - she should be tested earlier if she does not respond).
Rosie's feet were trimmed the next morning, her heels brought down to make her frogs weightbearing and her toes shortened to bring breakover back. The foam supports were no longer needed and she was fairly comfortable on 2 g Bute confined in her deep sawdust-bedded stable. Her pulse was still hovering around 50 bpm and she was still paddling slightly.
The following day she was more comfortable still, her pulse down to 44 bpm. She should remain confined until she is showing no signs of pain without pain relief, and until her feet have been realigned. She will then be allowed to roam in a slightly larger space, with her feet well supported and protected. Her insulin and glucose should be tested, and although she is not showing any symptoms of PPID, as she is 16 years old and this is her first recognised episode of laminitis, we have suggested that she has ACTH tested to rule out PPID, but perhaps not until the seasonal rise for the best chance of a diagnostic result (as long as she continues to respond to current treatment - she should be tested earlier if she does not respond).
Why did Rosie get laminitis this year when she's never had it before?
Quite simply, too much energy in and too little energy out - too much food, too little exercise!
Exercise is the best insulin sensitizer, but Rosie hasn't been ridden since before Christmas - this is the first spring since maturity that she hasn't been in work, due to lack of a rider. 2 years ago she was working in a riding school, and last year being ridden lightly, but probably enough to keep her insulin sensitive and to keep the weight off her. Plus the grass growth is exceptional this year - we had a very sunny start to the year, followed by heavy rainfall which has brought on excessive grass growth - and Rosie is a horse who doesn't stop eating! When we explained that she could have been eating the equivalent in grass of around half a 20kg sack of medium to high energy feed per day, this episode of laminitis no longer seemed such a surprise!
Quite simply, too much energy in and too little energy out - too much food, too little exercise!
Exercise is the best insulin sensitizer, but Rosie hasn't been ridden since before Christmas - this is the first spring since maturity that she hasn't been in work, due to lack of a rider. 2 years ago she was working in a riding school, and last year being ridden lightly, but probably enough to keep her insulin sensitive and to keep the weight off her. Plus the grass growth is exceptional this year - we had a very sunny start to the year, followed by heavy rainfall which has brought on excessive grass growth - and Rosie is a horse who doesn't stop eating! When we explained that she could have been eating the equivalent in grass of around half a 20kg sack of medium to high energy feed per day, this episode of laminitis no longer seemed such a surprise!