UPDATE: 5 yr old mare with early onset laminitis

[wingnut]

Hi everyone! I finally got the results from the blood work we had done on my five year old mare, Izzy. The results confirm our suspicions. Quote from vet's email:

"Her Leptin was very high and her insulin was high so she does have Equine Metabolic Syndrome."

Information from results:

• ACTH endogenous: ACTH Baseline: 9.11 pg/mL (Range: 9 - 35)

• Insulin baseline: Insulin: 40.56 uIU/mL (Range: 10 - 40)
  
• Leptin Baseline: Leptin: 23.48 ng/mL (Range: 1 - 4)

Additional information from results:

Insulin baseline


INSULIN: The insulin reference range above is for horses on pasture or given hay before testing. Horses fasted overnight are expected to have insulin levels <20 uIU/mL. In Equine Metabolic Syndrome (EMS), the concentration of insulin is generally greater than the reference values above. High insulin concentrations may also be caused by grain meals, pregnancy, PPID, and illness. The higher the insulin concentration is, the more likely is the diagnosis of EMS. If an elevated insulin may be due to equine Cushing’s disease (pituitary pars intermedia dysfunction or PPID), then ACTH baseline or dexamethasone suppression testing is recommended. When alternate explanations for hyperinsulinemia are considered (e.g., pre-test grain meal, pain or other sources of stress), a leptin test may aid in the diagnosis of EMS, because leptin is often elevated in EMS and less affected by th other factors that modulate insulin .

Leptin Baseline
Additional Reference Ranges: Intermediate 4 - 7 ng/mL, High > 7 ng/mL. In Equine Metabolic Syndrome (EMS), the concentration of leptin is generally in the high or intermediate reference range above. However the leptin test is meant to be interpreted in the context of insulin testing for EMS. Unlike insulin, leptin is less likely to be affected by post-grain meal or stress, and thus may be useful in ruling out other causes of hyperinsulinemia. As with insulin, the higher the leptin concentration is, the more likely is the diagnosis of EMS. An intermediate to high leptin concentration without hyperinsulinemia may indicate that the horse is overweight or obese and at risk for developing EMS or is being treated for EMS.

The areas in red were highlighted by my vet.

We've had her off the pasture since she first showed symptoms. She hasn't had banamine in 2 weeks now. She is showing no signs of discomfort. Her "cresty neck" has diminished a bit and is much softer. With luck, we prevented any serious, long term damage by recognizing the problem so early and treating immediately. I also now know what to keep an eye out for in both terms of her movement and behavior.

We took her to our latest club show this past Sunday and she did well (in youth showmanship) so I think we have her back to square one and will work to keep her there.

Thanks again for everyone's concern and advice. This board once again proved to be invaluable to me in a time of need. I cannot tell you how much I appreciate that!

 

[muffntuf]

If your vet agrees, get her on metformin right away with Isoxuprine! PM me for me details.

 

[targetsmom]

Thanks for the update! I would put her on Remission if she isn't on it already. It is just a magnesium - chromium supplement that is designed to reduce the risk of founder. I think a year's supply is about $20 on-line. Our show mare is doing well on that plus dry lot, and low starch everything. We buy beet pulp with no molasses and test our hay. Because our mare "works" (all performance classes) she is also on a low starch "grain" - Nutrena Safe Choice Special Care. If you are careful, you should be able to mange this pretty well.

 

[wingnut]

muffntuff: I've asked my vet about add on meds like metformin and am awaiting her response.

And of course, I was going out just now to give everybody some work on the lunge line, practice standing for halter and jumping some jumps too (not the 5 yr old though...no jumping for her) and it's raining. Its not suppose to start until later tonight daggummit!

 

[Marty]

I'm happy for you Wing. Give yourself a huge pat on the back for knowing what was going on and saving your horse.

Luv ya.

 

[misty'smom]

Wingnut happy to hear that your mare is doing better!

I have been reading what others posted about Laminitis too so I can understand this condition better. My 2 minis are yearlings and are healthy and happy but I think it is good to have knowledge about the different diseases. From what I understand recognizing it quickly and getting the Vet to come is crucial and Wingnut you did this for your Mare and it helped her recover!!

One question I have is what does having a "Crested neck" mean?? If there is any other info you all think would be good for me to know about please post!!

I grew up with the big guys but mostly just riding them and general care. My Dad and Uncle tended to the big issues. Also that was many, many years ago!!!!! LOL

 

[wingnut]

Thanks Marty

Misty's Mom: I'll try to find some pics, but a "cresty neck" is when the top of the neck (where the mane attaches) gets SUPER thick and even hard.

Here's a set of "scoring" images: http://www.hygain.com.au/Nutrition_Center/Cresty-neck-scoring.php and https://share.ehs.uen.org/sites/default/files/Laminitis%20risk.pdf

Based on these two links, my horse's neck was a 3.

 

[targetsmom]

Wow, I had never heard of the scoring system so really appreciate your posting it!!! Based on that I would rate my mare as a 3 also. My mare (who has never foaled) also has fat deposits near her udder. My first horse (over 50 years ago) also had a cresty neck and she foundered many times, but of course, we knew less about it then. But 50 years later they still don't have a magic bullet for dealing with it, just more knowledge to prevent it.

 

[muffntuf]

Generally if they have a crest, fat pocket on the withers and shoulders, over the flanks, or in the bag or sheeth area - they are too fat and could be predisposed to IR or EMS or possibly it could be one of the many Cushings indicators.

 

[chandab]

Thanks Marty

Misty's Mom: I'll try to find some pics, but a "cresty neck" is when the top of the neck (where the mane attaches) gets SUPER thick and even hard.

Here's a set of "scoring" images: http://www.hygain.com.au/Nutrition_Center/Cresty-neck-scoring.php and https://share.ehs.uen.org/sites/default/files/Laminitis%20risk.pdf

Based on these two links, my horse's neck was a 3.

My couple with issues are about a 3 too.

 

[rubyviewminis]

Sorry, but I have to disagree with using Nutrena Safechoice Special Care for laminitic prone horses. My mare WAS on that when she developed pregnancy induced laminitis. My vet specializes in metobolic/nutritional feeding problems and we put all my minis on LMF feeds. She was able to get them to keep it delivered in stock here thank goodness. It was developed by the Dr.'s who started www.safergrass.org. Safechoice products just had too many ingredient triggers in it. We also soaked her hay until we got her under control and had the hay tested.

 

[muffntuf]

Interesting information rubyviewminis but could you say more about 'Safechoice products just had too many ingredient triggers in it.' That might help other folks out. I looked at that feed but it was over the 11% NSC when you looked at structured carbs and sugars, so that is why I nixed it.

Thanks!

 

[targetsmom]

There are 2 Nutrena Safe Choice products and I use the original one for most of our minis, and I know that one is not "low starch". I tried several other brands of low starch feeds for my mare but FOR HER, as an all around performance horse, they didn't give her enough energy. I know the Safe Choice Special Care is not the lowest starch feed out there, but it is a good compromise for MY HORSE. I think this is a good example of how you need to find what is best for your horse and not just feed what works for someone else. I saw a noticeable improvement in her energy and performance when I switched to this feed, with no bad consequences.

 

[rubyviewminis]

Well, as you eluded to, it is complicated depending on the horse, the horses usage, total diet, climate etc. Even the hay can differ in total DE and WSC, NSC, and ESC from one end of the field to the other. Besides testing the three hays I had, the first thing my vet did was pull my mare off everything except her Omega Horseshine. The Expert she was consulting in Idaho said that was the best supplement to have an IR prone horse on mainly for the Omega fatty acids, and the vitamin and mineral content which promoted the ability to improve insulin sensitivity and decrease the threshold for laminitis. I learned a lot like grasses have more sugar after drought stress, evenings, or cool nights followed by warm sunny days.

I can't find my papers on that, I will look it up. Her diet needed line by line a set of requirements for each nutrient, I won't go into the list here. WITH Safechoice the totals were WAY over the required amounts. And in the areas that specially sensitive horses can't handle. Take out the Safechoice and add in the LMF Super Supplement for Alfalfa we were advised to use and it brought those totals down to closer to what the required amounts were. I do know that I always fed Safechoice and argued with my vet. But she was right, as soon as we pulled her off it, and I started giving her just alfalfa until we had an analysis to formulate a diet for her, she didn't have another episode. The base ingredients and fillers in Safechoice put the total NSC over 10%. A Cushing or IR horse has to stay under 10% for their total diet daily to avoid an episode of laminitis ocurring. I have also always used slow feed nets so that they have a constant, steady supply all day, not just a few quick meals that throw their glycemic index up.

They wanted to start her on LMF Super Supplement which I was leary of after all we went through. She did fine. Now she is on Development with the foal because her foal is huge and started pulling her down. She no longer has issues with her diet.

But that was just us, and you are right, find what is best for your horse. I will say though, I use and also spend MUCH less on concentrate feeds now with LMF feeds, than with Safechoice. And I don't know if it is the Omega Horseshine or LMF Supplement, but they have that extra glow and color now. At least after a bath.

I can't find it at all! I do remember my vet telling me it was about the base ingredient difference raising the total NSC. I wish I was more helpful. I wanted to say though, thank you so much for the papaya juice info. It sure helped pick up her appetite! Now, if I could find it around here for me.

 

[muffntuf]

Thanks I appreciate you sharing. LMF isn't something that is common for everyone, the equivalent for my area is ADM Ultra Fiber, almost the exact same thing. BUT it still has a high NSC for an IR/EMS or Cushing's horse.

I found that Remission is for a horse who isn't in a laminitic episode - but rather for one that had a mild case and then it can help.

 

[wingnut]

For now, I'll continue to give NO feed to this horse nor my other two younger mare (both 4 years old). They receive a ration balancer (McCauley's M30) about 3 times a week. I will need to investigate if this particular supplement is something she should have or not. It does have cane molasses as an ingredient (I can't find the URL where I finally found the ingredient list online!). I'll be touching base with the equine specialist at our feed mill and getting her input. She's the one who pointed me toward the M30.

With regards to other supplements, I'll be looking into all the options, determining what I have easily available to me and go from there. There's a lot out there folks have used with good results and then I hear others saying they had no obvious positive results from the same supplement. I've been down this road (finding the right product or products) with my hard keeper and would like to avoid throwing money out the door like I did with her. It's hard though! I had to keep from buying several things last week when I stopped in at our mill store. I told myself to WAIT until I have the results, but man did I want to buy at least one of the supplements that have been recommended to me! LOL!

 

[targetsmom]

I think one of the other big differences between my horse and most that get in this situation is that I started my mare on the low starch feeds (including soaking her hay for awhile) BEFORE she suffered a laminitic episode. So far, so good.... But having had a horse 50 years ago with a heavy crest that DID founder, she would have repeat episodes quite often. So I think one big key is to prevent that first episode. By the way, that is her in my current avatar, with her show record.