# Testing for Insulin resistance



## Jericho (6 October 2010)

I have been struggling a bit with my barefoot mare and other than doing lots of work with her I have been doing everything I can to maximise her chances of staying barefoot e.g. low sugar diet. restricted grazing, different surfaces in field, she comes off the grass into stable/ concrete yard wit soaked hay during the day (which also gives her feet chance to dry), out at night but she is worse than ever with regards to footiness and I am sure she suffered some low grade lami a few weeks ago which we managed for and I think we caught it in time. However she still just isnt right and although in and around field, lunging on grass etc she is absolutely fine she was really sore and ouchy on roads and tracks on Saturday and I am at the point of putting shoes back on her fronts. I do however this may just mask the problem and I should rule out other reasons as to why she is ouchy

I realise the flush of grass isnt going to help but I am considering have blood tests done for insulin resistance as someone suggested that she might have this (she is a very good doer too and her hooves are slightly bull nosed) although she is not obsese nor has fatty deposits over eyes, neck, base of tail or withers.

The vet is due anyway for teeth and vacs so do you think he will think I am mad for asking for blood tests ? Can anyone give me an idea of how much a insulin resistance blood test might cost?


----------



## Alibear (6 October 2010)

I've been told it's about £70 and needs to be done when the horse is calm and not stressed. It more money for the vet so I don't see why he wouldn't do as you ask.

Althgouh to be hoenst i appears that everyone whose barefoot has had their horse tested. That said mine is being done in a few weeks time.

What about just using hoof boots in front for road hacks? Thats what I did with mine when he was previously barefoot? I know some total purists are against it but if it makes your horse happy and comfy why not, they won't change the structure of the hoof. 

The saddlery Shop are great with advice on choosing and fitting boots. You can also try and return if they don't fit as long as you follow their instructions on how to do this to the letter.


----------



## cptrayes (6 October 2010)

The test is very prone to false negatives and you will waste your money if she is, as she sounds, a marginal case. The bull nose feet are very significant, I've only seen them twice and both times on insulin resistant horses. If she's the horse in your pic, I wouldn't be at all surprised. My very very sensitive one had to be removed from grass altogether to get him sound on stones. He also had to be off grass for his health, and if you don't feel that would be fair you'll need to boot or shoe. The blood test won't change anything, really, so if I were you I'd save your money and buy some boots with it.


----------



## Lotty (6 October 2010)

I had the test done on my mare a couple of months ago. I will hunt out the vet bill to find out what he charged me.


----------



## ImogenBurrows (6 October 2010)

cptrayes said:



			The test is *very prone to false negatives and you will waste your money if she is, as she sounds, a marginal case*. The bull nose feet are *very significant, I've only seen them twice and both times on insulin resistant horses*. If she's the horse in your pic, I wouldn't be at all surprised. My very very sensitive one had to be removed from grass altogether to get him sound on stones. He also had to be off grass for his health, and if you don't feel that would be fair you'll need to boot or shoe. The *blood test won't change anything, really*, so if I were you I'd save your money and buy some boots with it.
		
Click to expand...

Oh dear.  I disagree strongly.  Foot conformation can be relevant but not really in diagnosing insulin resistance.  Testing is pretty reliable now is you use the right tests, and WILL change a LOT potentially.  Stop focusing on the barefoot....it's not why the horse has laminitis.

The testing at Liphook for the laminitic profile is very good and reliable TBH.  The key thing is ensuring you starve the horse for at least 12hrs plus, i.e. give feed at 6pm and nothing overnight....take blood next morning prior to feed.  The best testing I'd get in this situation is the full profile of resting insulin and glucose, cortisol may be useful but personally I'd recommend the chilled ACTH too.  This is reliable too as we have new good normal parameters which take into account the seasonal variation.  the ratios of insulin and glucose _help_ to quantify laminitic risk. 

If the horse is over 14yrs, don't rule out Cushings.  Treatment for metabolic syndrome is cheap and pretty successful so this is well worth doing and Cushings treatment is good and works out at about £1 per day. 

I would expect the whole lot to cost about £70-100...with the Cheap day visit scheme if they do one and the blood sample fee. Ask your vets advice. 

Hope that helps.
Imogen


----------



## brucea (6 October 2010)

This is reliable too as we have new good normal parameters which take into account the seasonal variation.
		
Click to expand...

I think the seasonal ACTH changes are not really recognised by vets as a contributing factor. I had a chat with Prof Bowker about this a year or so ago. It was fascinating - like one one my horses, he has two that never get access to grass but show seasonal footiness in the Spring and Autumn, usually around the time the coats change.

There's no grass based reason for this change. It's quite clear when it starts to have an effect on my sensitive chap. And it is around this time of the year that a number of horses have footiness and laminitic symptoms.

Not sure how we manage that - except to be very observant. Not much we can do about it - the seasons are what they are. We use Agnus castus which seems to help a little, but not enough to really say it is useful.


----------



## ImogenBurrows (6 October 2010)

brucea said:



			I think the seasonal ACTH changes are not really recognised by vets as a contributing factor. I had a chat with Prof Bowker about this a year or so ago. It was fascinating - like one one my horses, he has two that never get access to grass but show seasonal footiness in the Spring and Autumn, usually around the time the coats change.

There's no grass based reason for this change. It's quite clear when it starts to have an effect on my sensitive chap. And it is around this time of the year that a number of horses have footiness and laminitic symptoms.

Not sure how we manage that - except to be very observant. Not much we can do about it - the seasons are what they are. We use Agnus castus which seems to help a little, but not enough to really say it is useful.
		
Click to expand...

Hmm, I think you're probably right about the ACTH flux acting as a trigger factor in normal or more sensitive cases. And I'm not really sure how you'd control that either....

I get frustrated by the over diagnosis of grass as the root cause (pardon the pun), We know that hormone based disease: metabolic syndrome/insulin resistance/ Cushings etc is ACTUALLY the biggest contributing causal factor of Cushings from research (extensive by Cathy McGowan's team - now at Liverpool) but the same research showed owner's believed grass and carbohydrate overload to still be the biggest factors.

There are around 15 causes of laminitis that we KNOW about....what about all the ones we don't!!! Ahhh. My head hurts already.

Good point though- I may have to look into that one!! 
 Imogen


----------



## brucea (7 October 2010)

Well - there is grass and there is grass. Often the grass that is left in so called starvation paddocks is the worst kind - stressed and high in NSC

Here's an interesting thing - I have one that goes footy in the open field on "normal grass" but manages quite well, and thrives, on both the grass that is knee high and allowed to go to foggage OR the grass in the lee strip under the trees which is long, but shaded and lower in NSC's.

If the horse is footy, you take it off grass, and then it recovers back to it's good old self then the grass was obviously a problem. 

I agree - there are many other causes of laminitis, and I see it as a spectrum with some horses at the severe right hand end but a lamentable many on the low, slightly compromised end. 

Endotoxaemia, carb overload, insulin resistance, pituitary problems, dehydration or shock, steroids, extreme loading, unbalanced trimmming and shoeing, concussion....all good ways to cause or encourage laminitis - but these are perhaps minority causes and I still believe the major cause in this country is access to inappropriate pasture for that horse.  So probably be the best strategy for the average owner if they think their horse may have foot problems may be to address grass first, but look to the professionals for evaluation of the other causes.


----------



## ImogenBurrows (7 October 2010)

brucea said:



			Well - there is grass and there is grass. Often the grass that is left in so called starvation paddocks is the worst kind - stressed and high in NSC
		
Click to expand...

I quite agree.




			Here's an interesting thing - I have one that goes footy in the open field on "normal grass" but manages quite well, and thrives, on both the grass that is knee high and allowed to go to foggage OR the grass in the lee strip under the trees which is long, but shaded and lower in NSC's.
		
Click to expand...

This is logical.

If the horse is footy, you take it off grass, and then it recovers back to it's good old self then the grass was obviously a problem. 




			I agree - there are many other causes of laminitis, and I see it as a spectrum with some horses at the severe right hand end but a lamentable many on the low, slightly compromised end.
		
Click to expand...

And frustratingly these are often overlooked and not treated properly so theses are the tough cases that dwindle on and on.....




			Endotoxaemia, carb overload, insulin resistance, pituitary problems, dehydration or shock, steroids, extreme loading, unbalanced trimmming and shoeing, concussion....all good ways to cause or encourage laminitis - but these are perhaps minority causes and I still believe the *major cause in this country is access to inappropriate pasture for that horse*.  So probably be the best strategy for the average owner if they think their horse may have foot problems may be to address grass first, but look to the professionals for evaluation of the other causes.
		
Click to expand...

 Your statement is a contradiction really.  I agree with it though.  Grass is a massive risk factor, ESPECIALLY in the cases the _another_ underlying cause.  But the causal factor is just that - the underlying cause....so grass would be another trigger factor but not the primary problem. 
I agrees that taking the horse of grass is always the first step for an owner...but then don't just stop there thinking that's the most common cause - you are best in a lotg of cases checking out other reasons - especially if the case of laminitis seems undeserved!

Imogen


----------



## cptrayes (7 October 2010)

What will the blood test change if it comes back positive for insulin resistance Imogen? Won't she just be told to put the horse on a low grass exposure, low sugar, high fibre diet - ie exactly the same as she needs to do to keep it barefoot happy on stones?  I believe that the latest research and advice is that together with that diet, working for 30 minutes a day will control most IR horses.

I'm not sure you are right about the barefoot having no impact on laminitis. It's widely accepted by the people who have done clinical research on barefoot that a barefoot horse has a greater blood supply to the foot than a shod horse. If it takes a certain amount of toxin to trigger laminitis, then that amount of toxin will be delivered earlier to a barefoot horse than a shod one and it would show symptoms earlier.


----------



## cptrayes (7 October 2010)

ImogenBurrows said:



			I get frustrated by the over diagnosis of grass as the root cause (pardon the pun), We know that hormone based disease: metabolic syndrome/insulin resistance/ Cushings etc is ACTUALLY the biggest contributing causal factor of Cushings from research (extensive by Cathy McGowan's team - now at Liverpool) but the same research showed owner's believed grass and carbohydrate overload to still be the biggest factors.
		
Click to expand...

Had to have a shower to work out why I wasn't happy with this Imogen    You say IR is a very common cause of laminitis, and grass is not the cause as often as owners think. But for the vast majority of barefoot horses who are simply feeling stones, restriction of grass intake and a low sugar feed is all that will be required to control them. So for the average owner of a footie (sub clinical laminitic)  barefoot horse grass IS the root cause. 

Also, I have realised that like most (all?) vets, you probably don't very often see barefoot horses that work really hard on tough surfaces. Those of us who have them will tell you that one of the benefits you get is an intimate knowledge of how diet affects your horses' feet. And that with a sensitive one, you can tell the fluctuation in grass sugars from day to day by just how well your horse performs.  Of course if you mainly see working  horses which are shod, you will never get that feedback.

Going back to the original poster's problem, you sound very open minded and willing to consider alternatives, but I'd bet my bottom dollar that the vast majority of vets would simply say to this owner "oh for goodness sake get some shoes on it".


----------



## Ashf (7 October 2010)

What is the procedure for testing for insulin resistence in horses. I've had the tests myself as I am a diabetic (type2), and it involves a couple of blood tests on 12 hours starvation, after ingestion of a glucose drink, sitting quietly for 2 hours and then testing again. I did my own tests with a meter on top of the hospital tests and they went from 5 pre test to 17 after 30 minutes, and then only back down to 15 after 2 hours. I walked home about 1.5 miles afterwards and testing at that point beforeI ate was 2.9 - which made me feel fairly ropey.

Also has there been any testing or treatment with metformin on horses diagnosed with the condition (does it work on horses ?)


----------



## peanut (7 October 2010)

brucea said:



			Well - there is grass and there is grass. Often the grass that is left in so called starvation paddocks is the worst kind - stressed and high in NSC

Here's an interesting thing - I have one that goes footy in the open field on "normal grass" but manages quite well, and thrives, on both the grass that is knee high and allowed to go to foggage OR the grass in the lee strip under the trees which is long, but shaded and lower in NSC's.
		
Click to expand...

I'm so confused about grass for laminitics.  Is there anyway of having grass tested for NSC?  I know that sun/rain play an enormous part but how do you know whether your grass is safe?

My skinny tb had a touch of laminitis a couple of years ago and has been on restricted grazing ever since and her paddock does get quite sparse in the summer months.  I find it impossible to brave putting her on longer grass despite knowing that stressed is worse.


----------



## Jericho (7 October 2010)

again thank you for all your replies. This is all so confusing and whilst I understand what everyone is saying and it all seems to make sense I cant really see how to make it work. It seems the only way I can be sure that she doesnt have sore feet or risk lami is to take her off the grass completely. 

Martha - I am completely with you! I just dont know what grass to put my two out on - my field is now a mix of a muddy patch the size of a tennis court, 1 acre area they grazed over the summer which was very bare but now after 5 weeks of sun and rain and no horses on it looks like a lush green playing field and about and 2 1/2 acre patch which hasnt really been grazed for about 4 months so between 5 and 8 inches tall with lots of weeds and rank grass.  

I have tried to set up a track system in this longer grass right under the trees and let them have an extra foot of the grass each night which they mow down to about 4 inches although after the initial yippee grass they soon go off it.  Its a good area as they browse the trees and the sun doesnt get to it first thing in the morning so I can get her in before the frost/sun combo kicks in (in theory anyway!)

Once trodden down the grass looks very soggy and mucky and they just pick  it so it obviously isnt that nice and sweet - she seems no worse no better on this than when she was off the grass completely ( and actually their poos are no greener or wetter than normal - my mare quickly shows in her poo when she has had lush green grass!) 

I am not really sure what the next step other than to go ahead with a test which will at least tell me that she must be kept off the grass rather than maybe kept off.

(Oh and yes I do ride her in boots anyway but not really keen on them as she isnt striding out in them as I hoped - her greatest / best movement is on the lunge on grass so I know that she can be comfortable in certain circumstances.


----------



## Ashf (7 October 2010)

martha said:



			I'm so confused about grass for laminitics.  Is there anyway of having grass tested for NSC?  I know that sun/rain play an enormous part but how do you know whether your grass is safe?

My skinny tb had a touch of laminitis a couple of years ago and has been on restricted grazing ever since and her paddock does get quite sparse in the summer months.  I find it impossible to brave putting her on longer grass despite knowing that stressed is worse.
		
Click to expand...

The sugars are made in the roots and carried up into the blades. A paddock grazed right down and then on a growth spurt after rain/sun  is actually going to yield more sugar weight for weight than a horse eating from long grass as the further up the blade from the root, the less sugar - given they eat the same quantity - which they won't because they have ot work harder for the same volume. Best to keep in an area where the only access to forage is what you give them if worried about laminitis.


----------



## cptrayes (7 October 2010)

Jericho in your situation no-one would blame you if you shod her. 

The one that I keep off grass completely has to be off it for other reasons than footiness, otherwise I would think very hard about whether that lifestyle was fair if all he needed was some shoes. 

Unfortunately his metabolic issues are so serious that, among other things including raging sweet itch, skin "allergies" and ravenous hunger, his feet are life-threateningly weak when he eats grass. He has none of those things off grass. His previous owner judged his quality of life was so poor it was not fair to keep him alive. I agree with her, too, but with his new people, who can give him a good life without any grazing and love him to bits, he has a life worth living. 

I'm intrigued that your mare isnt right in boots either - are you sure she doesn't just have thrush, which would still cause her problems in boots as her frogs bore weight. Sorry if this has already been covered, I don't have time right now to read right through, I have to go buy some horse food or there will be some angry horses around complaining about the poor service


----------



## ossy (7 October 2010)

My friends very fit top dressage pony developed laminitis one year, did the usual and came sound, next spring/summer put it in a strvation paddock, fat mask, weighed hay net ect and got laminities again, then that winter got it agian. After that he was tested for it.  Don't ask me exactly how it was done but he went off for 3 days to the vet hospital for it and the test came back positive and his laminities was diagnosed as a resulting factor of this resitance.  He was put on medication daily in his feeds to counter act the resistance similar to type 2 tyablets humans get, but unfortunatly there had been so much pedal bone rotation from the previous incidents that he had to be PTS.  Maybe if he had had the tests done earyier it would have been a differnt story.  I think its worth a shot and talking to your vet about it.


----------



## brucea (7 October 2010)

Here's an interesting question and a little test

Which do you believe is the safer grass?

A






or B






Now I have found that the long foggage is definitely the best for two of mine, the third manages 12 hours on it, the fourth gets no grass.

The short grass LOOKS OK - but is it safe? I don't think so

We strip graze the long stuff, and they do much better on it - but we have to continue to move the tape or they greaze the shorter more stressed grass

It is really importanbt for horse owners to understand grass, how it grows, what affects the NSC, and how you can plan for it to be a little safer.


----------



## soloequestrian (7 October 2010)

Ashf said:



			Also has there been any testing or treatment with metformin on horses diagnosed with the condition (does it work on horses ?)
		
Click to expand...

My horse was on metformin for a month or so after getting post-operative laminitis earlier this year.  She had to have about 40 tablets per day I think and the things are like little chunks of granite.  When she was coming off them, I got a bit suspicious about the vets because they couldn't seem to make up their minds how best to wean her off.  In the end I asked a diabetes expert at work and he said just to stop giving her them.  I did that, and she immediately perked up considerably - they must have been making her feel grotty.  So yes, it is used in horses but I've no idea to what extent.


----------



## ossy (7 October 2010)

soloequestrian said:



			My horse was on metformin for a month or so after getting post-operative laminitis earlier this year.  She had to have about 40 tablets per day I think and the things are like little chunks of granite.  When she was coming off them, I got a bit suspicious about the vets because they couldn't seem to make up their minds how best to wean her off.  In the end I asked a diabetes expert at work and he said just to stop giving her them.  I did that, and she immediately perked up considerably - they must have been making her feel grotty.  So yes, it is used in horses but I've no idea to what extent.
		
Click to expand...

Metaformin thats what my friends horse was on it did help him and they didn't seem to have any major side effects


----------



## Burnttoast (7 October 2010)

brucea said:



			Here's an interesting question and a little test

Which do you believe is the safer grass?

A






or B






Now I have found that the long foggage is definitely the best for two of mine, the third manages 12 hours on it, the fourth gets no grass.

The short grass LOOKS OK - but is it safe? I don't think so

We strip graze the long stuff, and they do much better on it - but we have to continue to move the tape or they greaze the shorter more stressed grass

It is really importanbt for horse owners to understand grass, how it grows, what affects the NSC, and how you can plan for it to be a little safer.
		
Click to expand...


Can I add this pic - that is, a situation between the two above - for comments? This is ryegrass mix(?) that had cattle on it the year before. Not mine - looks like poison to me but I'd be interested in other opinions.


----------



## ImogenBurrows (7 October 2010)

cptrayes said:



			Had to have a shower to work out why I wasn't happy with this Imogen    You say IR is a very common cause of laminitis, and grass is not the cause as often as owners think. But for the vast majority of barefoot horses who are simply feeling stones, *restriction of grass intake and a low sugar feed is all that will be required to control them*. So for the average owner of a footie (sub clinical laminitic)  barefoot horse grass IS the root cause.
		
Click to expand...

Subtle difference but the grass and feed is the primary control and treatment plan, so it SEEMS as if it's causing the problem...generally it's not. It will work as the trigger factor though so taking it away will often resolve the lami - TBH it's starting to sound like I'm splitting hairs....as long as it's controlled I don'tmind 




			Also, I have realised that like most (all?) vets, you probably don't very often see barefoot horses that work really hard on tough surfaces. Those of us who have them will tell you that one of the benefits you get is an intimate knowledge of how diet affects your horses' feet. And that with a sensitive one, you can tell the fluctuation in grass sugars from day to day by just how well your horse performs.  Of course if you mainly see working  horses which are shod, you will never get that feedback.

Going back to the original poster's problem, you sound very open minded and willing to consider alternatives, but I'd bet my bottom dollar that the vast majority of vets would simply say to this owner "oh for goodness sake get some shoes on it".
		
Click to expand...

I have actually owned and worked horses in no shoes for many years....and would love to keep more without shoes where possible.  Shoeing is marvellous. If done right. But it's another thing to go wrong and frequently does.  A lot of ponies for example are shod because people think they ought to be or it's fashionable....most don't require shoes of any form IMO and mine didn't and were worked v hard. (Plus no lami!!!)



Ashf said:



			What is the procedure for testing for insulin resistence in horses. I've had the tests myself as I am a diabetic (type2), and it involves a couple of blood tests on 12 hours starvation, after ingestion of a glucose drink, sitting quietly for 2 hours and then testing again. I did my own tests with a meter on top of the hospital tests and they went from 5 pre test to 17 after 30 minutes, and then only back down to 15 after 2 hours. I walked home about 1.5 miles afterwards and testing at that point beforeI ate was 2.9 - which made me feel fairly ropey.
		
Click to expand...

Think I touched on this... usually just starved glucose and insulin levels and then Liphook also works out a RISQI ratio to quantify a rough estimate of risk.  Crude but often enough alone.  OGTT as you described are also done but more in malabsoprtion cases 




			Also has there been any testing or treatment with metformin on horses diagnosed with the condition (does it work on horses ?)
		
Click to expand...

Yes, see other posts....still a lot of research in progress but it has been used at 15mg/kg twice daily for years and then it was discovered this is too low.  Horses are now being put on doses of 30mg.kg twice daily - I haven't experience side-effects other than weight loss in some cases. 



soloequestrian said:



			My horse was on metformin for a month or so after getting post-operative laminitis earlier this year.  She had to have about 40 tablets per day I think and the things are like little chunks of granite.  When she was coming off them, I got a bit suspicious about the vets because they couldn't seem to make up their minds how best to wean her off.  In the end I asked a diabetes expert at work and he said just to stop giving her them.  I did that, and she immediately perked up considerably - they must have been making her feel grotty.  So yes, it is used in horses but I've no idea to what extent.
		
Click to expand...

The tablets are hard! There are two mg sizes 500mg and 850mg (we have to use the human ones)   Make sure you have the larger size to minimise the number of tablets being given!! It is used quite a bit and has been for quite some time now 

Hope that helps,
Imogen


----------



## brucea (7 October 2010)

Murf15

I have learned a few things about grass - they may be invalid observations but here they are...purely my own opinions from years of keeping sensitive horses.

Heavilly grazed grass is generally not good - tends to be stressed and when grass plant is stressed the NSC levels are higher. Other things that really stress grass are weedkillers which do affect the grass forcing overgrowth to compensate, and short grazen grass that has been very dry in the mid summer.

The mature, fully grown plant is best to feed - it has a full length of leaf and is not "under stress"

Once it has grown to its maximum height and seeded, it can be fed as foggage in strip grazing

Rye is not necessarily altogether bad - it is an "improved" species and not ideal - but stressed rye is, I think, worse than any other species

Grass grown under trees tends to be lower NSC and safer - probably just becuase of the shade,

There are many different species of grass - we have almost 12 different species in the pasture we rent. Some are the tall species, like rye, some mid length like yorkshire fog amd false oat grass, and some are the short growing creeping fesque species. We also have a lot of meadow plants which they eat - everything from the tiny vetches, orchids and even some ladies bedstraw, thistles (they love the heads) and gorse round the sides. Fortunately we have enough ground to allow all the fields to grow long and strip feed them. Variety is important.

The dangerous pasture I think, from observation, is the single species, rye, heavily grazed and fertilised. 

But the key is to think of the pasture as a big living organism - and to try and understand how it reacts to stress, changing weather, seasonal variations. I have never done the sampling to measure NSC - becuase it will probably be different in a few days, or weeks depending on the weather.


----------



## magicgirl (7 October 2010)

ImogenBurrows said:



			The tablets are hard! There are two mg sizes 500mg and 850mg (we have to use the human ones)   Make sure you have the larger size to minimise the number of tablets being given!! It is used quite a bit and has been for quite some time now 

Hope that helps,
Imogen
		
Click to expand...

My pony is on these tablets.  The 500mg ones go straight in a coffee grinder and the 850mg have to go in a pestle and morter before they go in the coffee grinder. The 850mg are very hard work but the 500mg are much easier to deal with.


----------



## ImogenBurrows (7 October 2010)

magicgirl said:



			My pony is on these tablets.  The 500mg ones go straight in a coffee grinder and the 850mg have to go in a pestle and morter before they go in the coffee grinder. The 850mg are very hard work but the 500mg are much easier to deal with.
		
Click to expand...

That's good advice and I shall suggest this in the future!!! Coffe grinder...good work!!!


----------



## cptrayes (7 October 2010)

Love the horse Bruce, hate the grass! 

Imogen I am again impressed by your knowledge and open-mindedness. I do hope no-one manages to put you off posting here, you're a gem!!


----------



## Burnttoast (7 October 2010)

cptrayes said:



			Love the horse Bruce, hate the grass! 

Click to expand...

Twas I who posted the horse (the black Irishman above). He's not mine, I used to share him. He is a sweetie , hence my concern. This is the grass he will be coming back to in the spring after a winter away on foggage, and he'll have access to similar all the rest of the summer/autumn. I posted this because tho he doesn't appear as yet to be 'sensitive' he is getting fat, in an IR kind of way, and there isn't enough acreage for him and his friends to be on the long long stuff all the time (which I agree looks preferable, in general). There's the weight loss issue to consider too, and he's not losing weight on this, but would on short, 'stressed' grass. Whether the latter would now be too much for his system is unclear, however!

This is all very new to me - I've been in horses since I was little, bar a gap of 10 years at uni, and when I came back to them I was amazed at the number of fat horses that seem to be around these days. I'd never been involved with a case of laminitis until this year, yet all the yards I was on/worked on had limited grazing and you could argue that the horses were permanently on stressed grass as a result. Perhaps they avoided the IR/sensitivity/laminitis issues because they were never allowed to become overweight, regardless of their age/workload. This is all types, too - ponies, natives, TBs, partbreds, etc.

Just thinking aloud really - but it bothers me that my friends are so keen to avoid short stressed grass even for horses that don't appear yet to be very sensitive to it that they would rather let the horses get overweight by having free access to this type of grass - therefore making them susceptible?


----------



## brucea (7 October 2010)

I agree with CP entirely - I didn't want to comment about that grass - it might be OK, but without knowing the history of the sward it would be misleading to comment

It may be old, fertilised, recently drilled, less than 3 years old, having been sprayed with weedkiller....I'd postulate the sward looks relatively new from what the picture shows but without seeing it...

The horses should probably not have free access to this - this should be stripped and possibly only access for so many hours a day - but strip extended each day so the grass does not get stressed.

It might be better being left to its own devices for 2 years.


----------



## AndySpooner (10 October 2010)

When people accept that horses are browzing animals and not grazing animals like sheep and cattle and should not be given access to improved grasses laminitis will become a lot less common.

People must stop feeding horses like fattening cattle, and vets must accept that the general management and husbandry needs addressing rather than covering up or just treating the syptoms.

End of rant.


----------



## ImogenBurrows (10 October 2010)

AndySpooner said:



			When people accept that horses are browzing animals and not grazing animals like sheep and cattle and should not be given access to improved grasses laminitis will become a lot less common.

People must stop feeding horses like fattening cattle,
		
Click to expand...

I quite agree - a lot of our pastures are fertilised and were/are cattle pastures, who need a totally different calorific requirement - but do get laminitis too 




			and *vets must accept that the general management and husbandry needs addressing rather than covering up or just treating the syptoms*.

End of rant.
		
Click to expand...

OOoooooooo 

I think as a rule I'd speak for most vets to say the mainstay of our consultations especially at the start of laminitis in a new case revolves around adjusting the patients current management system to try and get a quicker recovery time and prevent future relapse of this horrid horrid disease.  

Sadly it'd not always that easy as yards aren't always in a position to allow strip grazing or bringing in/out at odd times in the day; some won't allow night turn out.... Owners often hate the thought of a grazing muzzle and so management alterations are limited indeed.  

I think it's a little unfair to say we're covering up or just treating symptoms.  Sure we treat symptoms...we have to - that's why you ring us, because there's a symptom - mainly pain in these cases.  There are a great number of us who are pushing to find out underlying causes - but sadly this costs money and time and testing, and often for many reasons, owners do not want to put horses/ponies through this.  We are then is the position you describe.  Sometimes we try very hard and are STILL unable to find underlying causes or explanations. I think you may not appreciate how frustrating all these situations can be for a vet.  

Vets become vets mainly because we like to cure things.  It's often selfish to say, but it makes me feel good to help your horse get better.  There are many reasons why I can't do this in certain cases....but that never means I'm trying to cover up causes for a condition. 

Management, particularly of grazing, is known not to be the _largest_ cause of laminitis from years of research...but it IS still a _large_ causal factor without doubt.  It is also crucial to consider and often in chronic cases the mainstay of successful treatment. 

Rant possibly over, depending on subsequent replies 

Imogen


----------



## Jericho (10 October 2010)

Thank you all so much for replies especially Imogen, cptrayes and brucea who as always proivde excellent information. AndySpooner - I have come round to this way of thinking totally now along with all the knowledge I have gained recently about grass etc. Hence I had fenced all the way along the edge of the field about 24ft wide under the trees / hedge line where the sparser ranker shaded and frankly pretty scrubby grass was and was extending this length about 4 foot every other day. Was just starting to feel that I was managing it well as she was doing really well on it (has been much less footy over the last 5 days of so) and I am much happier with her weight than I was 4 weeks ago. 

However mare decided otherwise and jumped out!!!!  So now have to spend more money and get some more 5 ft electric posts - argghhhhhhh. She has always been on grazing fenced off by electric fencing and never tried it before so I can only assume that she wants to get to the better tasting sweeter grass which I guess is good as it means the stuff she is on isnt.......

Anyway, I will continue to treat her as a mild IR/laminitic case and see how that goes, thanks again


----------



## AndySpooner (11 October 2010)

ImogenBurrows said:



			OOoooooooo 

I think as a rule I'd speak for most vets to say the mainstay of our consultations especially at the start of laminitis in a new case revolves around adjusting the patients current management system to try and get a quicker recovery time and prevent future relapse of this horrid horrid disease.  

Sadly it'd not always that easy as yards aren't always in a position to allow strip grazing or bringing in/out at odd times in the day; some won't allow night turn out.... Owners often hate the thought of a grazing muzzle and so management alterations are limited indeed.  

I think it's a little unfair to say we're covering up or just treating symptoms.  Sure we treat symptoms...we have to - that's why you ring us, because there's a symptom - mainly pain in these cases.  There are a great number of us who are pushing to find out underlying causes - but sadly this costs money and time and testing, and often for many reasons, owners do not want to put horses/ponies through this.  We are then is the position you describe.  Sometimes we try very hard and are STILL unable to find underlying causes or explanations. I think you may not appreciate how frustrating all these situations can be for a vet.  

Vets become vets mainly because we like to cure things.  It's often selfish to say, but it makes me feel good to help your horse get better.  There are many reasons why I can't do this in certain cases....but that never means I'm trying to cover up causes for a condition. 

Management, particularly of grazing, is known not to be the _largest_ cause of laminitis from years of research...but it IS still a _large_ causal factor without doubt.  It is also crucial to consider and often in chronic cases the mainstay of successful treatment. 

Rant possibly over, depending on subsequent replies 

Imogen
		
Click to expand...

I think perhaps that I have expressed myself badly in my post when I refered to vets 'covering up' the symptoms, by this I did not mean that vets, were somehow underhand in treating syptoms like lameness or pain, and whilst I understand that any horse or pet owner, farmer or whatever, does not want to see an animal in pain, that pain very often serves a purpose.

By this I mean that if a horse may aggrivate the problem by over exercising itself, pain in the foot for example will stop this. By the liberal use of pain killers this natural protection is taken away, the horse feels little or no pain and so behaves like a horse and gallops about. To stop this, we box rest, thereby relieving one symptom and causing more problems, through box rest and stress.

Just because a horse is not kicking the door of a box doesn't mean that it is not showing signs of stress, the horse which shuts down and stands immobile for hours is just as stressed.

Owners hateing grazing muzzles is an anthropomophic, reaction, which is not a good reason not to use them.

Yard owners should be providing safe grazing for their clients, considering the cost of livery. The diversification of farmers into livery, appears to be encouraging the wrong sort of grazing for horses, by the fixation with green unpoached fields, and restricted turnout.

The welfare of the horse is paramount in all this but I do feel that this often comes second due to a basic lack of understanding and an unwillingness to understand the horses specific requirements.


----------



## ImogenBurrows (11 October 2010)

AndySpooner said:



			I think perhaps that I have expressed myself badly in my post when I refered to vets 'covering up' the symptoms, by this I did not mean that vets, were somehow underhand in treating syptoms like lameness or pain, and whilst I understand that any horse or pet owner, farmer or whatever, does not want to see an animal in pain, that pain very often serves a purpose.

By this I mean that if a horse may aggrivate the problem by over exercising itself, pain in the foot for example will stop this. _By the liberal use of pain killers this natural protection is taken away, the horse feels little or no pain and so behaves like a horse and gallops about. To stop this, we box rest, thereby relieving one symptom and causing more problems, through box rest and stress._

Click to expand...

I agree with this logic but there is a halfway house here.  Painkillers aren't just given liberally for stopping pain.  That sounds a bit odd, but they are anti-inflammatories which is the reason they are given primarily.  If ongoing inflammation is not stopped this will encourage loosening of the vital laminar junction, encouraging and allowing pedal bone rotation.  Pain itself sets off a vicious cycle of  inflammatory mediators in a cascade of events which culminate in steroid hormone and others exerting an effect on the laminae in the foot....(far to complicated for me to remember all their fancy names off the top of my head!!)

The "keeping the horse able to feel the pain" argument is actually far outweighed now by these negative effects of inflammatory mediators.  

Plus TBH IME or treating WAYYYYYYY too many active aggressive laminitics, I'd be quite happy to say, 'bute's good, but it's not that good. 




			Just because a horse is not kicking the door of a box doesn't mean that it is not showing signs of stress, the horse which shuts down and stands immobile for hours is just as stressed.
		
Click to expand...

While this is very true, especially in the early phases it is a necessary evil...the walking is the thing which is really painful, but also encourage rotation of the pedal bone due to the biomechanics (gravity pushing down; Laminar inflammation pushing the pedal bone round at the toe; and the pull of the DDFT on the back of the pedal bone also causing rotation).




			Owners hateing grazing muzzles is an anthropomophic, reaction, which is not a good reason not to use them.
		
Click to expand...

Yup. Totally, but I can't persuade some people at all!




			Yard owners should be providing safe grazing for their clients, considering the cost of livery. The diversification of farmers into livery, appears to be encouraging the wrong sort of grazing for horses, by the fixation with green unpoached fields, and restricted turnout.

The welfare of the horse is paramount in all this but I do feel that this often comes second due to a basic lack of understanding and an unwillingness to understand the horses specific requirements.
		
Click to expand...

I'd love this to be the attitude in all yard and adopted by all owner's managers, but it's not.  Don't know why, I've never understood it.  I just often have to work with what I have...


----------



## AndySpooner (11 October 2010)

ImogenBurrows said:



			I agree with this logic but there is a halfway house here.  Painkillers aren't just given liberally for stopping pain.  That sounds a bit odd, but they are anti-inflammatories which is the reason they are given primarily.  If ongoing inflammation is not stopped this will encourage loosening of the vital laminar junction, encouraging and allowing pedal bone rotation.  Pain itself sets off a vicious cycle of  inflammatory mediators in a cascade of events which culminate in steroid hormone and others exerting an effect on the laminae in the foot....(far to complicated for me to remember all their fancy names off the top of my head!!)

The "keeping the horse able to feel the pain" argument is actually far outweighed now by these negative effects of inflammatory mediators.  

Plus TBH IME or treating WAYYYYYYY too many active aggressive laminitics, I'd be quite happy to say, 'bute's good, but it's not that good. [QUOTE


By the time the attack is acute the damage to the laminar junction is massive. If the horse is flat out nothing should be done to encourage the horse to stand, which will increase  rotation of the pedal bone.

The metabolic disruption within the horse's body should be allowed to stabalize, which will in turn allow the interupted blood flow back into the hoof, reducing the inflamation.

Attempting to treat the inflamation in the hoof, which is a syptom of the illness, is detrimental to the recovery of the horse in the initial stages of the attack and will hinder the reversal  of rotation and re attachment of the pedal bone in the long term.
		
Click to expand...


----------



## brucea (11 October 2010)

Sadly grazing muzzles are as much a curse as they are a blessing.

The problem is that ponies (mostly ponies) get very good at removing them, so you turn them out thinking that they're safe and then come back to hunt around the field for them several hours later when pony has porky-pigged himself and is lying with four feet up in the air!

Also I have seen cobs have a real temper fit and basically beat up other horses to try ot initiate grooming to remove them

MNot to forget the real risks of turning ponies out wiht any kind of headcollar device with shoes on - does not bear thinking about

I gave up on using them when our lami pony ran straight out, up to the cob, who promptly just pulled it off!


----------



## AndySpooner (11 October 2010)

I agree, much better to get the system right rather than have to attempt using muzzels and such like, but, just part of the joy of horses. lol.


----------



## ImogenBurrows (11 October 2010)

AndySpooner said:



			By the time the attack is acute the damage to the laminar junction is massive. If the horse is flat out nothing should be done to encourage the horse to stand, which will increase  rotation of the pedal bone.

The metabolic disruption within the horse's body should be allowed to stabalize, which will in turn allow the interupted blood flow back into the hoof, reducing the inflamation.

Attempting to treat the inflamation in the hoof, which is a syptom of the illness, is detrimental to the recovery of the horse in the initial stages of the attack and will hinder the reversal  of rotation and re attachment of the pedal bone in the long term.
		
Click to expand...

 Oooofff.  This is a line of action I'm afraid I would disagree with.

So to clarify you're saying no anti-inflammatories in severe, acute laminitis?
Really? No pain relief....or would you give pain relief, just not NSAIDs? 

wow.  I'd like you to do two things before reposting to answer me please.
First, imagine turning up to a client with a horse in this state (down, sweating, raised heart rate, acutely painful, possiblilty of secondary stress colic) and tell them you are going to give nothing to relieve the pain....and play out that conversation in your head. 
Second, imagine how you'd justify to the Royal College of Veterinary Surgeons and Veterinary defence Society just how you got to the conclusion that withholding pain relief/anti-inflammatories was not only ok but in the interest of the patient.  

I would not support this argument, no matter what the underlying science you use to defend it.  My job is to prioritise the welfare of the horse.  I hope I've misunderstood your post as this wouldn't not be in the horse's welfare how ever you dress it up. 

Regards 
Imogen


----------



## brucea (12 October 2010)

When my professional laminitic was down, as opposed to the one who does it just for a hobby... 

He got quite large doses of antinflamatories when the vet came out immediately the problem became apparent, and we had him on danilon twice a day, and he got ACP's injected and as tablets. He was already barefoot.

That lot completely chilled him out and he spent  his first 10 days mostly lying down in a deep straw bed, we took his food and water close to him, and he only got up to relieve himself in a bed at the back of the stables. He's an obsessively clean little guy. When he was able to get up, he actually recovered to the point where he could walk the fifty yards to the outdoor dry lot in about 2 weeks, where he had waiting for him a 5 ton pile of sand to lie in and a pea gravel area. 

Three months after that he was out walking booted behind us on gentle hacks, within the year he was back into his driving job, doing 10 miles at a time booted up with 12mm pads. Now he is tromping round the tracks in the woods across pretty sharp rough tracks, unbooted, no trouble at all.

It is entirely possible to have a really successful laminitic rehabilitation if you recognise the problem, intervene as early as possible, take the vet's medications, work through to the real root cause, and use a hoofcare professional who has experience of laminitic rehabilitation and can steer you in the right direction. 

What I don't do though,  is give the other one Danilon if he is "just a little bit footy" as a result of having a bit too much grass. We prefer to remove the aggravating factor (the grass) and then see how he progresses for a few days. If we give him Danilon at that point we won't see whether we have simply masked the problem or we are solving it. But there is a very clear cut off where we think  "this is not OK" and we need to get intervention here.

It's never ethically acceptable to leave them in pain.


----------



## AndySpooner (12 October 2010)

ImogenBurrows said:



 Oooofff.  This is a line of action I'm afraid I would disagree with.

So to clarify you're saying no anti-inflammatories in severe, acute laminitis?
Really? No pain relief....or would you give pain relief, just not NSAIDs? 

wow.  I'd like you to do two things before reposting to answer me please.
First, imagine turning up to a client with a horse in this state (down, sweating, raised heart rate, acutely painful, possiblilty of secondary stress colic) and tell them you are going to give nothing to relieve the pain....and play out that conversation in your head. 
Second, imagine how you'd justify to the Royal College of Veterinary Surgeons and Veterinary defence Society just how you got to the conclusion that withholding pain relief/anti-inflammatories was not only ok but in the interest of the patient.  

I would not support this argument, no matter what the underlying science you use to defend it.  My job is to prioritise the welfare of the horse.  I hope I've misunderstood your post as this wouldn't not be in the horse's welfare how ever you dress it up. 

Regards 
Imogen
		
Click to expand...

Well  Imogen, what you describe is an absolute train crash, even though the goal posts have moved a bit, I'll go with it. Lol.

Firstly you cannot not provide some pain relief, in the circumstances you describe.

Not really in favour of NSAIDS as inflammatory phase may be critical to successful healing because the chemical signals released during inflammation may be essential in sustaining the healing cascade.

However, what I am really talking about is the desire many have to get the horse up too soon.

Failure to address the primary cause of the attack, eg. 'my horse is lamanitic, but, I cannot stop feeding sugar, because she loves it.'

The overall medicalization of badly managed horses.

Regards

Andy


----------



## ImogenBurrows (12 October 2010)

AndySpooner said:



			Well  Imogen, what you describe is an absolute train crash, even though the goal posts have moved a bit, I'll go with it. Lol.
		
Click to expand...

 




			Firstly you cannot not provide some pain relief, in the circumstances you describe.
		
Click to expand...

Phew




			Not really in favour of NSAIDS as inflammatory phase may be critical to successful healing because the chemical signals released during inflammation may be essential in sustaining the healing cascade.
		
Click to expand...

This is quite a good description of the phases of laminitis and also treatments. http://www.completerider.com/futireartices/Laminitis - Page 2.htm
I get what you're trying to achieve by protecting the inflammatory mediators for their good..., so what pain relief _would_ you provide if not NSAIDs? 




			However, what I am really talking about is the desire many have to get the horse up too soon.
		
Click to expand...

This is also agree with - people are very stressed when the horse is down and I often say that the more time the horse spends down initially (as long as it'd not down from uncontrolled pain) the better - least amount of weight possible going through the feet  can only be good.  BUT the horse should be able to rise is required...




			Failure to address the primary cause of the attack, eg. 'my horse is lamanitic, but, I cannot stop feeding sugar, because she loves it.'

The overall medicalization of badly managed horses.

Regards

Andy
		
Click to expand...

Yes, I struggle with the feeding comment.... 

I think ultimately we are going to agree on one point - medical treatment are*NOT* and should not be ever in anyway a substitute for obtaining the correct underlying cause and removal and/or treatment of _that_.

I'm going to be very interested about one further thing though. 

NSAIDs in the horse are usually and combined block of all the COX enzymes (cyclo-oxygenase 1 and 2) which control the inflammatory cascade. http://osteoarthritis.about.com/od/osteoarthritismedications/a/cyclooxygenase.htm
There has recently been the release of a specific COX2 inhibiting NSAID - Equioxx http://equioxx.us.merial.com/about.asp
This _should_ minimise side effects seen with the other NSAIDs (although in my hands not common) and also note the bit where it says the clinical relevance has yet to be determined! 

I wonder where this is going to fit in for laminitis treatment...if at all.

All the best 
Imogen


----------



## AndySpooner (12 October 2010)

Hi Imogen,

In truth 'bute' is what I have and would use, though I do get a bit concerned about the high levels often prescribed for laminitics and the duration of administration.

I think that it is early days  yet as far as equioxx is concerned, but, if inhibiting COX 2 only is achievable with no ill effects then it may well have a role in the treatment of laminitus.

I believe that AQHA are constantly looking for a drug which will enhance the training and performance of reining horses, but thats a whole other can of worms.

Anecdotally, there appears to be a rise in the level of gastric ulcers reported in equines which leads me to wonder about the level of NSAIDS being prescribed generally. 

Andy


----------



## ImogenBurrows (13 October 2010)

AndySpooner said:



			Hi Imogen,

In truth 'bute' is what I have and would use, though I do get a bit concerned about the high levels often prescribed for laminitics and the duration of administration.

I think that it is early days  yet as far as equioxx is concerned, but, if inhibiting COX 2 only is achievable with no ill effects then it may well have a role in the treatment of laminitus.

I believe that AQHA are constantly looking for a drug which will enhance the training and performance of reining horses, but thats a whole other can of worms.

Anecdotally, there appears to be a rise in the level of gastric ulcers reported in equines which leads me to wonder about the level of NSAIDS being prescribed generally. 

Andy
		
Click to expand...

Hi Andy,

There has been so much work into the side effects of using both long term lower doses of PBZ and higher doses in the short term. 

This and my experience of using both of these strategies in practice would support evidence of little or no side effects being created.  Sure they can happen but I have generally only seen them from high dose usage in _sick, dehydrated foals_ - often in the form a kidney disease and usually when a foal has been on concurrent gentamycin which is also likely to hammer the kidneys (and has probably actually been the main problem).

Often people seem to worry really hard about the *gastric* ulceration and link this to NSAID use in the horse.  The thing is inflammation and ulceration in the gastrointestinal tract due to NSAID use is most commonly found in the right dorsal colon, especially in ponies, and that in itself is uncommon.  Kidney effects are next up in line, but again the horse probably has to have a significant degree of dehydration or pre-existing kidney disease concurrently or prior to the treatment.

Lastly _gastric_ ulceration can occur from the NSAID use, but is rare.  It is also in a different location within the stomach in comparison to the ulcers forming from EGUS from other causes. EGUS cases tend to have ulcers predominantly located around and on the margo plicatus which is the distinct band around the stomach dividing the glandular and non-glandular areas of the lining or running up into the non-glandular area. 
	
	
		
		
	


	




whereas the NSAID induced ulcers generally sit low down in the glandular portion. This is unusual in EGUS. 

I honestly believe that EGUS is more commonly diagnosed, not due to incidence increasing, but due to awareness and ease of diagnosis, increase insurance to pick up the cost and possibly the shift in management of other breeds, rather than just the thoroughbred into a more indorr, concentrate based diet type of system. 

Hope that might allay a few fears.
Imogen


----------

