IR/Hypothyroidism and Laminitis- Any Suggestions?

[horsegirl888]

Hi everyone, I don't normally post on the Horse Care forum, but I was just wondering if you might have some suggestions.

A week ago, my 17 year old Anglo-Arabian mare came in from her daily turnout in the pasture, lame on both front feet. We had the vet out immediately, and he diagnosed it as mild laminitis (sensitive to hoof testers on the toe).

She has been diagnosed "low thyroid" for the last 2 years, and used to get 2 scoops (teaspoons) of Thyro-L once a day. We do not know for sure whether this is actual hypothyroidism or insulin resistance, which I know can be a cause of low thyroid, but we can't have her tested for it now because by the thyroid test that we got back 4 days ago, her thyroid is still "low" (2.0, normal is 2.5-4.8) and we don't want to take her off of the Thyro-L in the middle of this.

Prior to this incident she has been doing well on Thyro-L and 25/75 grass/alfalfa hay mixed with 100% grass hay. She also got Progressive Grass Balancer feed, with a small amount of high-fat "Envision." We have now learned that ANY alfalfa hay was not a good thing, and that Progressive feed was also not a good solution as it is soy-based. We were not informed of the risks of alfalfa or soy when we became aware of her thyroid condition, and she improved so rapidly on the Thyro-L that we did not make more changes to her diet.

When we got the laminitis diagnosis, we discussed her feed with our vet. We have now changed her hay over to straight 100% grass. We also cut back her Progressive Grass Balancer to half of the amount we started her on, and she is now getting only about 1/2 lb. per day. We don't think it's a good idea to completely change her diet at this point. She had been on the small amount of alfalfa hay and full ration of Progressive for 1 year with no issues prior to this episode.

Sorry for the long story, but I'm just wondering if anyone has seen anything like this. She's on bute and the vet has told us to bump her Thyro-L up to 3 scoops per day, which we have done. She's not getting any better, in fact, she was slightly worse than she has been lately tonight.

Right now she's barefoot, and was trimmed by our farrier according to the advice of our vet a day after she was diagnosed. She's not head-bobbing lame, and she doesn't have the characteristic laminitis stance, but she's definitely sore on both fronts.

We have been keeping in touch with the vet. At this point he recommends keeping her on the bute and waiting for a few more days. We are going to have him out tomorrow if she is still not improving. He's been great about this, as has our farrier. It's been a week so far. If it's still not looking good within the next one, the vet is recommending X-Rays and/or corrective shoes.

How does this sound to everyone? I have no experience with this at all and was just looking for some extra support/suggestions? Thank you ever so much.

-Horsegirl

[JB]

www.safergrass.org
http://www.thehorse.com/ViewArticle.aspx?ID=12588
http://www.thehorse.com/ViewArticle.aspx?ID=10113
http://www.thehorse.com/pdf/factsheets/insulin-resistance/insulin-resistance.pdf
http://www.thehorse.com/ViewArticle.aspx?ID=11627
Lots more at The Horse.

you have GOT to start soaking her hay. All of it. Unless you can get hay that is tested at 10% NSC or less, soak it, 30-60 minutes, drain the water.

[horsegirl888]

Thank you. I created an account and am reading through the articles. I will do what you (and the article) suggested about soaking her hay, it has not been tested yet, and that's another thing that needs to be done. It is sounding more and more like IR the more I read about it. If I am understanding this right, I can't have her tested for IR while she is on Thyro-L and get an accurate result.

We are going to speak to our vet in the morning about IR. We were given the "low thyroid" diagnosis and advised to put her on the Thyro-L without much consideration to the dietary aspect of this condition (this "fixed" the symptoms, but obviously not the primary problem), and this needs to change. Thank you so much for the help.

[BornToRide]

As generally easy keepers, Arabs are notorious for developing IR. IR can supress thyroid function. Even just grass hay can be too high in sugars for some sensitive horses. I would also take her off the progressive feed right now and avoid anything that contains soy, as that also supresses thyroid function and makes IR worse.

The Yahoo Equine Cushings group also has tons of helpful information on this subject. Check in their files for emergency diet and put her on that now and read up on Items to avoid in IR & Cushings horses.

Best wishes!

[Daydream Believer]

Wow...just wow..it's like deja vu reading your post. I also had IR and unexplained laminitis this summer on the same brand of feed in a mare who had no history of problems. She was on it about 4 months before she developed the laminitis and had about 3 degrees of rotation. I removed the soy based feed as I had learned that soy could be implicated in IR and thyroid conditions and she immediately improved, recovered to full soundness within a few weeks, and has remained without problems since then. This was in late August when this happened.

My mare was never tested for thyroid as we had no reason to be concerned prior to this problem. The mare was in foal at the time and was found to have very low progesterone levels for the stage of pregnancy that she was in also. We dealt with that problem by using Regumate for about a month and she's held on to the foal and is due soon. Of course we can't prove the feed had anything to do with her founder and hormone problems but nothing else changed and the fact she recovered so quickly was convincing. She tested negative for IR also.

I had a rash of IR type symptoms in a significant number of my horses also after starting my horses on the soy based feed. Now on a soy free diet, they are all doing much better with normal weight and no IR symptoms.

I really would take your mare off that feed completely. If she has developed a sensitivity to the soy...and sensitivities...allergies...whatever...can develop over time due to repeated exposure, than keeping her on even a small amount may inhibit her recovery. You have lots of options like beet pulp, rice bran, flax and hay pellets and there are soy free supplements like LinPro that can help supplement her. I do feed alfalfa pellets to this mare with no problems at all...alfalfa has much lower quantities of phytoestrogens than soy generally. I don't feed much of it either...about 2 lbs a day.

I would also soak hay until you can get it tested to see if the NSC levels are safe for her.

[Katy Watts]

If I am understanding this right, I can't have her tested for IR while she is on Thyro-L and get an accurate result.


Nope. Doesn't matter. Get a full thyroid panel while you are testing to see if levels are OK on current dose.

Soak hay, like NOW! Couple hours is probably better. LOTS of water.
Katy

[horsegirl888]

For those of you that had problems with the soy-based feed or have heard about them, did you remove all of the feed immediately, or gradually wean them off of it? As I said, she is on half of her normal ration already.

Thank you everyone. Again, we will make sure to ask our vet about all of this (aside from soaking the hay- it will be soaked for her next feeding tomorrow AM) before we do anything, but I really, really appreciate all of the input. Thank you again.

[Daydream Believer]

For those of you that had problems with the soy-based feed or have heard about them, did you remove all of the feed immediately, or gradually wean them off of it? As I said, she is on half of her normal ration already.



I removed the feed immediately. I already had been doing some research into the soy and possible effects and the obesity/IR epidemic on my farm last Summer and when the mare suddenly got laminitis, I just decided to pull them all off of it. I know changing feed quickly has some risk but I was more worried about the problems I was seeing related to the feed and the effect of possible allergic reactions.

I also saw positive changes after the feed was removed quite fast...within days...on the laminitic mare and a foal that had drastic behavior problems that started when she began eating grain with her dam. If you search back on my posts to about August and Sept of 08, you will find the threads of what happened. The first thread was in the breeding forum also and there were several other discussions on soy here in Horse Care since then.

Again, if you are dealing with a sensitivity or an allergy to soy...and soy is a major allergen, simply reducing the amount is not the answer. It also may not be an allergy but a reaction to the phytoestrogens/thyroid effect. Either way, it's not worth it to keep her on it and experimenting if she's in active laminitis. Until you have the laminitis under control, I'd take her off concentrates of any kind and soak her hay...like tomorrow a.m. You have to stop the laminitis first and you need to react quickly.

[Pat Ness]

Horsegirl - I see you are in MN. I send my hay samples to a place in st. cloud - about $17.00 for the samples. FYI - I had 2 horse founder on straight grass hay. Alfalfa gets a bad rap - fed it for 23 years and never had a problem. I test all my hay now and alfalfa is rarely over 11 % sugar. The grass has been as high as 15%. Good Luck.

[Liberty]

...The Yahoo Equine Cushings group also has tons of helpful information on this subject. Check in their files for emergency diet and put her on that now and read up on Items to avoid in IR & Cushings horses....


Ditto. That group was instrumental in helping me get my IR mare straightened out after she foundered (my local vets had been insisting it was "only an abscess"... :no: )

Here's the link to the Yahoo Cushings/IR Group:
http://pets.groups.yahoo.com/group/EquineCushings/

Good luck!

[Altamont Sport Horses]

Ditto. That group was instrumental in helping me get my IR mare straightened out after she foundered (my local vets had been insisting it was "only an abscess"... :no: )

Here's the link to the Yahoo Cushings/IR Group:
http://pets.groups.yahoo.com/group/EquineCushings/

Good luck!

Join this Group as soon as possible. It will save you time, effort and money to do things correctly the first time and to get your mare healthy, safe, and comfortable ASAP. The amount of information there is incredible. I wish I had joined the group before my horse was even tested.

I agree you should test the thyroid level to make sure she is getting enough from her current dosage. But her thyroid could be low to Cushings. Read up on the most up to date testing methods for Cushings, etc. and which labs are good. If your vet doesn't use the right test, right lab, try to convince him/her or find a different vet. You need accurate results that mean something. Do not do a dex suppression test!

There is an emergency diet for these conditions and it is available on the list. Other things which may be applicable to you are keeping your horse's feet and legs warm to protect them in cold weather as they are more likely to become laminitic when it is cold.

Join the Group and start learning.

[rcloisonne]

Other things which may be applicable to you are keeping your horse's feet and legs warm to protect them in cold weather as they are more likely to become laminitic when it is cold.
Considering Chris Pollitt's experimental model proves icing of the feet and lower legs for 48 hours prevents laminitis in horses purposely fed a carbohydrate overload, why would a horse be more likely to develop laminitis when it's cold outside? Specifically, what is the mechanism?

And if I were the OP, I'd want at least a T3, as well as a T4, taken to determine if the horse really needs to be supplemented with levothyroxine. Primary hypothroidism is extremely rare in an adult horse. Given the number of prescriptions handed out for drugs like Thyro-L though, you'd never know it. :no:

www.ivis.org/proceedings/aaep/2002/910102000178.PDF

[joharavhf]

Great advice here as to the diet changes. I found the BIGGEST help for my old guy when he was foundering was soaking the hay. Soaking hay SUCKS, but it's worth it in the long run.

Everyone here has addressed your diet concerns, I want to pry more in to what you're doing to stop the laminitic episode besides diet.

I had an old (Arab!) gelding who went in to laminitis from Cushings and it took us nearly 2 weeks to get him out of the acute laminitis. One of the things we did immediately was pad him up on styrofoam. It sounds hilarious, but it did offer him some relief. I was also soaking his hooves 2-3x per day in ice water for 20 minutes each time (I think! This was 6 years ago....). The styrofoam pads I used were the EDSS Styrofoam Blocks. (http://www.hopeforsoundness.com/techsupport/instguides/styrofoamguide.htm). I found that I got a more even "application" with these blocks than using the blue insulating styrofoam from the hardware store!

I also had accupuncture performed on him - and quite a bit of blood was "drained" at that point from the accupuncture site.

The *BIGGEST* thing though that pulled him out of the acute phase was the injection of Adequan. My vet had told me that at that point she had been using it in other laminitis cases as it is supposed to "soothe inflammation" in the body....Although Adequan is not LISTED as a treatment for laminitis, I found that my gelding responded within two shots of the miracle drug.

Laminitis is a big pain in the butt. It's scary. It's hard work. But it IS manageable once you find out what the cause is and start treating for that. Sounds like you already know what *some* of the cause is, so once you clarify the diet, you should be good to go. Hang in there - it may be a long road, but there are SOOOOO many resources nowadays! Good Luck :D

[BornToRide]

Considering Chris Pollitt's experimental model proves icing of the feet and lower legs for 48 hours prevents laminitis in horses purposely fed a carbohydrate overload, why would a horse be more likely to develop laminitis when it's cold outside? Specifically, what is the mechanism?First, standing around in the cold and applying cryotherapy directly to a limb are two different things.

Secondly, horses with IR and /or Cushings tend to be more affected by cold temperature as their body temp regulation tend to be compromised, which can push them into a laminitic episode. I do believe that stress is a factor here.

[Altamont Sport Horses]

Considering Chris Pollitt's experimental model proves icing of the feet and lower legs for 48 hours prevents laminitis in horses purposely fed a carbohydrate overload, why would a horse be more likely to develop laminitis when it's cold outside? Specifically, what is the mechanism?[/url]

We're not talking about a horse fed a carbohydrate overload in this case. There are different degrees of "prevention". Primary prevention would be preventing the horse from being exposed to conditions that would initiate the laminitis. Secondary prevention would be preventing the laminitis from occuring when the horse has been exposure to those conditions - in this case carbohydrate overload. Tertiary prevention would involve treatment to reduce damage to the foot, assist in pain management, etc. once laminitis has begun. Chris Pollitt's model is addressing secondary prevention of laminitis. Keeping the feet warm of a horse prone to laminitis when there is no acute laminitis would be primary prevention.

While I don't know the exact mechanism I would expect that keeping the feet and legs warm would be helping to maintain good circulation to the foot although it could be something else entirely. Living in Alabama this really hasn't been a concern for me so far so I have not read up on it yet but it has been mentioned quite a bit on the EquineCushings group which is why I took note of it. If you want to understand the mechanism I'm sure you could ask Dr. Kellon, the vet contributing to this very educational Group. It may be discussed in detail already on the Group message board or in the files as well. I can't imagine the extra effort would be recommended if it wasn't helpful and didn't have some scientific or experiential basis.

[EqTrainer]

Considering Chris Pollitt's experimental model proves icing of the feet and lower legs for 48 hours prevents laminitis in horses purposely fed a carbohydrate overload, why would a horse be more likely to develop laminitis when it's cold outside? Specifically, what is the mechanism?

And if I were the OP, I'd want at least a T3, as well as a T4, taken to determine if the horse really needs to be supplemented with levothyroxine. Primary hypothroidism is extremely rare in an adult horse. Given the number of prescriptions handed out for drugs like Thyro-L though, you'd never know it. :no:

www.ivis.org/proceedings/aaep/2002/910102000178.PDF (http://www.ivis.org/proceedings/aaep/2002/910102000178.PDF)

Ditto to all of this.

I treat Arabs the same as I treat ponies unless proven differently - air ferns that should be fed a NO concentrate diet - instead they get beet pulp and a multi-vitamin. Extra magnesium. I do feed the IR horses I rehab the Progressive Diet Balancer but those horses are big, non-air fern breeds. I have never had an issue - in fact, they recover on it, which says a lot to me - but it's not the same phenotype of horse at all. Which I think is very important to understand.

Does this horse have adipose fat pads? A crest? Is she skinny or fat? Or skinny w/adipose fat pads and a crest? Sometimes sorting out the body type takes some imagination :lol:

[rcloisonne]

First, standing around in the cold and applying cryotherapy directly to a limb are two different things.
How are they "two different things"? Please explain.

Secondly, horses with IR and /or Cushings tend to be more affected by cold temperature as their body temp regulation tend to be compromised, which can push them into a laminitic episode. I do believe that stress is a factor here.
Stress I can understand but as the horses' ideal temperature is around 40F, what is cold to us is not cold to them.

While I agree these older horses with chronic laminitis often have more problems in the winter (I had one), IMO, it is caused by the very hard ground they're forced to walk on and possibly hormonal changes due to the short length of daylight hours. In other words, it has little to do with temperature itself.

Hey, if wrapping your horse's legs and feet to keep them nice and toasty warm makes you feel good about yourself, go for it. Just don't expect it will prevent laminitis because there's not a shred of evidence that it will. Really, this sounds like another of EK's ludicrous theories.

[horsegirl888]

Thank you everyone for all of the information. She is off of all concentrates, we are getting non-molasses beet pulp and a vitamin supplement to give instead, and we are getting her tested for IR, hopefully tomorrow. We are also getting radiographs and possibly corrective shoes if needed.

We had her thyroid reading tested right after the laminitis was diagnosed (seven days ago), and it was low (2.0, normal range 2.5-4.8). This is when we put her on the higher dose of Thyro-L.

The specific cause of all of this is largely unidentified as of yet, she is used to being turned out for 12 hours in the cold (normal day here in MN is 20 degrees or so)- she is blanketed, I have never wrapped her legs or feet.

She is in good weight (approximately a six to a six point five on the BCS), but has tended towards a cresty neck when she does get overweight. I have a couple of older pictures, not any close-ups, but just to get an idea of her body type- not that this may be a factor, but regardless-

http://www.facebook.com/photo.php?pid=269659&l=c99d5&id=1312343883
http://www.facebook.com/photo.php?pid=152446&l=e5ba3&id=1312343883

Her neck is also slightly cresty now, which is what is making us think her thyroid levels, whatever may be causing this, are out of whack.

Cushings is another important consideration- thank you for bringing it to my attention. I really appreciate everything everyone has brought up. It is great to have such excellent information and support in what is a very stressful time. Thanks again.

-Horsegirl

[appychik]

Just bumping...

OP, was your mare diagnosed with IR? What's been your course of action so far? Just wondering as my boy was just diagnosed last week (we're also in MN) and I'm still trying to figure out what to do.

[high hat]

There is an emergency diet for these conditions and it is available on the list.

I signed up for the group and can't find the diet could someone pm it to me or add the link please?

[Altamont Sport Horses]

I signed up for the group and can't find the diet could someone pm it to me or add the link please?

Sign in to your groups and then on the left hand side of the screen under "Messages" there is a link for "Files." You will find tons and tons of information in there but fortunately the Emergency Diet is the first file in the first folder. Click as follows:
-Files
-1 Start Here!!!
-Basic Nutritional Needs - And in here you will find the "Emergency Diet" and "Basic Nutritional Needs for Insulin Resistance"

You've got a lot of reading ahead of you. :)

[high hat]

Thanks,