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update post #112 Laminitis woes/vaccine reaction

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  • #41
    Knowledge is power. If you're interested in firocoxib, look up the package inserts for both drugs and compare. All the data--the dosage numbers and such--comes directly from there.

    If you are looking to add firocoxib to her regimen, Previcox is a perfectly safe way to go.

    Another pain killer that might be interesting to investigate is gabapentin:

    http://avmajournals.avma.org/doi/abs...nalCode=javma&

    Very, very little risk of side effects and might be VERY useful.

    Comment


    • #42
      I have a mare that was four months pregnant when she had colic surgery. She was not under my care at the time, but long story short, she foundered due to sepsis. She held the foal, believe it or not, and has been back under my care since Halloween-ish.
      She spent months from the time of her surgery until after she foaled at Alamo Pintado where they took awesome care of her. She rotated in one foot and dropped in the other. She was on antibiotics, bute with ranitidine for the inevitable ulcers, with banamine on bad days up until about three weeks ago. We have now weaned her off bute and banamine, and she is only on gabapentin (has had that about 6 weeks) and is doing great! We let her roam around the farm as she wants to, and today she was trotting quite well on the grass outside. I think it has made a huge difference in her pain management.
      I also got her Soft-ride shoes which she hasn't needed in the last couple weeks. They also made a huge difference to her comfort level. She was extremely thin when we got her back under our care, and we followed the advice from the vet at Alamo and our vet here (did I mention the vets are awesome ). She was initially twice a day getting Platinum RX oil, extra vitamins, Ultium, timothy pellets, timothy hay (soaked), and we began adding in alfalfa. She now gets equal alfalfa and timothy and looks great along with everything but the oil.
      I, too, scoured the web for information on diet, since she her founder was due to sepsis, not based on metabolic issues.

      I am so sorry you and your mare are going through this, but it sounds like you are doing everything you can.

      Comment


      • #43
        I forgot to mention our almost 30 year old stallion is on firocoxib and is doing very well on it for arthritis. We tried the mare on it for a couple weeks, but didn't see much of a difference in her.

        Comment

        • Original Poster

          #44
          Our second opinion vet visit was enlightening and I'm feeling more hopeful. The vet ruled out gabapentin right away. Gabapentin is great for neuro type pain; however, it does have the side effect of strongly increased perfusion, the effects of which take an extraordinarily long time to revert to normal. Because she is pregnant, we would have to stop the gabapentin well before her anticipated delivery date to prevent postpartum hemorrhage. Gabapentin changes the structure of the red blood cells so they can squeeze through places in greater abundance. There is also a known increased risk of abortion and she is still at too high a risk of aborting from the laminitis, so this is not a good choice for her while she is pregnant. After she has safely foaled out, this could be a good choice.

          This vet did think that firocoxib had a place, but wants her only on a maximum of 1/4 tablet per day and top up any pain relief needs with Banamine, and of course continue the Regumate until day 310 of her pregnancy.

          We took more x-rays. Despite her jumping career and her age of 18 years, the mare has no arthritis whatsoever. She has, however, rotated quite a bit from the laminitis, but it is still very much in the treatable range. The x-ray gave evidence of continuing acute inflammation. Based on the x-rays, the farrier will have more changes to make with her trims. Right now there is no growth to allow a trim, so she got some strategically placed pads applied. I learned a neat trick to paint some nail polish on the hoof wall just under her coronet band. The line of nail polish will show how uneven her hoof growth is, which will, in essence, give us a very good idea of how much blood vessel damage has taken place within the laminae. Blood vessels = feeding tissue =repair and growth.

          Now we wait to see how she grows.
          Practice! Patience! Persistence!
          http://www.mariposasporthorses.com/
          https://www.facebook.com/MariposaSportHorses/

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          • #45
            Thanks for the update - she sounds as if she's managing better

            How stressful for all of you
            ((Hugs))

            Comment


            • #46
              Just for my own education - 1/4 tab of what size? In other words, how many mg? I only ask because there's a 227mg tab of which a horse should only get 1/4 (57mg), but that's a normal dose sort of equivalant to 1gm bute. Is he talking about that, or 1/4 of a 57mg tab?

              I'm glad you're seeing the light at the end of this tunnel
              ______________________________
              The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

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              • #47
                Sending jingles for stabilization for your mare, with no more 'reactions". Please keep us posted as to hers and the foal's condition.

                Finally - get some rest! Sounds like you have a couple of fighters on your hands - from the caretaker of a 34 YR TB Chesnut mare who drags me to and from the paddock each day. Have to love the redheads!
                "Never do anything that you have to explain twice to the paramedics."
                Courtesy my cousin Tim

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                • Original Poster

                  #48
                  firocoxib is shown to cause birth defects in rabbits, rats and dogs; human warnings.

                  I cross posted this in the breeding forum, because while at first I was excited about starting firocoxib, I have since read a study in Europe and now I am very alarmed.

                  (Copy and paste of my poste in breeders forum)

                  I read a very comprehensive report on this that included toxicity reports (low risk for adult horses), but there were some considerable fetogenic deformities and deaths at relatively low doses when tested in rabbits and rats even down to only 1 mg/kg. While I realize horses are not nearly the same as rabbits or rats, it made the researchers concerned enough to totally mark it contraindicated in dogs who are pregnant and nursing.

                  "Developmental toxicity studies revealed that firocoxib was Embryotoxic/foetotoxic in both the rat and rabbit inducing a variety of external, visceral and skeletal Malformations, anomalies and variations. The rabbit was far more sensitive than the rat to these Effects. Consequently firocoxib is contraindicated for use during pregnancy and lactation in dogs."


                  They also tested toxicity effects on the humans who were administering the drug and again found enough concern that all women of child-bearing age, pregnant or nursing should NOT handle this drug without using gloves. Washing of hands thoroughly is recommended.

                  "Also, given the fact that reproductive toxicity was the most sensitive toxicological endpoint, the SPC includes a warning statement concerning use of the product by women of child-bearing age. Women of child-bearing age should avoid contact with, or wear disposable gloves, when administering the product."


                  An adult horse, I see no problem with giving this drug. At the usual dose of 0.1 mg/kg an adult horse can deal with this drug no problem; however, a fetus is an entirely different thing. Even at late 2nd trimester or 3rd trimester there is active growth of the skeleton and many of the mutations were skeletal in origin, as well as cardiac and gastrointestinal including imperforate anus (sealed anus) being specifically noted. A foal does not have the drug clearance capabilities of an adult horse and their bodies are WAY smaller. As far as I can see, the drug manufacturer went ahead and had it licensed for use in horses without any specific drug testing on horses, specifically with regards to fetotoxicogenic effects!

                  Specifically what concerns me is that it is already known that the horse is far more sensitive to this drug than even dogs!! So, if dogs have a problem, then why the h3!! would they offer it to pregnant mares??

                  THUS, I'm looking for information from people who have specifically used this drug IN A PREGNANT MARE.

                  Here's the full study done in Europe:
                  http://www.ema.europa.eu/docs/en_GB/...C500063226.pdf
                  Practice! Patience! Persistence!
                  http://www.mariposasporthorses.com/
                  https://www.facebook.com/MariposaSportHorses/

                  Comment


                  • #49
                    Wow, just came across this thread. Good luck to you and your mare. To replace the protein of soy you can feed split peas. The kind you buy in the super market to make soup. I use them instead of soy products on my mare and it is a good safe source of protein for horses. There are so many things you can feed for good protein levels other than soy. Peanuts are good too.
                    Charlie Piccione
                    Natural Performance Hoof Care

                    Comment


                    • #50
                      Not an earth shattering suggestion but a deep bed of peat moss might be better then shavings, it is really "cushy", and I have been told that it draws heat out of the feet.
                      Best wishes for health

                      Comment


                      • #51
                        Molasses free beet pulp, 1-2 oz iodized table salt, magnesium 1.5g/day per 500 lbs body weight, vitamin e 1000 IU/day per 500 lbs body weight, and 2 oz stabilized flax are a good base to start with for laminitic horses (per Dr. Kellon's yahoo group). You could try "my feed xl" it is online calculator that takes into account your horse, any conditions they have, their diet, and then analyzes to see where it is lacking. I used it on my IR horse to balance his diet and choose grains and supplements that would be safe for him. Good luck!

                        Comment


                        • #52
                          FYI, even though you mentioned a time or two that she does not have any pre-existing metabolic problems, it is not unheard of for (both humans and horses) to have gestational diabetes. Did your second opinion Vet get a blood draw to test the ratio of insulin to glucose, and to see if she does have elevated blood glucose? If not, that would be another good thing to check.

                          Dr. Kellon does consultations for other Veterinarians, specifically and especially for nutritional support in treating various conditions, and she definitely is someone I would want involved in a consulting role for such a situation as this. Her website is www.drkellon.com and she is sure to have some helpful advice.

                          ETA, just remembered you are in far frozen north tundra region. Are you keeping your mares legs warm!? If she is not in standing wraps, I would be willing to bet she ought to be. If you do not have those available, shipping boots would work.
                          Jeanie
                          RIP Sasha, best dog ever, pictured shortly before she died, Death either by euthanasia or natural causes is only the end of the animal inhabiting its body; I believe the spirit lives on.

                          Comment


                          • #53
                            Originally posted by rodawn View Post
                            I cross posted this in the breeding forum, because while at first I was excited about starting firocoxib, I have since read a study in Europe and now I am very alarmed.

                            I read a very comprehensive report on this that included toxicity reports (low risk for adult horses), but there were some considerable fetogenic deformities and deaths at relatively low doses when tested in rabbits and rats even down to only 1 mg/kg. While I realize horses are not nearly the same as rabbits or rats, it made the researchers concerned enough to totally mark it contraindicated in dogs who are pregnant and nursing.
                            I can't access the document that you linked, nor can I find it in pubmed, so I can't critique it directly. But "birth defects" of the type most people imagine almost all occur during embryogenesis (in humans, that's the first trimester or so), when structures are actually forming. After that point, almost all the "parts" are in place and simply growing/ developing, so exposures don't usually have catastrophic results unless they directly affect the fetus/ placenta, notable exceptions being cardiac defects (complex structure).

                            That said, I've read this thread with interest. I admire that you are looking for all the information you can so that you make informed decisions. The problem that I see (as someone whose job it is to read and critique scientific literature) is that you aren't really able to breakdown and contextualize some of it. So everything seems alarming.

                            Statistical associations just that -- increased odds/risks of a given outcome related to a given exposure. They are not 100%. Even thalidomide did not harm every exposed embryo/fetus. A good medical or veterinary practitioner will WEIGH those increased risks, informed by their training and clinical judgement, against the risks of not using the drug/treatment.

                            I'm am totally not saying this to criticize, but to encourage you to rely on (trusted) practitioners who can put these risks into perspective for you.

                            Comment


                            • #54
                              Here is the full text of the summary document on firocoxib.

                              http://www.ema.europa.eu/docs/en_GB/...C500063226.pdf

                              The bunnies and rats were given VERY large doses of this drug.

                              They also tested toxicity effects on the humans who were administering the drug and again found enough concern that all women of child-bearing age, pregnant or nursing should NOT handle this drug without using gloves. Washing of hands thoroughly is recommended.
                              Almost all drugs that are not approved for humans (meaning, have not been studied for teratogenicity in humans) carry some sort of precaution about being handled by pregnant women. I could not find in the paper where they tested the effects on humans--that would be wildly unethical.

                              I agree with baxtersmom. Simply reading lots of papers is like simply owning a grand piano. You have to know what to do with it in order for it to be useful. The subtleties of complicated, critical-care decision making are nearly impossible to teach oneself. That is an art that is come by with years and years of background training and then more years and years of implementation.

                              Good luck. Sounds like you are doing everything humanly possible, but you may be scaring yourself more than you are helping your mare with some of your reading.
                              Click here before you buy.

                              Comment

                              • Original Poster

                                #55
                                Ok, so someone asked me for an update.

                                She has been up and down in her course. X-rays of her left foot continue to change and are now on the dismal side of the spectrum. She has less than 1/4 inch before the coffin bone punctures the sole. Because her foot is still changing she is not allowed movement. Once the changes stop and she starts actively growing hoof again, she will be allowed to get moving. She is still on very deep bedding. She is wearing a special heel lift frog support rubber pad because it is soft, protects her sole, and will prevent abscessing. It provides cushioning from anything hard. Her foot is packed with goop - a pepperminty pine tar with iodine in it which never freezes solid and effectively seals the foot from junk getting under the pad. It also prevents thrush and other infections. This was the 3rd try to get it right as the mare dictated. The first heel lift she was never happy with and would stand with her toes pointed downhill (her outdoor stall has one corner that is slightly sloping and she would specifically stand there), so the whole team decided this meant she wanted more heel. At first, she hated the shoe as walking with high-heels was feeling a bit odd to her, but after the week, she has adjusted and is feeling better and now wants to stand on the level.

                                The vet has been talking about severing the ligament that attaches to the heel of the coffin bone, but I'm reluctant because there is no reversing this - maybe I would consider as a last resort if we were going to lose her altogether. The farrier has agreed with me on this matter. It is better to raise the heel, wait for her stabilize and start showing signs of growth (she hasn't even grown 1 cm in 2 months), and then after a few months of good active growth he will consider reworking the trim to bring the coffin bone in proper alignment with the ground. One problem at a time as these things go. All the farriers he has been consulting with all agree with the treatment we have her on right now. So, I will stick with this.

                                Regarding firocoxib and my concerns (please note I work in health care so I understand product monographs really, really well) - The vet agreed there is considerable risk using this drug in a pregnant mare at this stage of her pregnancy. Horses are 10x more sensitive to the drug than dogs or rabbits. Her foal is at a stage of rapid skeletal development and the drug targets the skeleton - this is why it is so good against arthritis - and it can cause significant skeletal deformities. The box clearly warns even pregnant women should not be handling or even so much as breathing in any dust from this drug. So, there is no denying the risk is there and it is significant. I reluctantly started the firocoxib. We have 10 tablets, which will last us 40 days. Her dose is 0.1 mg/kg. Once she is through this box, I'm taking her off it and returning to banamine if she needs it. That said, every drug has risks to foals, even banamine and bute. I have resigned myself to the fact that I will not likely have a normally developed foal and I'm okay with this. I get to keep my mare, maybe, if we're really lucky, she will survive this.

                                She did give us a scare a week ago and went completely off her food for 2 straight days, decided she hated beet pulp, was twisting up her nose, not finishing her hay (which is getting soaked). We started another round of ranitidine right away. Within 2 doses, her appetite returned, so she is now on ranitidine for 14 days. After that, she will be switched to omeprazole for maintenance. The vet chose ranitidine because it starts to work faster than omeprazole and it's cheaper. I have to shoot it up her mouth, but that's okay. Good thing she's easy to handle!

                                Before this latest x-ray and before we realized she was still having changes, I tried leaving her gate wide open to see if she would venture out. Nothing doing. The second she touches harder ground, she backs up into the softer shavings. So, Nickers gets what she wants - right now, she wants soft plushy ground, so this is what we give her. She gets more x-rays in April and maybe she will have stabilized.

                                At all of your suggestions, I have looked up Dr Kellon. I have been basically feeding Nickers exactly as I should. Her reaction and her case were just so severe that she is just going to take a really long time to settle and this has proven to be the case. All pregnant mares are slightly metabolic and so her pregnancy hinders her progress. Recommended raw split peas too as someone above also suggested as protein source especially since she will react to soy. We are just trying her on them and so far so good.

                                We did try a wee tiny bit of alfalfa pellets - like 1/2 a cup. She did react to it as some of you predicted, but even Dr. Kellon said it was worth a try. Being as she is pregnant, her nutritional requirements are going to make life a challenge. She also reacted to ProForm ProFiber Crunch with a sugar soluable guarantee of less than 9.8%. So, yes, indeed a challenge.

                                She has lost a fair chunk of weight in fairly short order partly due to her no-sugar diet and no doubt the presence of ulcers. Even though she has tended to be an easy keeper, she has always been easy to maintain her weight or lose it if necessary. It is only reasonable to expect her to have ulcers, as she was on 4 grams of bute for 7 days at a time before switching her out to Banamine 10 cc twice a day, and then switching her off to firocoxib. These were massive doses of NSAIDs, but she required them. I'm surprised she didn't go into kidney failure, really. I'm extremely surprised she is still pregnant! Day 234.

                                So her course is up and down, but the general overall trend is very slow improvement. She is no longer collapsing from pain or spending vast amounts of time laying down. Most days she is no longer shifting her weight from foot to foot. We bundle her up every time a cold snap comes. Most days, it's above freezing and she's quite comfortable, but when the temperature drops from a temporary blurp from Old Man Winter, she gets bundled up. So, we hold steady, and wait and see, and literally just take things one day at a time. I keep a detailed health log about her which I find helpful for trying to figure out any deteriorations - cold is indeed a factor as Sdlbredfan mentioned above. However, all that being said, I still feel like we are chasing problem after problem. Each problem comes up and a solution is there, but it has consequences, which leads to the next problem, and so it goes always in defensive mode. I don't yet feel we are on the offensive or have the upper hand.
                                Practice! Patience! Persistence!
                                http://www.mariposasporthorses.com/
                                https://www.facebook.com/MariposaSportHorses/

                                Comment


                                • #56
                                  Rodawn so happy to hear that on some fronts you guys are making positive progress! Dr. Kellon if you are interested might also be able to recommend someone to give you a second opinion on the x-rays and trim of your horse if you are at all interested. My understanding was frog support pads were the first step and if it didn't improve something like a heart bar shoe were normally in order. Just a thought. Also, if she is reactive to the cold you could try leg wraps or shipping boots to keep her extremities warm which seems to help. Heck I think some people even take tube socks and put them over the hooves to keep the extremities warm. Still lots of jingles for your mare and glad improvements are being made!

                                  Comment


                                  • #57
                                    The "high heels/heel lift" caught my eye. Why was that prescribed? That seems so counterproductive to a "moving" foot as it really increases pressure on the toe I'm not knocking you, just trying to understand something that most laminitis/founder experts say is a huge no-no, and why it's a good thing in this case

                                    Still jingling very madly that she stabilizes soon so she can start to recover!
                                    ______________________________
                                    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                                    Comment


                                    • #58
                                      Jingling madly for your mare and foal... and you. What an ordeal... I hope you all come out of it in good shape. When is she due again?

                                      Comment


                                      • #59
                                        Originally posted by sherian View Post
                                        Not an earth shattering suggestion but a deep bed of peat moss might be better then shavings, it is really "cushy", and I have been told that it draws heat out of the feet.
                                        Best wishes for health
                                        This is the opposite of what my farrier suggests.......depending on how bad the case is he has his clients bed the stall with a very fine sand and has them put a pile just out side the stall door......sand offers support for the sole by allowing the hoof to sink down and into the sand till the sole touches the sand.

                                        Dalemma

                                        Comment


                                        • #60
                                          rodawn, I hope your mare is hanging in there. I went through this with our dear Highland pony when the barn manager where she was boarded inexplicably took her off dry lot one day and threw her out on thick June pasture and 'forgot' her there for 4 hours. She didn't fess up right away, so when the pony came up lame, it was initially diagnosed as an acute abcess with the Rx soaking. It's a miracle we didn't do her more damage by soaking her sole, but she didn't sink, thank God. When she didn't respond, the vet came back and the Barn Manager had to fess up so we could treat the pony properly. It was a long haul and I wish you all the best with your mare and the foal.
                                          I just finished a really great equine nutrition course and your dilemma about feeding enough protein to help the mare through these important last few months and keeping the WSCs low is an interesting one.
                                          I second the recommendation of Dr. Eleanor Kellen's Yahoo group. It was a great help to me. Here are a few interesting webinars that may be of some help to you. Although you said that a vaccination triggered the laminitis, these webinars may have some helpful information for you:
                                          http://myhorseuniversity.com/resourc...initis_april09

                                          http://myhorseuniversity.com/resources/webcasts/emsrisk

                                          Best of luck to you. Please keep us posted on her progress.
                                          Last edited by chai; Mar. 13, 2013, 10:29 PM. Reason: spelling

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