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Fred's Blog - Page 1
An Introduction to Fred
Fred just after he arrived on our yard
We don't really know for sure how Fred got laminitis but we do know that he arrived in the UK in October 2006 as a four year old with severe laminitis on both front feet and a swollen jaw. We know that in July 2006 he'd been fully sound on all surfaces without shoes and that the initial laminitis attack happened just after that and was treated with heart bar shoes and one and a half inch high heel wedges.
I first saw Fred in December '06. By that point the farrier and vet had really not managed to help him much. If anything he was getting worse. His heel wedges had been reduced in height somewhat, but he was still barely able to walk on hard ground even with lots of bute.
X-rays taken just prior to this showed very little rotation (2 or 3 degrees) but some signs of sinker. There was also a strong depression in the coronary band at the toe suggesting that the pedal bone had sunk badly. The temperature of the coronary band at the toe was significantly lower than elsewhere suggesting that he had lost circulation in this area (presumably from pressure necrosis caused by the sinker).
We pulled his shoes and replaced them with Old Mac G2 boots and therapeutic pads shaped to remove pressure from the most tender area of his sole (under the tip of the pedal bone). That done, he was immediately more comfortable (although still a very sad horse).
Here's his left fore in December '06. You can see where sinker had caused the wall to kink at the toe. The sinker had only just happened at this point, so the damage is still limited.
By March 2007, Fred was a lot more comfortable but still wasn't improving as fast as either I or the owner would have liked. It had been an extremely hard period for Fred's owner and by this time she was looking for a new home for him. After careful consideration, I decided to offer to buy him a) because I thought he was a lovely horse that deserved help and b) because this was a chance for me to work with a serious laminitis case on a more intensive basis.
16th March 2007 - Fred finds a new home
We've just collected Fred. He travelled with a low dose of bute (enough to help with the discomfort but not enough to encourage him to be silly in the truck). He had his Old Mac boots and pads on and apart from being a bit stressed at first, travelled surprisingly well for the 1 hour journey back to our yard. A rather sad farewell from his old owner, but a new start for him in his new surroundings.
We've provided him with a large stable with deep bedding and a 10m x 10m sand turnout area (which at first we'll allow him into during the day only). The idea is that our other four horses can talk to him over the fence and keep him company.
Fred's new home - turnout and king size stable
He's rather stressed since he arrived and is pacing up and down in his turnout area. At least he looks really comfortable on the sand (although he seems a bit stiff on his right hind for some reason - it doesn't appear to be the foot).
As well as hay, he's now on the following diet daily fed as one feed: 1/2lb Speedibeet, 1/2lb Simple System Lucienuts, 1 cup Simple System Instant Linseed, 50ml of pharmaceutical grade magnesium oxide, 20ml table salt. He's still got pulses on all four feet (2/5 on fronts, 1/5 on hinds). We've taken him off the bute because he seems reasonably comfortable without it so long as he stays on a soft surface.
26th March 2007
Fred is still very stressy. He keeps wearing the sand through almost to the concrete underneath on a strip along the fence on one side of the turnout area (I seem to be spending more time shovelling the sand back to where it should be than anything else right now). The only good thing is that all this movement is stimulating lots of growth.
He's lost quite a bit of weight with the stress of the move. He's now on two feeds a day. His total daily feed is: 2lb Speedibeet, 2lb Simple System Lucienuts, 2 cups Simple System Instant Linseed, 80ml of pharmaceutical grade magnesium oxide, 30ml table salt. On this diet he seems to be putting weight back on again with no worsening of his pulses - which is a relief.
His swollen jaw doesn't seem to be at all painful and hasn't changed in weeks, so for the moment we're going to leave him to chill - the last thing he needs right now is the stress of having a vet to see him.
I've given him a quick trim. His feet aren't far enough on yet for it to be worth doing anything drastic. All I've done is shorten the heels and lift the worst of the toe flare off the ground. Here's the left fore after the trim. There's just a touch of straight growth at the top of the hoof which is really encouraging. Even more encouraging is that the wall is growing at the toe as well which means that the sinker is repairing and the circulation has returned to that area. The coronary band is now warm all round the foot.
Dave Siemens the chiropractor came to run a clinic at our yard today. While he was here, I asked him to take a look at Fred. He found some stiffness in the hip on the right hind and did some adjustments in that area. He's now moving much more fluidly and actually strode out across the concrete without any boots!
We had been letting our other four horses into the turnout pen overnight when Fred was shut in his stable. The idea was that Fred could have company over the stable door but it seems Jazz has been bullying him and he's ended up with cuts and grazes all over his face. Jazz and the others are now firmly excluded from Fred's turnout pen!
It seems that Fred's stress is nothing to do with separation anxiety - other than the anxiety of being separated from grass! Clare took him for a brief supervised graze on our front lawn today. He didn't even notice that he'd been removed from his friends and he was ecstatic about the grass. Once back in his turnout pen, he started stressing again (although generally he's not stressing anywhere near as much now that he's settled in). His pulses are now pretty good - occasionally I can just feel them - so we're going to try re-introducing him to grass starting with half and hour per day (on already well grazed grass) and gradually increasing it while checking his pulses regularly.
Here's Fred turned out at grass for half an hour and looking very happy! We're throwing Zafirah and Olly out with him as they don't bully him (he keeps them both in order very nicely).
The grass turnout has been a great success. His pulses are if anything lower when he's been out at grass - maybe the stress of being separated from his beloved green stuff is what's pushing his pulses up! He's now out during the day every day. Normally for a laminitic, I'd recommend nightime turnout as the sugar levels in the grass are lower - but he really does seem to be totally immune to grass-related problems which is a massive boon and daytime turnout works out more convenient with the other horses. The fact that he's coping so well with grass right in the middle of spring makes me think that his original laminitis attack probably had nothing to do with grazing - I wonder if he got into a feedstore?
Today was trim day and this time there was lots to trim off. Here's the left fore just prior to trimming:
You can see how the foot has run forwards (i.e. the wall has rotated away from the pedal bone) as a result of the period where the inflammation wasn't fully under control. You can also see how the growth rings are closer together at the toe and further apart at the heel - showing far higher growth at the heel as he rocked back to take the weight off the painful toe. However, the most recent growth ring (the highest up) is almost parallel to the hairline, so the imabalance in growth rate has almost gone. The thick areas of false sole are starting to peel away - underneath these areas were very crumbly and I was able to pull most of the false sole off just with a hoofpick.
While peeling off the false sole, I uncovered a sub-solar haematoma. This is an area of serious bruising that is caused when all the weight of the horse falls on the tip of the pedal bone. While he was in wedge shoes, his pedal bone was lifted at the heel to the point where it dug into the sole like a chisel. With the wall providing very little support due to the failure of the laminar attachment, the sole became so bruised that a blood-blister formed. This blood blister got incorporated into the solar horn as it grew down and has now reached the surface. You can see that the haematoma is crescent shaped - mirroring the shape of the tip of the pedal bone. This looks nasty, but it's old damage and between that and the pedal bone there's a good cm or so of new and reasonably solid solar horn.
Here's the same foot after the trim. I've not removed as much toe as I sometimes do simply because there wasn't that much rotation in the first place (his main problem was sinker) and he's so comfortable there's no point removing horn for the sake of it. Cutting further into laminar wedge increases slightly the risk of infection and abscessing, so I don't do that unless it's actually needed to encourage better laminar attachment. Hopefully I can take the rest of the rotated wall off slowly over the next few trims.
I've also left some of the quarter flaring just so that he has some good(ish) wall to stand on. I don't quite trust the sole at the toe to take all the weight yet. I'll probably take this at the next trim.
The vet came today to look at Fred's jaw. He's confirmed my suspicions that the jaw bone has been fractured and has then healed hence the strange shape of his jaw. I can only assume that this happened either in the three months before he left Germany or in transit. I also wonder if there is any way the broken jaw could have been connected to the original laminitis attack. Could the pain have triggered the attack? The good news is that it's fully healed, hasn't affected his teeth and doesn't seem to bother him at all - just makes him look a touch lop-sided.
I spoke again to the previous owner and got some more details on Fred's history which has helped clarify the picture. It seems that when Fred first arrived in the UK, the jaw was swollen but wasn't showing significant signs of tenderness - which suggests that the break had happened some weeks before. That puts the broken jaw incident somewhere around the same timeframe as the original laminitis attack - which strengthens my suspicions that the two things are linked. I guess we'll never know the real story.
Fred is now out at grass 24/7 - which I'm thrilled with (and so is he). He's much more chilled with this arrangement and the lower stress levels can only help. He is still having occasional very slightly raised pulses on his front feet but these seem to be more linked to hard ground than the grass. We've finally had some rain and the ground is softer, so I'm going to monitor the situation and see if the softer ground helps. If not, I may have to go back to turning him out in boots and pads for a while until the soles have healed further.
I'm probably going to have to trim him again a little sooner than I'd expected. The extra movement out at grass is stimulating more growth and given that he's still shifting his weight back into his heels very slightly, the heel growth is overtaking the toe growth. The last thing he needs his high heels again, so I'll keep a careful eye on this.
He's also picked up a central sulcus infection on the off fore frog. This is not uncommon in these cases. The original high heels result in a lot of distortion to the shape of the frog (with the frog contracted and the central suclus crushed together) and as the heels come down the frog changes shape very rapidly. Occasionally the frog's central sulcus opens rapidly but retains a cap of horn over the top of the new sulcus which allows infection to hide underneath. With the cap trimmed off, the infection suddenly becomes apparent. I'm treating it with MSM cream daily and it's responding well.
The MSM cream has done the trick - the frog infection has cleared up nicely. He's also much more comfy now we've had some rain and the ground is a bit softer, which saves me the hassle of boots and pads. He and Olly are looking really happy together in their lilttle enclosure - they seem to be becoming good friends.
He's now starting to really chip off the excess toe wall (especially on the off fore) - which is good as it's the cue for me to start thinking about the next stage of trimming back the damaged hoof capsule. I always like to follow the cues the horse gives me.
The heel height is definitely picking up a touch, so I'll probably have to trim again a little sooner than expected. I've tidied up a few loose bits of wall today and will probably do a full trim again in the next week or so.
The right fore showing how the excess wall is chipping away. The strong healthy growth in the top part of the hoof is also becoming more and more obvious
As predicted, I ended up trimming him today a little earlier than I'd originally intended. His lordship was rather full of himself and declined to stand still for the trim, so I ended up not quite taking as much horn as I'd intended, but despite that I'm pretty pleased with progress. The sole is looking more healthy and is slowly coming back to a better shape. And I've been able to trim more of the rotated toe away bringing things back to a little more normal shape. Here's the photos of the left fore again:
I'm still really waiting for him to become fully sound on hard ground. As yet, he still avoids using his toes properly - but given the shape of the foot, this is not really surprising. He seems to get more and more comfortable in the field though - a few days ago I saw him cantering for the first time and today he jumped over the electric fence as I was moving it (only a foot or so high, but still nice to see).
Fred's been a touch lame in front the last few days. We've just had a Ben Hart clinic here over the weekend with lots of new and exciting horses staying in the field next to Fred's. He's been spotted hooning around and I'm not sure that's helped his feet - ah well, at least he's having fun! I've had suspicions about the frog on the left fore and today he came in with a rather obvious frog abscess (already blown). I forgot to take a photo before smothering the area with MSM, but here it is after trimming away the worst of the damage... MSM and all (the abscess is on the right hand heel bulb):
We also soaked the right fore in borax while we were at it as the laminar wedge is rotting away faster than I'd like. He was exceptionally good... he stood in the bucket first time and stayed there for 20 minutes while we played with getting him to lower his head to a subtle pressure on the lead rope. Sadly he was far better at standing in the bucket than at lowering his head - yielding to pressure is not one of his strong points... yet!
Fred has been looking a touch more lame on his fronts the last couple of days. It looks like he's about to shed a large thickness of false sole on both front feet, but I'm concerned that this is happening too early (I'm not convinced that the new sole underneath is thick enough yet). The problem seems to be that infection is tracking through the laminar wedge and into a damaged layer of sole. It's going to be pretty difficult to stop this happening while he's out in the field 24/7 and given that he was so unhappy stabled, I'm not particularly keen to bring him back in. I'm soaking his feet in borax to try to stave off the innevitable for as long as possible and I've decide to leave him out for a while in boots and pads (also soaked in borax). He's definitely more comfy in the boots and hopefully this will reduce the effects of infection and also help to keep the false sole in place for longer. Along the way it should also help him grow more healthy sole underneath. I'll be checking the boots/pads for rubbing/infection every day.
Here he is about to go out in his boots/pads:
I've trimmed him again today. There's some signs that there's been a touch more rotation since he arrived here which I'm a bit disappointed about, but overall he's improving well. The feet now are almost unrecognisable from when I first saw him. The original rotation was very slightly off centre which wasn't very obvious before, but now that the laminar wedge has rotted somewhat and the wall broken away, you can see that the laminar wedge isn't even. That's resulted in him unbalancing the front feet - which I've corrected in the trim.
The boots and pads seem to have helped a lot and I've had no problems with them rubbing (which is a relief) despite them being on 24/7 for three weeks. The sole hasn't shed and if anything has toughened up again. The growth rate has increased a touch from the pads, which is no bad thing. He's still a touch less sound on the right fore than the left, but I suspect that's just a matter of time. He's now reasonably comfortable on smooth hard ground, but when his feet get packed with dirt, he finds that uncomfortable. I'm going to give him a few days without the boots to see how he goes, but I'll probably put him back in boots for a while, but this time without the pads (given that packed dirt seems to be uncomfortable now). I'm really now playing a waiting game, he's not going to come fully sound until there's a reasonable amount of wall on the ground.
Here's his left fore again just before the trim:
© 2007-2008 Richard Vialls