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Fred's Blog - Page 2
15th July 2007
Fred has been improving steadily since the boots came off. Yesterday, Fred was looking really good. He galloped across the field for his tea and looked fully sound. Even the slight lameness on his right fore seemed to have gone. I was starting to think seriously about putting him on the lunge to see how he was. All of which makes today's news the more sad.
Today, Fred came in from the field very lame on all four feet, but especially the fronts. He had only slightly raised pulses and not much heat. His walk was typical of an acute laminitis attack - placing his hind feet very forwards and hobbling. His front coronary bands were swollen.
By the time the vet arrived, the pulses were noticeably raised (although still not high) and there was significant heat in all four feet. The vet confirmed it as a serious case of laminitis and gave him intravenous bute and some bute sachets for the coming days. I've hosed his feet to help reduce the inflammation and confined him to a stable with a deep bed. Now all I can do is wait to see how much damage has been done.
I'm really struggling to work out what's gone wrong. Until now he was steadily improving. The vet has commented that a number of horses have come down with laminitis in the last few days, perhaps as a result of the unseasonal weather, but Fred has been out at grass now for some time and has survived similar flushes of grass growth without any ill effects. If the weather was to blame, I'd have expected to see at least some warning signs yesterday. The only other thing I can think of is that perhaps someone has been feeding him something inappropriate over the gate. We have quite a few tourists walking the lanes at this time of year, so that might be a possibility. I'll be putting up signs requesting people not to feed the horses, just in case.
Fred has been in for just over a week now. Initially he was stabled on a deep bed of Hemcore, but despite being on ACP he was rather stressed about being stabled. He finally proved to me that stabling wasn't a good plan by breaking down his stable door. Rather than break the door as such, he actually demolished the wall it was attached to:
Sadly, that's the only useable stable I have right now as the other two are currently being re-roofed. If I shut the stable door again, he's likely to pull the entire wall down on his head. So now Olly and Fred are free to come and go between the small sand school and the stable:
In order to protect his feet now he's not on a deep bed, I've had to boot Fred in front. The boots are fitted with therapeutic foam pads with a cutout under where the tip of the pedal bone sits so as not to put pressure on the most damaged area of the sole. Today I've also had to add hiking socks to the mix as his heel bulbs were starting to get rubbed. He looks a bit comical:
I'm still very concerned about him, as is my vet. Despite being on bute, he's very uncomfortable. The pulses, heat and discomfort on the hind feet seem to have pretty much gone which suggests that the original cause of the laminitis is largely under control, but the coronary bands on the front feet are bulging. It's not possible to decide without X-rays whether this is because of new rotation/sink or whether there's a build up of fluid in the feet (either abscessing or more likely just serum released as a result of the internal damage) that is putting pressure on the coronary bands.
I really need X-rays to decide where to go next, but unfortunately our vet's portable X-ray machine is out of action and he's not fit to travel to the surgery. Sadly, none of the other local veterinary practices had portable machines available so I've had to get a vet in from further afield which has meant a longer delay than I'd have liked while I waited for this vet to be able to come. The X-rays are to be taken this afternoon - hopefully they'll give me a better idea of what's going.
The next few days are going to be tough both for Fred and for me. I've got rather attached to him in the last few months and I really don't want to see him lose his battle with laminitis.
The X-rays weren't quite as bad as my worst fears, but they weren't good news. There's around 10 degrees of rotation on the right fore and around 20 degrees on the left fore. The soles are pretty thin at around 4mm but could be worse. The only good news is that while both feet have sunk, they haven't sunk as far as I'd feared. I was going to post the X-rays (I've also managed to obtain the ones that were taken for the previous owner in October), but they don't seem to have scanned very well. I'll have another go when I have more time to play.
There may well still be some build up of fluid in the feet, but judging by the X-rays, that's not the biggest issue right now.
I've altered his pads significantly in the light of the X-rays. The left fore in particular is tipped forwards - the angle between the base of the pedal bone and the ground is around 10 degrees, whereas I'd prefer it to be more like 3. I can't drop the heels any more - high heels aren't the problem, it's thin sole! So I've put a reverse wedge pad under his normal pad so as to lift the toe upwards slightly. Here's a photo of the pad arrangement. There are two pads, the bottom one is a wedge to lift the toe, the upper one is to mould to the bottom of the foot, with a cut-out under where the worst inflammation is in the sole (i.e. under the tip of the pedal bone). Since these photos were taken, I've cut a pedal bone cut out from the wedge pad also to match the upper pad as I could see that the wedge pad was still touching the sole in that area. The last photo shows that everyone in our household is obsessed with hooves - even our new kitten!
This new padding arrangement seems to have already made him more comfortable. He's moderately happy to pick up the right fore now - which suggests the left fore (the worse of the two) is more comfy in the pads.
Diet wise, he's on (per day, divided into two feeds): ad lib hay, 3lb speedibeet (to stop him losing weight too fast), a cup of Simple System Instant Linseed, 40g of pharmaceutical grade magnesium oxide (this is a lot higher dose that I'd normally use but he's got nothing to lose!), 40g table salt, four Bute, 500mg ACP and Global Herbs Acid-X (to protect his stomach from the possibility of stomach ulcers caused by the bute), 50ml Global Herbs Laminitis Prone Supplement and mint to make it all pallatable.
We're thinking that a possible reason for his problems is poor digestion (stomach ulcers?) as he's impossible to keep weight on and is constantly ravenous. For that reason, my vet is sourcing some Gastroguard for him which should arrive tomorrow.
This evening, he's moving a little more freely, so I think he's still got a chance. But unless he's looking significantly more comfortable in the next day or two, then I think I'll have to call an end to it. Finger's (and everything else) crossed for the poor lad.
After comments from the other vet in the practice I've decided not to go with the Gastroguard as I'm not convinced of it's effectiveness. Instead, I've put him on 50ml/day Slippery Elm (which is good at coating inflammed areas of gut wall and promoting healing) and I've ordered some Equimins Hoof Mender (a high dose biotin based supplement aimed at promoting improved horn growth).
This morning I've trimmed the front feet very slightly - mostly to reduce heel growth that's occured since the attack, especially on the left fore. He's a lot more comfortable and is happy to be led around in his boots and pads. He coped well with having one foot off the ground for a minute at a time (with the other one booted), which is a really good sign. I think he's over the worst. The next challenge is to start reducing the ACP and bute. He needs to be off the ACP within the next few days and his bute dose needs to be reduced as fast as possible. I certainly can't keep him on four bute per day for more than another couple of days. I just have to hope that he copes on the lower doses.
I've now got the X-rays scanned in. Firstly, here's the X-rays taken 23rd October 2006. He was in high heel wedges and heart bar shoes at the time. You can see that the tip of the pedal bone has already started to remodel, probably as a result of the force placed on it by the heel wedges.
And here's the X-rays taken a few days ago. The new rotation is clearly evident, as is how thin the sole is under the tip of the pedal bone. Also clear is the more serious remodelling at the tip of the pedal bone. This cannot be as a result of the recent attack as it couldn't have happened so fast. Given that Fred was in heel wedges for nearly two months after the first set of X-rays were taken, it's most likely that the remodelling happened then.
Today I've cut Fred's bute to one per day (he was on two per day). He's also on 15ml of Global Herbs Bute-X twice per day and I'm just finishing off ramping down the ACP (he's down to 50mg/day and will be off entirely in the next day or so). The good news is that he seems to be reasonably comfortable on this mix. He's still clearly uncomfortable on his front feet, but the discomfort is at a low enough level that it's not stopping him walking around and getting on with life. When a bot fly started hassling him yesterday, he actually cantered back into the stable. Ideally I want to get him off the bute altogether reasonably soon, although I expect to have to keep using the Bute-X for a few weeks yet.
The gut support also seems to be helping. It's difficult to be sure, but I think he's starting to put a tiny bit more weight on - up to now he's always been very ribby. His droppings are looking a little better formed with slightly less long fibres in them, which also encourages me that his digestion is improving despite all the bute. And the final piece of evidence is that he's eating slightly less hay. Previously he was eating as much as 20kg of hay per day - which was a strong clue that his gut wasn't working correctly given that he wasn't putting weight on. If he's eating slightly less, this suggests that he's getting more nutrition from the hay and so doesn't feel the need to eat as much. It's still very early to be absolutely sure about this, but so far the signs are promising. I'm guessing it will take many weeks to heal his gut fully - always assuming that really is the problem.
This evening I've given him a very light trim. There was quite a build up of exfoliating frog (and a little exfoliating sole) that wasn't coming off properly with the socks, pads and boots in place. I've trimmed the exfoliating frog away and scraped some of the exfoliating sole out in the seat of corn area and next to the bars (so that it doesn't cause pressure points). Even with regular use of borax, this exfoliating material is tending to smell a bit, so trimming the worst off should help. I've very slightly rounded the toes to make sure there's no wall on the ground there and I've also trimmed the heels back a bit.
Based on the X-rays, the sole is very thin at the toe on the LF so I've trimmed this foot carefully so as not to take any material further forwards than the widest part of the foot. The ideal would be to rotate the foot backwards around the mid point of the foot so that the heels end up lower, but the toe is lifted slightly off the ground. As yet I've not got quite enough wall in the quarters to do this as effectively as I'd like, but I've been careful to leave the wall there so that it will give me something to lift the toe up with in time. Meanwhile, he's staying in the wedge shaped pad on this foot as it seems to be really helping with comfort.
Here's the left fore again after the trim. At first sight, things don't look too bad - in fact these photos look superficially better than the last set I posted. A more careful look shows that the toe is short of height - the heels are the correct length, so the shallow angle of the hairline suggests that there isn't enough sole height at the toe (as confirmed by the X-rays). The beginnings of the new attached growth can be seen at the toe just under the hairline and it's clear that the new growth is at a much steeper angle than the old rotated growth. It's too early to get a really good idea of the change of angle as the periople always confuses the picture, but there's definitely a strong change there. On the plus side, there's very little new flaring in the quarters - quarter flaring was a major headache when trimming out the damage from the previous attack because it left very little good material to stand him on. The other plus point is that there's a reasonable amount of toe growth for three and a half weeks post attack and the growth rate looks pretty even between toe and heel - so it looks like the coronary band wasn't damaged anywhere near as badly as in the previous attack.
All told, I'm a lot more positive about his future than I was two weeks ago. He's still got a long way to go and it remains to be seen just how sound I can get him given the degree of damage that has happened (especially to the pedal bone) - but I think he's pretty much out of danger now.
It's now just 5 weeks since the attack and I'm pleased with his improvement. He's definitely putting on weight and he's walking around much more freely (admitedly still in the boots and pads). He still has a tiny limp on his left fore, but even that's reducing.
We let him and Olly out into the yard last night so they could wander around on the concrete. With the boots on his front feet, he looks as comfy on the concrete as he does on sand - which shows that there's no discomfort left in the hind feet. I'm taking that as a sign that the underlying laminitis is well under control, so I turned him and Olly out for an hour at grass tonight (about a quarter of an acre of well grazed grass for the two of them). He was thrilled to be out at grass (he practically dragged me out to the field). Once the hour was up, he cantered back over to me so that he could be brought in for his evening feed (I had been a touch worried he'd refuse to be caught). He's a way off being able to canter without the boots and pads, but I'm still pretty pleased with that result. As ever, it's just a waiting game now. The routine from now on (relapses permitting) will be that he has a choice of stable, sand school and concrete yard for most of the day, combined with gradually increasing periods of turnout at grass.
Fred is now out at grass overnight (for around 8-9 hours). It's only a tiny area (about a quarter of an acre) and it's been heavily grazed first by my other horses, so I can be confident that he's not getting too much grass. I'm putting some hay out for him and he's eating about half as much hay overnight as he was when in, so presumably he's eating an equivalent amount of grass as well.
He's improved dramatically since having this limited turnout. I can't say whether it's the grass that's helping (which would surprise me, but anything's possible) or the fact that he's got more room to move around. He certainly seems happier when he's out and it's possible at this stage that increased movement is helping with lymphatic drainage from the feet and so reducing the inflammation.
Externally, the front hooves are progressing pretty much as expected. Both feet had very thin soles under the tips of the pedal bones on the x-rays but have now produced a healthy amount of false sole. I'd be worried if there was too much false sole as this would suggest that the levels of inflammation were still high, but equally I wanted to see some additional sole growth to stiffen the sole and provide enough comfort for him to be able to take some weight on the sole without bruising it. So all in all, I'm happy with progress there. I'm a little less happy with the state of the coronary bands at the toe. They are both somewhat distorted, but it's still too early to see how bad the damage is.
Based on this progress, I've removed the pads from his boots as a trial. He did not seem to notice that they were gone, so I'm reasonably happy that his soles are recovering well and that he no longer needs the pads with the relief cutouts under the tips of the pedal bones. I'll monitor this carefully over the next few days and replace the pads if there's any sign that he's not coping well without them. I'll keep the boots on for the moment as his soles are likely to still need some degree of protection from wear so that they can build up a more normal thickness. I also don't want him standing on any stones that might be lurking in the field (it's generally a pretty clean field) and bruising the sole again until they're more fully healed. That said, even with the socks, I'm not happy with keeping him in boots 24/7 any longer than necessary, so I will try to get him out of them as soon as I think he's up to it.
5th September (evening)
Having watched him move for a few hours and kept a close eye on his pulses, I've decided to put pads (with the cut-outs under the tips of the pedal bones) back into his boots for now. He just wasn't quite moving as well without the pads and his pulses were very slightly higher. It would seem that the inflammed solar corium under the tip of the pedal bone hasn't yet settled down enough to be able to take weight. I'll probably try again in a couple of weeks.
Having gradually increased the proportion of the time he's turned out at grass without any signs of problems, I've decided now to try turning him out 24 hours per day. He's out (with Olly) on a 1 acre field that has already been grazed heavily by our other horses. They're getting lots of supplementary hay, which they're eating so I'm happy that there isn't too much grass for Fred. As ever, I'll monitor Fred very carefully for signs that this new arrangement isn't suiting him.
He's still in the boots and pads for the time being - given the failure of the previous attempt to wean him off the pads, I think he'll probably need to stay in boots and pads for a few weeks more.
Fred's now looking extremely comfortable in his boots and pads. He's showing off extended trot in the field and is also at times galloping around with Olly. His walk still looks a tiny bit abnormal but that may be because of the shaped pads. I plan to keep him in the boots and pads just a little longer to make absolutely sure that the soles are in a good shape.
Today I trimmed his front feet again - just a very light trim to reduce the heel height. There's the beginnings of a new tight wall coming down from the coronary band - perhaps 4 weeks' worth of growth. It's too early to be able to see exactly what angle the new growth is at, but it looks consistent with the rotation that showed up on the last set of X-rays. At the moment, all the new horn growth is a touch uneven and the coronary band is still stlighly lumpy but all that should grow out now that the wall is being produced reasonably normally again. The heels are still a touch high in relation to the toes but this is more lack of height in the toes than excess in the heels. This is one of the reasons I'm keeping him in boots for now, so that the sole can continue to thicken up at the toes without any wear to slow the process down.
Here's the left fore (apologies for the piece of hay that got into the first photo - he was eating at the time and I didn't notice as I took the shot):
It's a while since I last updated this blog, and Fred has come on leaps and bounds in that time. He's now permanently (I hope) out of the boots and pads and is also off the pain killers. He's walking better and better around the field, no longer limping on the LF at all and taking more weight on forehand. His walk is now so good that you have to look carefully to see that it's not entirely normal.
The slippery elm seems to be working in that he's finally putting a touch of weight on. But the progress on that front seems slow, so I've just moved him onto Hilton Herbs Gastri-X (which contains slippery elm plus lots of other herbs that should work synergistically with it). I'm hoping that will heal his gut faster as I'm now more and more convinced that his gut is where the problems originate.
I trimmed Fred again today. Here's the left fore as usual. You can see the better attachment of wall starting to grow down although it's taken quite a while for the attachment to form (which is not surprising given the degree of rotation). At the moment, it's still too early to do much more than trim for balance and bring the breakover back.
Yesterday, Fred was looking a tiny bit footy on the LF. Today he's come in really lame on it. The temperature is up, the pulses are up and the skin above the hairline is a touch puffy. This looks very much like an abscess brewing - probably affecting a large proportion of the foot. I'm not entirely surprised by this - I'm more surprised that he hasn't had one before given the extend of the damage to the front feet.
Hopefully this will just be a normal abscess that will blow naturally and that will be the end of it. My one concern is that, with the degree of damage caused by 20 degrees of rotation, the abscess could potentially affect the entire foot - at which point the hoof capsule might potentially slough off. Sloughing hoof capsules are a known complication in very severe laminitis cases. Hopefully the healing process has progressed far enough that the risk of sloughing is minimal.
Well Fred's been doing a good job of stressing me over the last 12 days. He gradually got more and more lame on the left fore and the right fore started to look lame within a few days as well. I've been hoping all along that this is an abscess on the left fore and that by shifting his weight more to the right fore he was making this sore too.
The problem is that it's very difficult to tell the difference between new onset laminitis and a toe abscess - both cause significant toe pain, raised pulses, etc. Normally, toe pain in one foot only would be obviously an abscess rather than laminitis, which in most cases affects left and right feet equallly. However, given that the left fore had far more mechanical damage from previous attacks, it wasn't impossible that a new laminitis attack would affect the left fore first and then the right fore less strongly after a few days. So I've been left guessing whether this is another laminitis attack or an abscess. I took him off the Gastri-X just in case this was causing laminitis (unlikely, but I prefer to be safe than sorry).
Things came to a head yesterday morning. When I checked on him first thing, he was standing in a pretty good laminitis stance (although favouring the left fore a little more than the right) and didn't want to come over for his bucket of feed. I immediately put boots and pads back on him, but this didn't seem to help much. He'd already been on Bute-X for a few days, but I upped the dose of that too. I was really starting to think that my hope that this was an abscess was wrong and that he was having another laminitis attack. Given the level of damage still to grow out from the last attack, I really felt that he was not going to survive this.
By the evening he was looking a little better. And this morning he was dramatically improved. I pulled the boots off again and found a small area of black gunk in the white line which I think is the remains of an abscess blow (it's not uncommon for laminitics to blow abscesses back out through the laminar wedge rather than at the coronary band). So it looks like I was probably right with my original assumption that it's an abscess.
I've soaked the foot in Epsom Salts and put a poultice on it. It remains to be seen whether he comes sound again in the next week or two.
In the meantime, even the short period he was on the Gastri-X seems to have made a real difference. For starter's he's less stressy generally. He's eating a little less and is having longer periods of not eating. He's also less stressed about being taken away from food. His coat has picked up a bit more of a shine and... he's putting on weight really well. If he carries on at this rate, he'll be up to a good weight in another couple of weeks. I'm really excited about this as I'm more and more convinced that all his problems stem from poor gut function. If he's finally putting on weight, that really suggests his gut is finally starting to work properly. If that really is what's happening and my thoughts on the causes of his laminitis are right, then I might finally have the laminitis under control. It still remains to be seen whether the damage done already is recoverable though.Next Page
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