Let me tell you, the response regarding MamaTess’ laminitis from so many of you readers has been overwhelming!

Such great ideas and sharing of information…

I plan on assembling it all and posting it when things calm a little.

THANK YOU.

For today, I needed to spring into action very early.   I’m following one protocol – for now.

TODAY

This morning, I woke up at 2am and went to the barn.

She was horribly lame.

I gave her Bute and took apart my tack room, trying to find the purple foot pad material I had left over from Norma’s laminitis.   Clearly, the blue wasn’t working.

I finally found scraps of the purple (left over from creating Norma’s pads) and frankensteined two pads.

I grabbed my ready made duct booties and put those on her feet.  Luckily, she was able to let me have each foot long enough to secure the pads and booties.

I gave her the Regumate dose, some beet pulp with stomach herbs and some Orchard Grass.

Then, I went back inside and started emailing every specialist I knew.

RESPONSE

Luckily, the East Coast was awake and I received an email from Dr. Frank Reilly of Equine Medical and Surgical Associates.

Here it is:

Yes. Horses with multiple episodes of insulin induced laminitis(often seen in preg. horses/people due to preg. induced IR) will get nerve inflammation in the feet—peripheral neuropathy seen again, in diabetic people and in horses.
Early stages are controlled by cox1 nsaids like bute,stall rest, but as time goes on, the things that worked in the past start to fail.
There are 3 things to stop this pain:
1. Stop the insults of daily high insulin–the Heiro Program of 3 steps:
a. Hay–I assume a 1000 pounds, so needs 2% BW in hay =20 pounds—-10 pounds in am+10 pounds in pm–use a 1.5×1.5 inch nibble net to ensure the hay lasts between feedings–evn 1-2 hrs of fasting creates huge insulin surging–slow/steady hay lowers insulin.
b.grain–no hay is balanced–a ration balancer with extra protein/low carb will further lower insulin–go to our site at equinemedsurg.com, click articles/update then click best diet–scroll to a chart of many choices–pick one near you—feed 3 baking cups a day=1 pound–feed 1.5 in am+1.5 in pm.
c.Heiro–1 scoop am+1 scoop pm for 10 days then 1 scoop am–sprinkle of ration balancer.
2.Physical protection of feet–boots on –I like soft ride boots with turquiose inserts–get a pair.
If have another kind of boot, let me know what it is–cavallos will work in a pinch, but soft rides support sole best.
3.Meds—you are correct of estrous cycle at times leading to stress/pain leading to jump in insulin–she was probably on the edge and got pushed over.Keep up 10cc regumate. Now for inflamm–your cox 1 alone will NOT STOP the neuritis(nerve inflam)–you are seeing this.
To get comfort back quick is easy–remember pain ALSO raises insulin—if its not controlled its sending high insulin to laminae.
I would have vet in a1000 pound horse give:
Day 1—-6cc equioxx IV–this is a triple dose of a cox 2 med(600x more cox 2 then bute).I have done this dozens of times–it gets drug levels to peak needed quickly. In addition give 1 gram bute in am+1 gram of bute in pm–combining cox 1+cox2.
Day 2–same thing with bute, now go to oral—either 1 tube of equioxx paste inam+1 tube again(full ) inpm OR 1 of the 57 mg(NO 227mg broken up!!)) previcox in am and  anotehr 57 mg previcox in pm
Day 3,4,5–same as day 2.
Day 6—just the 2x a day of equioxx/previcox. NO bute.
Day 7–as day 6.
day8-21—-1 tube of equiox paste is am or 1 of the 57 mg previcox in am.
*******EVEN if sound, happy by day 7, go all 21–no cutting doses, no stop short—I tried that–it will fail.
Dawn: most horses with foot protection/new cox 2 program will be alot better by day 3-5—its quick.
NOTE: you will NOT knock out pain using label dose of equioxx or previcox—-higher dose gets nerve pain quick–done in many times–works.
COX2 drugs can get neuropathic pain—if your horse is alot better but not all the way, we can add gabapentin to this as plan b, but 99% respond to the above.DR.R

FEED

I then went to his website to figure out what to feed…  Here is some (there are many very informative and long articles… these are the highlights.)

Diet

The key is to control carbohydrate metabolism by eating the right foods in the proper amounts. The HEIRO™ program will greatly assist your horse in this project by helping to manage Insulin.

Your horse ideally will get: some fresh grass, some hay, some grain, and some snacks.  Often the scenario is the horse gets too much of one item and it causes a Laminitis trigger.

We will go over several items:  Grass intake management, hay to feed, fats/oils, good and bad snacks, hay testing.

Goal:  Practical, straight forward, understandable items to stop Laminitis and help your horse live a good life.

In the past, (2006, 2005, …) you would see the term NSC standing for non-structural carbohydrates. This term is still used by feed companies to categorize low carbohydrate feeds of about 10-15% NSC. When you test your hay or fresh grass you will not see this NSC listed any more due to recent changes in the way sugars are categorized. The new category for sugar content of hay/fresh grass is called ESC because it contains sugars and a partial amount of fructans.The starch category is the same as always.This new category can not be compared to your past analysis. Know that NSC is not ESC and that past sugar tests can not compare to ESC.

A.    Hay – Goal – slow, sustained release of nutrients all day long with no long periods of fasting.

1. Hay is essential in helping prevent Laminitis.  Your horse can not be on grass all day and can not get grass in the winter/bad weather.  Hay provides fiber to steady Glucose levels.  Hay provides eating activity for your horse (they eat 70-80% of the day).  Hay decreases stress which can steady stress hormones.  Hay stimulates the gut tone and motility. Steady hay eating avoids a problem. If the horse has fasted several hours and then is fed, can get Insulin surge beyond the normal which can be harmful. We want a slow, constant, low level of hay moving through.
2. Spread the hay — make horses walk to multiple small piles in the field to increase exercise.
3. Soaking hay— this can lower Carbohydrate levels and as a bonus has been shown to decrease allergens in “heave” horse reactions.  At times this is not practical in cold weather — you get a “hay sickle” in the bucket — the water freezes into ice.  This is a great time to test hay in fall when you are stocking up to feed it in the winter.  If it has low ESC/sugar/starch you will not need to soak it.  Also, test your horse’s Insulin level after a few days on the new hay.  This will let you know if all is Ok.  Most Laminitis is via fresh grass and not hay.  Pasture associated Laminitis accounts for 54% of equine Laminitis. (USDA Lameness and Laminitis National Health System 2000) Dr. Watt’s work on grass/hay sugar levels has been very helpful.
4.   What hay to feed and what levels do I look for if tested?
   1. Timothy Grass Hay – Good choice, easy to get.  If tested, want 8-12% protein, low end of normal range of ESC (Simple Sugars) that is 4.7-10.9%, and low end of normal range of starch that is 1.5-4%. Example: If 15% ESC and 6% starch, do not buy it – probable Laminitis trigger. If it is 5.7% ESC and 1.8% starch is Ok to buy and no need to soak
   2. Alfalfa Hay – Can mix with Timothy up to a 50:50 ratio. It has a slightly lower ESC, starch, and sugar than Timothy Hay. The Equi-Analytical web site has a print out showing its safety. If someone tells you Alfalfa is a problem in Insulin Resistant horses, they do not have the facts. ESC is 4.2-8.2% Starch is 0.8-3.2%. I usually will not go above a 50:50 ratio because higher amounts of Alfalfa seems to cause more gas and runny manure.
   3. Orchard Grass Hay – Very similar to Timothy Grass Hay. A good choice.
   4. Teff Grass – Tests we have run show it to be safe on sugar and starch, so, again, it is a good choice, When you test, you want similar values as Timothy. Can have mixes of Teff with Orchard or Timothy.
   5. Bermuda or “Coastal” Hay – These have double the starch of Orchard or Timothy, so you would need to soak these overnight and during the day prior to feed. 6% starch average, range 3.1-9.0. Since most Bermuda Hay is fed in the south, freezing “hay sickles” will not factor in. Timothy, Orchard, Timothy/Alfalfa, Orchard/Alfalfa are better choices.
   6. Avoid Totally: Wheat hay, Oat hay, Barley hay – all very bad. Huge starch.

      

   7. 5. Your horse, if not getting any fresh grass, will need 2% of body weight in hay daily.  In most Insulin Resistance horses, we want to reduce weight, so will feed less hay.  A normal 1,000 pound horse needs 20 pounds of hay.  To assist your horse in weight loss, instead of feeding the normal horse 2%, feed 1.8% or 18 pounds of hay.  To slow him down on eating, we covered the ways of putting in a field alone, blocking their view if in a stall.  A new way is to put the hay in a hay net.  The net will slow their ability to get big mouthfuls of hay.  At times, a horse may still go through his hay too fast even with a hay net and hence get stressed, get Insulin surges due to fasting.  Put the net into another net.  This is your plan B, because it will really slow the rate of eating down.  Perhaps do a double net in the night and a single during the day — your horse will talk to you.  To weigh hay, now is the time to get the bathroom scale to weigh a bale.
      6. Avoid feeding Blue Seal’s Hay Stretcher – it has molasses and a NSC of 22%. It comes in a large pellet.
      7. Often, the horse grazes during the day and is in at night. They eat the hay given to them between the 6:00 PM feeding and 9:00 PM, the horse is out of food, and goes with no food for 10 hours until the 7:00 AM feeding. When they are refed, they get a huge Insulin surge that can be 700% higher than normal. Essentially, the horse is being given a high-dose shot of Insulin every morning. No wonder they put on lots of fat and get Laminitic. The fresh grass intake is monitored but its the “in the stall with hay that doesn’t last” scenario that can be the real health danger. Ten pounds of hay that they eat throughout the night will cause less weight gain and protect the feet better than feeding five pounds of hay with almost half a day (or night) with no food.

      B.     Fat/Oil Supplements

      1. Do NOT use in Insulin Resistance horses.
         A study by the University of Kentucky’s Dept. of Veterinary Science in 2002 by Dr. Fitzgerald showed that an infusion of fat actually induced Insulin Resistance in horses in less than 2 hours time. This can lead to a Laminitis trigger. High fat diets can cause a crisis.
      2.  High Insulin levels already are promoting fat which in turn release toxins to further cause more and more Insulin. This cycle is not helped by promoting more fat with a high fat diet.
      3.  What to avoid:
         • NO OILS – No corn oil, no rice bran oil, no wheat germ oil.
         • NO RICE BRAN – two big reasons
           1. According to a USDA study by Dr. Marshal in his 1994 Rice Science Study (465 page report), it is approximately 16% fat. This is going to promote fat on your horse, add weight, and cause problems.
           2. Rice bran is loaded with starch. Dr. Marshal has it at 16% and Equi-Analytical Labs at almost a 20% average. This is 5 to 7 times more than timothy/orchard hay or beet pulp. Rice bran has an NSC level of about 25 which is extremely high.
           3. Rice bran’s NSC is very close to that of Wheat bran (30). Both need to be strongly avoided in these horses.
      4. High/increased fat is great in tying up horses, EPSSM, horses needing weight, but not in Insulin Resistance.
      5. On the bag of ingredients of many low carbo, low fat feeds you may see rice bran. DO NOT panic. They put in an extremely small amount for flavor. These products have low NSC values (10%) and low fat values (3-5%). The main point is not to add more of rice bran or wheat bran to the diet.
      6. Again, our goal: some grass, some hay, some grain, some snacks.

          

          Grain

         Yes, you will feed grain to an over weight Insulin Resistance horse. Why?

          

         1. An all-hay diet will lead to problems due to vitamin/micro nutrient deficiency.  If you hear that the solution to Laminitis in an Insulin Resistance horse is feeding it just  hay and keeping it on a dirt lot, you are getting inadequate and incorrect information.
         Again, our goal: some grass, some hay, some grain, some snacks.In the winter, grass options are lost, so grain is even more important at this time.
         1. What type to feed my horse?

            1. You want a low NSC pellet feed which will provide vitamins/micro nutrients and a high amount of protein.  These special feeds are very concentrated so you will only feed a small amount to your horse each day.  Normal horses can get up to 1% of body weight in grain a day for maintenance — that is 10 pounds of grain in a 1,000 pound horse.  With a low NSC concentrated feed, that same horse gets only 1 pounds a day.  You will mix the HEIRO™ in with the morning feed.  With Insulin Resistance horses, we want to reduce weight, so we will feed grain only once a day in the morning — your horse’s natural circadian rhythm has Insulin highest in the morning and we want HEIRO™ working then to control Insulin all day.
            2. There are many low NSC/low carb pellet feeds on the market but they are not all good for an Insulin Resistant horse because they may also have high fat. We want a low carbohydrate (low NSC), high protein, and low fat diet. To compare, sweet feeds have a NSC of 40% due to the sugars/starch of lots of corn, oats, and molasses and some feeds have 12-30% fat.

            Good Choices:

         Name of Feed	Company	NSC %	Protein %	Fat %	Approx. Cost of 50 lb. Bag
         Enrich 32	Purina Mills	10	32	5	$28.00
         Gro’n Win*	Buckeye Feed	10	32	5	$28.00
         Triple Crown 30	Triple Crown	13	30	3	$28.00
         M-30	McCauley Feeds	10	30	5	$28.00
         Equi-Pro MVP	Poulin Feed	10.5	24	3	$28.00
         Moormans Gro Strong Mintrate	Alliance Nutrition	12	33	2	$28.00
         Empower Balance Grass Formula	Nutrena	10	30	5	$28.00
         Winning Touch Sunshine Plus	Blue Seal	18	30	3	$28.00
         ProAdvantage Grass Formula	Progressive	10	30	5.5	$28.00
         Equine Choice 32	Kent Feeds	14	32	5	$28.00
         Essential K	Tribute Feed	14	28	6	$28.00
         AllPhase	Pennfield Feeds	15	26	3	$28.00
         * Avoid Gro’n Win GC which contains Glucosamine

          

          

         1. Why These?
            

            Low Carb/ High Protein	Low Carb/ 12-14% Protein
            1 Pound once a day.	2-2.5 pounds twice a day for a total of 5 pounds.
            High protein means increased muscle. Muscle is the biggest user of insulin, and this helps lower blood glucose.	X
            High protein helps increase magnesium absorption which helps lower insulin.	X
            High protein diets lower glucose uptake in the intestine decreasing insulin surges.	X
            Cost: about $360 a year per 1000 lb. horse. Save over $700 per horse.	About $1080 a year per 1000 lb. horse.

         2. Which low carbo feeds to avoid? Ones with extra fat such as Purina Ultium, Ker Re-Leve, and Blue Seal Carb-Guard. These are great options in tie up, PSSM, and Cushings horses with no Insulin Resistance.Summary: Not all “lite” feeds are best for Insulin Resistant horses. You will feed a very small amount of one of these four in the morning along with HEIRO™, beet pulp, and a handful of alfalfa pellets.

          

      AFTER ALL OF THAT READING, IT WAS ALMOST DAWN AND TIME TO CALL MY VET

   At sunrise (my brain was already full and the day hadn’t even started yet), I called my vet.
   She immediately came over and administered the IV Equioxx.
   I spent the day gathering/ordering all of the medicines/products and feed outlined above.

5. She seemed better tonight.  She did walk all over the barn, looking for her dinner that I had stashed in mini holed hay nets all over the barn…  She needs enough to keep her going all night, but not enough to make her fat.
6. I will keep you all posted.  (I’m sorry, I cannot get rid of these stoopid numbers aside the paragraphs… it is some formatting thing left over from cutting and pasting the articles)

7. HORSE AND MAN is a blog in growth… if you like this, please pass it around!

8. 

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