Vet case study: steroid-induced laminitis [H&H VIP]
The horse
Welsh part-bred Ystradmeadow Sancho (Alfie, born 2008) was bought by Gina Bruce for her daughter Isabella as a 3-year-old.
“He had a bit of a rough start — it turned out he was a rig,” says Gina.
However, after an operation at the Royal Veterinary College to remove both testicles from his abdomen, Alfie was soon broken and working well for his new owners, doing occasional unaffiliated showjumping, hacking and dressage, which is Isabella’s “true passion”.
He is now working at elementary and finished 7th in the novice restricted and 10th in the music freestyle at the 2014 Winter Championships.
The history
As his work progressed his owners noticed a slight intermittent lameness in the hindquarters on the right.
In March 2012 he was blocked and X-rayed and an inflamed cartilage was found in the stifle. Unfortunately, the treatment for this resulted in Alfie struggling with a far bigger problem — laminitis.
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The treatment
The Bruces’ vet, Luisa Smith from House and Jackson, suggested they treated his stifle problem with a steroid injection, and a week’s box rest, after which Alfie should be able gradually to restart working.
The vet explained that there is a very small risk of such an injection triggering laminitis, which the Bruces understood and accepted.
“I understood that if it was going to happen, the laminitis was most likely to strike in the first 48hrs,” says Gina. “So when that passed without incident I felt more relaxed.”
However, when Alfie came towards the end of his week’s box rest, the Bruces noticed he wasn’t looking comfortable and found he had massive digital pulses in his front feet. He was shuffling badly and was clearly extremely sore. The vet came straight out.
Alfie was treated with ACP and given Danilon for pain relief and its anti-inflammatory effects. His feet were packed out with a plasticine-type material for support and taped up. He was then put on box rest on this regime for about 3 months.
“Alfie is quite feisty, a real biter, and not a very nice character in the stable. Box rest made him very depressed,” says Gina. “He just lay on the floor. It was soul destroying to see him.”
After this time his feet were X-rayed to reassure the vets nothing in the foot was moving (in some cases of laminitis the coffin bone — also known as the pedal bone — sinks or rotates within the hoof, leading to permanent damage to the foot). Alfie’s X-rays showed no sign of rotation which was very good news.
Around this time the vet also tested Alfie for Equine Metabolic Syndrome (EMS), which is a hormonal disorder that can cause laminitis.
The primary disorder in EMS is insulin resistance. Insulin enhances the uptake of glucose from the bloodstream into cells, and in conjunction with glucagon plays the major part in regulating blood sugar levels. Horses with EMS do not respond to insulin as they should, so glucose remains in the bloodstream, much as it does with human type II diabetes sufferers.
Alfie produced a borderline result, but the vet strongly believed he may be insulin resistant and suggested starting him on some Metformin tablets, which essentially lowers the sugars in the body. He began on 14 tablets twice a day as he returned to work.
“The improvement was terrific, right away,” says Gina, although persuading a feisty horse like Alfie to start work again sedately after so much enforced box rest was not easy — he was sedated initially to help keep him manageable. Gradually his medication was decreased and he was completely medication free by October 2012.
“It took months for him to overcome the laminitic stance,” Gina explained. “Horses become so used to their feet hurting them that the can retain this ‘braced’ position even when it no longer hurts. For some time he would walk very gingerly on hard ground once he was out of the school.”
The outcome
The Bruces persevered with his rehabilitiation and after the best part of 8 months largely confined to his box, Alfie was back on the road.
Isabella took him to an unaffiliated dressage competition in November 2012 and he won, first time out. He affiliated with British Dressage in March 2013 and has continued his success.
Ongoing management
Gina has read everything she can find about Alfie’s condition and management since a horse that has suffered laminitis is always at risk of getting it again.
As Alfie’s laminitis is related to EMS, the Bruces are very careful to minimize his glucose/ sugar intake.
Alfie is kept stabled, goes out for 3 hours or so to graze each day, but is now muzzled.
“And he is never turned out in snow, ice or frost as this can intensify the sugars in the grass that trigger the problem,” adds Gina.
His hay is soaked overnight and Alfie is fed Blue Chip Lami-Lite.
“Having had horses all my life it is still hard to have a horse with laminitis and not give them carrots and polos,” says Gina.
The future
The vet believes regular work is important, with time off best avoided so Gina says that if he is ever off with any other ailment, she will discuss with the vet whether to put him back on Metformin.
The costs
About £3,000 in veterinary fees.
Contacts
www.houseandjackson.co.uk in Essex
Tel 01277 823808/features/laminitis-in-horses-signs-treatment-57937
Lucy edited Horse & Hound from March 2002 until June 2014 and never had a dull day. She events (very badly) for fun, hunts whenever she can, and has written on topics ranging from embryo transfer to fall simulators. She’s reported from the 2006 Aachen World Equestrian Games and 2011 European Eventing Championships.