Cushing Candidate?

As my followers (and detractors) will undoubtedly confirm, I am often dismissive of traces of blood in the white line. Such traces are often the result of a trauma at some indeterminate time in the past and now, often between three and eight months later, neither owner, nor horse, nor hoof have any recollection of anything untoward and at the next trim, the traces will probably have disappeared all by themselves.

IMG_0035

(trim incomplete)

Certainly, none of the photos I have ever commented upon, would have given us at Sabots Libres any cause for concern. The traces were small, often relatively vague, and frequently only reported in one foot. But the case I am about to touch on here is definitely a cause for concern and set the alarm bells ringing during a routine 6 weekly trim yesterday.

IMG_0038

The horse in question is a 22 year old mare, shod on the recommendation of the breeder/seller until aged about 20 due to a trauma, resulting in club feet, suffered when young. (This is not a classic case of club foot as described elsewhere on this site but could have been avoided by the same means – however, that is beyond the scope of this article).

More significant is that she was being fed grain and cereal up to the age of about 18. This was stopped due to allergic reactions to cereals and pollen–the latter probably being exacerbated by the inappropriate feed. This cessation of feeding supplements and an altered system of distribution of (ad lib) hay was successful in reducing the allergies to an insignificant level.

But the damage had probably already been long done. The last trim showed traces of red in the white line that do set off alarm bells. As we can see from this first photograph, there are red traces extending from the rear into the front quarters.

The extent of the traces is the main cause for concern; they are particularly concentrated around both sides whereas ‘insignificant’ traumatic damage will usually be seen at the front and medially.

When we examine the other hoof, it is clear that something is not right. In this case, the red traces are visible almost full circle. Clearly something out of the ordinary has been going on in the hoof which cannot be written off as a couple of unhandy manoeuvres in the field.

What is also obvious, is that this is not an ‘ordinary’ laminitis. The horse no longer has access to grains nor cereals, the grass is far from rich in sugars and essentially, there has been–and still is–no sign of discomfort in the hoofs. What is noticeable/notable is the poor moult whereby there is still a lot of thicker hair in patches. This gives rise to immediate thoughts of Cushing or, more correctly, PPID (Pituitary Pars Intermedia Dysfunction). This is an incurable but reasonably treatable hormonal condition whereby the body loses its ability to control certain functions. This can manifest itself in various symptoms, among which a poor moult, excessive disordered hair-growth and chronic laminitis.

IMG_0037

The area top-right is the normal summer coat while bottom-left the coat is clearly a lot thicker

When we add up these factors–a long-term grain diet (which additionally has led to allergic reactions), the poor moult and unusually large traces of blood in the white line–then our suspicions are aroused significantly. Obviously, it is not possible to simply say ‘Cushings’, the need for proper testing is unavoidable. However, this is not the best moment to test. The period of greatest–and most testable–hormonal activity is from August to October with the peak in September; by November, the values have usually receded to insignificant and thus indeterminate levels. For this reason, a blood sample will be taken in a few weeks time and sent off for testing.

The results will be posted here in due course.

Autumn is in the Air

and with it, laminitis…

No, you are not hallucinating! The title is indeed very familiar and refers back to the last available published article, Spring is in the Air.  Many people associate laminitis with the spring and it is probably true to say that the majority of (acute) cases and probably the most severe occur in springtime. Restricted or often no turn-out during the winter followed by exposure to new grass is one of the major triggers for laminitis. With the onset of autumn, these susceptible horses are exposed to conditions similar to the winter/spring exposure; during the summer, they have been feeding on sufficiently rich food that they maintain their sugar levels only to be hammered by the peaks presented by the autumn grasses that, as in the spring, don’t have quite the right conditions to put all the sugars to good use (growth).

However, when we look at the “problem” seriously, it is less laminitis and more the owners that are the danger to the horse. Owners that don’t follow advice, owners that are too embroiled in traditions, owners that consider that they know better, owners that are quite simply bloody-minded!!!

Granted, some cases of laminitis are the result of an accident: the horse breaks out and gorges itself on the stock of chicken feed next door, for instance; others are simply owner ignorance: the horse is overfed on the wrong types of food during the winter, at the same time it is confined to a box 22 hours a day and on the first sunny day of spring, is turned out into the lushest field of rye grass in the whole of Northern Europe! For the whole day…

It is at this point that we get called in… vet and trimmer now working together – or maybe even against each other – to try and get the horse back on track. Not wishing to tar all vets with the same brush, but some – and I can name quite a few – consider shoeing, box-rest and phenylbutazone to be the answer (and we can present all the arguments as to why this is not the route to take). We will take the steps that we as professionals consider essential to get the horse back to normal as quickly as possible but we must have the cooperation of the owner – and that is where it all so often falls down.

The horse must move, must be kept off grain and cereal foods, must not be locked-up at night… And this regime must continue after the horse has recovered. And yet, how many owners revert to their old ways, locking the horse up for up to 22 hours a day, returning to the “two-meals-a-day” commercial food routine with ineffectual balancers, mixers and the o-so-deadly grains and cereals. Even compacted feeds based upon grasses are unacceptable – they cause an imbalance in the continuous digestion of the horse and disrupt the natural working of the intestines. Unfortunately, owners are all too susceptible to the marketing claims of the manufacturers and the back-up of the equine dietary specialists whose research is almost invariably sponsored by the feed manufacturers.

And then the problem rears its ugly head again…and again and again. Sheer bloody-mindedness of the owner puts the horse at risk, initially every spring and autumn and eventually the whole year around – year in, year out.

I would like to say, if you know someone like this with a horse in a similar situation, help them see the error of their ways; but the sad reality is, they will seldom believe you, or they will say “yes, yes, I know…” followed by the inevitable “…but!”

Finally, let me just emphasise once again, I do not wish to tar all vets, nor all owners, with the same brush…

 

Spring is in the Air

and with it, laminitis…

Although we have come down to earth with a bump and, after the extraordinary February of this year, March has turned out to be a (fairly) normal March, spring is in the air. The trees are beginning to show signs of green, the daffodils are flowering and, here at least, the violets are in full swing. And the grass is starting to grow… Grass has a very bad press these days – and in some ways quite rightly – but should we be panicking?

We have long realised that there is a correlation between grass and founder or laminitis; for many years it was believed to lie in high concentrations of proteins but in recent years we have come to realise that it is a carbohydrate overload in the form of certain sugars that is the primary trigger. Spring grasses have always been to blame but in fact, late summer and autumn grasses can be high in damaging sugars too. So why do we particularly think of spring and is grass really all that bad?

In traditional circles, horses rarely see the light of day in the winter months and will be kept alive on a mixture of hay, possibly haylage, and commercial feed, almost always grain or cereal based with molasses to give it a “temptation factor” and to act is a binding agent. Hay alone is not a big problem, albeit that it is dead grass, it is often of a reasonable quality and has restricted sugar and starch content. Haylage is not simply hay bundled in plastic! Haylage is hay that has been cut “wet” and wrapped immediately. One of the principle reasons for producing haylage is the lack of need to dry the hay for several days, risking it being rained upon. It can also be stored longer, provided it is well sealed and the packing remains undamaged. The disadvantage is that the sugars in the hay are fermented creating a sweet, albeit to some, slightly acrid, smelling soft hay. The alcohol formed by this fermentation is reconverted into sugars by the body. These sugars are then in turn broken down by the body but rather than a slow bacterial breakdown, as with grass and hay, it is a much more rapid conversion similar to grain and cereal. As a result, horses on a diet including haylage and/or commercial feeds are maintaining their blood sugar levels throughout the winter.

Turning out for the first time on a beautiful spring morning, sun shining, birds singing and a crispness in the air that follows an early morning ground frost, would seem to be a great pleasure – and particularly for our horses. But the combination of low temperatures and sunshine will greatly increase the levels of damaging sugars in the grass. Already well stocked up on blood sugars from a winter of restricted movement and bad food, our horse is now confronted with field of delicious grass that will tip the balance completely. The overload results in rapid sugar intoxication and the equally rapid onset of laminitis.

Horses that are kept outdoors 24/7 all year round and not fed any form of grain or cereal based feed are much less likely to suffer from laminitis, even when confronted by the same carbohydrate rich grass. The reason is quite simple; during the winter period, the blood sugar levels drop considerably and a healthy horse will lose weight at this time. This does not mean it loses musculature, but any fat reserves that may have built up during the previous season will certainly have diminished. Because the blood sugar level is now low, the “hit” of spring sugars is not going to have the same effect on the feet. What we are doing, in effect, is breaking the cycle of insulin resistance (IR). If we keep building on the blood sugar levels, year in, year out, then the bomb is bound to go off at some time; if we break the cycle every winter, we effectively “defuse” the bomb. And like many things, if we carry on with a bad habit, the consequences often become irreversible. Insulin resistance is prevalent and is in most cases at the irreversible stage. Metabolic diseases such as PPID and EMS will often have their origins in insulin resistance.

Does the sort of grass make a difference? Yes, and no. Rye grass, very prevalent in Northern Europe because of its ease of growth and high yield, particular for the dairy and meat industry, probably has the worst press – and quite rightly too. Its sugar content is sufficiently high to form a rapid trigger for laminitis problems; nevertheless, many horses that are exposed to rye grass all year round, seem to develop something of a resistance to insulin resistance – a sort of immunity? And horses that are allowed to break their IR cycle every year are highly unlikely to succumb on rye grass.
That said, keeping horses – or any grazer for that matter – on a single type of grass is fundamentally wrong. Different grasses, weeds, plants and shrubs all bring with them their own very important characteristics and properties that horse must be allowed to tap into.
Extract from the Sabots Libres Newsletter, Spring 2016

Scaremongering…

Laminitis posterThis photo and a list of ten points was recently posted to a social media site:

Essentially a praiseworthy action from a group that has a generally responsible if occasionally misguided approach to hoof care. As they state, the owner is responsible for his or her horse’s welfare – an area fraught with misunderstandings and traditions.

Where the action breaks down is in the general statement and at least six of the points cited to underline the statement:

There is NEVER a horse we come across who has not suffered from or is suffering from chronic laminitis

In itself, this is a very bold and very disputable statement. I would challenge anyone to identify a horse that is fully recovered from a laminitic bout. When there is little or no damage to the corium, a hoof will regrow conform  to its natural pattern. But to actually claim that every single horse has or has had laminitis…sorry but this is either pure hyperbole or scaremongering and is at best, highly unprofessional.

The ten points are:

  1. Laminitis can be both chronic & acute. Just because your horse isn’t leaning back in the ‘laminitis stance’ doesn’t mean it hasn’t got laminitis!
  2. Feed your horse grass everyday & your horse WILL show signs of chronic episodes of inflammation.
  3. Laminitis is not just about the feet…it affects the entire body & is now being redefined as a whole system inflammatory response syndrome.
  4. A horizontal ring on a hoof equals a laminitic inflammatory bout….the more severe & regular the rings, the more chronic your horse is.
  5. Swellings around the eyes & sheaths, fat pads & laminitic crests are signs your horse is a chronic laminitic.
  6. If your horse is footy without shoes, he is having chronic laminitic bouts.
  7. If your horse gets ‘gravel’ up its white lines, it’s because they are separated & weak…your horse has had chronic bouts of laminitis.
  8. Red lines/spots visible in the hoof walls/soles are very rarely down to ‘bruising’….they are signs of chronic bouts of laminitis…check other hooves for redness in the same areas, you’ll find them!
  9. If your horse ‘needs’ shoes because it can’t ‘cope’ without them (hooves DO NOT wear away barefoot) then your horse is a chronic laminitic.
  10. Lamintis (& colic) are the BIGGEST cause for horse DEATH around the world….because most (YES MOST) domestic horses suffer from chronic bouts during their lives!

It cannot be denied that exposure to grass can trigger a laminitic response but in fact the situation is far more complex than that. The complete lifestyle of the horse needs to be considered. Since a vast majority of horses spends the winter locked up in a box between 16 and 22 hours a day, with a minimum of exposure to the outside world, or a few hours in a paddock – often with a shortage of hay – at best, it is an enormous shock to the system when they are turned out in spring and suddenly encounter young sweet fresh grass. Many horses that do spend more time outside throughout the year, are often restricted to a very sedentary life: the occasional excursion to the riding ring on a Saturday afternoon being the height of activity. Add to this the often restricted space they live in (undersized fields) and most importantly, the bad foods they are almost always being fed – grain and cereals, and in excessive quantities – then we are indeed talking about laminitis waiting to happen.

On the other hand, the EquiLibre herd of 75+ horses, grazing on the grassy slopes of the Pyrenees during the summer and 80 hectares of rolling grassland in the Aude during the winter, do not have and have never had laminitis. These horses are exposed to grass for more than 8500 hours a year – that’s allowing ten days for the actual time they are ridden and unable to eat! But they also have to expend energy to eat. They climb over 1000 metres; they graze an area where rocks are not necessarily predominant, but they do reduce the amount of grass available.

A horse moves to eat, and eats to move.

This adage is essential to the well-being of the horse. Both physiologically and psychologically. Whilst it may seem strange to say that a horse is psychologically compromised if it cannot eat, this is in fact the case; the reason a horse displays stable vices is principally boredom resulting from inadequate contact with other horses and lack of food. (By chance, a study by Nottingham Trent University has been given UK press coverage today – it highlights the fact that horses fare badly when stabled.) The horse eats upwards of 15 “meals” over a period of between 12 and 16 hours a day.

My own horse does not have the luxury of 2,000ha of Pyrenee to wander, not even the 80ha of the winter. However, she is outside 24 hours a day, never blanketed, never fed anything other than supplemental hay when the grass in the field is almost non existent or if she has to be confined to the paddock for any period due to excessively wet fields or – as is now the case – the fields have been fertilised. And worst of all (shock-horror) the grass is probably the most unsuitable of all grasses, namely rye grass. And yet Fleur has solid feet, crunches rocks with impunity – and, just as the plumber has leaking taps, I’m afraid her feet are a little “neglected” and only get a look in every 12 to 15 weeks. But, Fleur has room to move in her field and even more importantly, she goes out on the road four to six times a week for at least an hour a time and often longer. This compensates more than adequately for the long trimming intervals, stimulates circulation in the hooves (purging toxins – read “sugars”) and emulates the daily movement of the natural horse.

I know Fleur is not a “fat little pony” but rather a half-blood Arabian, but there is another horse that has more or less the same regime as Fleur (the only exception being the owner that considers a blanket necessary if it is wet – but then again, if you brush your horse twice a day, there won’t be any protective fat left in the fur to ward the water off!). This is a – potentially – fat little pony. Brought up and kept in typical stabling for her first six years, she is an “eater”. But with good field management and not being over fed in winter, she too has fabulous hooves.

To go back to the points and make comment on the assertations:

Laminitis can be both chronic & acute. Just because your horse isn’t leaning back in the ‘laminitis stance’ doesn’t mean it hasn’t got laminitis!

Er, yeeeees! Laminitis does have both acute and chronic forms – and recurrent bouts of acute laminitis will often end up being referred to as chronic. Not quite sure why you need to mention the ‘laminitic stance’ or could it be that you are confusing “acute” with “severe”?

Feed your horse grass everyday & your horse WILL show signs of chronic episodes of inflammation.

Er, no. See above.

Laminitis is not just about the feet…it affects the entire body & is now being redefined as a whole system inflammatory response syndrome.

Yes and no. Laminitis is feet and nothing else. However, that which causes laminitis can certainly have an effect on other organs in the body so laminitis itself is not being described as a whole system inflammatory response syndrome, rather it is being listed as one of the symptoms. And of course a laminitic horse is going through compensatory measures to alleviate discomfort and pain – this has a knock on effect on the whole musculoskeletal structure.

A horizontal ring on a hoof equals a laminitic inflammatory bout….the more severe & regular the rings, the more chronic your horse is.

No, not really. Many laminitic horses don’t even display rings – more often than not, it is a localiased deformation of the hoof-wall often developing around mid hoof and usually most prominent in the front quarter. Rings develop from the corium, the growth centre of the hoof. They are often triggered by changes in weather, diet, medication and even location. Frequently the ring will be a thickening in the horn but the underlying white line remains a more or less constant width. However, I would agree that if there is a regular display of rings, then it should be taken seriously – something somewhere is not quite right.

Swellings around the eyes & sheaths, fat pads & laminitic crests are signs your horse is a chronic laminitic.

No. These are signs that your horse could develop laminitis, not that it is laminitic. And just what is a “laminitic crest” – or do you mean EMS and possibly PPID? 

If your horse is footy without shoes, he is having chronic laminitic bouts.

No, if your horse is footy without shoes, it could just be that his digital cushions have atrophied. Not unusual in our Northern climes with soft ground. Get your horse moving on asphalt and this will slowly get better. Another problem is also the owner’s expectations; just when is a horse “footy” and when is it just being sensible and feeling the ground? Many owners describe their horse as being lame when in actual fact, he is learning to feel.

If your horse gets ‘gravel’ up its white lines, it’s because they are separated & weak…your horse has had chronic bouts of laminitis.

Could be. But it can also be because the hoof-wall is projecting below the level of the sole, bowing outwards under pressure and rupturing the weakest part of the white line. Or simply that the horse has been travelling over a lot of tiny stones. The problem is when the gravel starts to penetrate a long way, and if Fusobacterium necrophorum gets on the scene, it will have a field day.

Red lines/spots visible in the hoof walls/soles are very rarely down to ‘bruising’….they are signs of chronic bouts of laminitis…check other hooves for redness in the same areas, you’ll find them!

Oh? Red spots are haemotoma. Bruises. Laminitis rarely causes bleeding (the word says it – laminae: layer, itis: swelling). Yes, you quite possibly will find spots in the same places on the other hooves, especially when they are caused by crossing rough terrain. When red occurs in a stretched white line, this will have its origins in a laminitic problem – often the now loosened laminae in the lower parts of the hoof-wall being ripped apart through pressure on the hoof-wall.

If your horse ‘needs’ shoes because it can’t ‘cope’ without them (hooves DO NOT wear away barefoot) then your horse is a chronic laminitic.

A wildly sweeping statement with no scientific basis whatsoever. Horses that cannot cope without shoes have usually not had the chance to prove themselves because the owner expects instant success and/or that his horse won’t feel the ground, just like when it is shod. Even the best barefoot horse should “feel” what is under its feet and react accordingly. This is what saves its joints and tendons – and essentially its life. And barefoot hoofs do wear away – but never to the point a horse cannot walk.

Lamintis (& colic) are the BIGGEST cause for horse DEATH around the world….because most (YES MOST) domestic horses suffer from chronic bouts during their lives.

A questionable statement – severe laminitis certainly results in the death of most sufferers but probably the biggest killer is horses being “broken in” far too young and being shod (many horses don’t even get the chance to be laminitic). But I will concede that 70% to 80% of all domestic horses will have founder (not necessarily full blown laminitis) but this is often the result of poor farriery practice – 90% of farriers not having a clue about the mechanics of the hoof let alone those of the horse.

Interesting point: two days after this poster and 10 points were published, The Laminitis Site, a well respected charity, published photos of a pony recovering from severe laminitis – doing what? Eating grass!

Uh Oh October…

Actually it should be “uh oh September” but that is both less alliterative and this year not so appropriate. September 2014 was particularly warm and the temperature was rarely lower than 15°C. But now October has arrived and the first really cold nights are just around the corner. Along with the increased dangers of higher fructose content in the grass.

We tend to think of springtime as being the most dangerous period for laminitis in our horses – and to a greater extent, that is true. Low temperatures and plenty of sun means a high rate of photosynthesis but just about no growth which leads to fructose being stored in the plant for later growth. Added to this the fact that many horses are kept indoors throughout the winter because owners believe that their horses are incapable of withstanding temperatures below about 10˚C and they are worried about them getting wet. The state of the pasture is also a consideration. All this means a sledgehammer blow to the system during spring turnout after such a period of “abstinence” and some horses (actually a surprisingly high number) are not capable of coping with this change.

But now the autumn is upon us, even with the possible promise of warmer days in mid-October, we are starting to run into the same sort of circumstances that increase the amount of fructose in the grass. Only now, the danger moment is shifted from the morning to the evening. A sunny day with temperatures not reaching above about 15˚C will mean higher fructose levels in the afternoon and evening rather than early mornings.

Because our horses have been out all summer, they are less prone to the dangers of high fructose levels but those horses that are particularly sensitive need more protection.

This table may be of some help determining the danger moments:

Weather Plant Metabolism Fructose Levels
Night Temp Day Temp Sun Photosynthesis Growth morning afternoon evening night
<0˚C <0˚C No No None 3 3 3 3
<0˚C <0˚C Much Much None 5 5 5 5
<0˚C <15˚C Much Much Low 5 4 4 3
>5˚C <15˚C Much Much Low 1 3 4 2
>15˚C >15˚C Much Much High 1 2 3 2
>15˚C >15˚C No Little Much 1 1 1 1
The risk on a scale from 1 (low) to 5 (very high)

Laminitis Research

Sadly, all too often, research goes off the rails. What starts out as good intention, collaboration and free exchange of ideas, turns into a race – not for the ultimate cure, but for the most funding to insure “successful” continuation of the project.
Sometimes, research gets “found out”: the recent revelation that the various omega fats were not essential to being healthy – it was based upon one very questionably executed bit of research; anti-oxidants combatting free radicals turns out to be more of a marketing ploy for cosmetic and health-food manufacturers than reality; that saccharine is carcinogenic – when the equivalent of 22 times the human daily intake is injected into rats (I think this would possibly apply to a lot of substances, either natural or synthetic). At other times, the research just continues and gigantic sums of money are invested – not infrequently just to insure that the research remains perpetual and not as a means to an end.
But the worst is research for research’s sake. I can understand the research into lung cancer – even if smoking is a major cause, it is not the only cause so just stopping smoking is only going to help some sufferers. However, research into something we know how to prevent is really malicious. And laminitis is one of those things.
It is known that when horses are subjected to high levels of toxins, one of the first effects is seen in the hoofs. We know that these toxins can vary from (excess) antibiotics and other drugs, through various poisonous plants to incomplete expulsion of the placenta. We also know that by far the most dangerous and prevalent cause, is high levels of fructose. Still the research continues – and in a gruesome way. Perfectly healthy horses are (often force-) fed a high sugar diet resulting in acute laminitis, causing great pain and suffering to the animal. The suffering is relatively short-lived since the horse is then euthanised, often within hours of being fed the sugars, by means of lethal injection, or “humane killer” – otherwise known as the penetrating captive bolt; basically they are shot through the brain.
It is time to stop this sort of research – prevention of this type of laminitis is simple. Stop feeding sugars – either by effective pasture management or, if you really need to feed commercial products (which you don’t), by elimination of the sugars in such products.

Jaime Jackson, director of the American Association of Natural Hoof Care Practitioners (AANHCP) and long time promoter of the natural living environment for horses, is sounding the bell in the States where in the past 5 years, there have been at least four major studies into laminitis. The research situation is Europe is a little less shocking, nevertheless, similar research is undoubtedly taking place somewhere on the European continent. If you are aware of universities or research establishments carrying out research into laminitis – particularly destructive inhumane research, now is the time to call a halt to it.

In the link below, you will find a memo from Jaime Jackson describing the situation – although I cannot entirely agree with his stance on cancer research, and certainly not at European levels, I do agree with the basic message. At the back of the document is a letter – you can use this as a template to write to a research establishment asking them to cease.

http://www.aanhcp.net/Laminitis%20and%20PETA.pdf

Thank you for your support.