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Insulin Resistance ~ Cushings Disease ~ Equine Metabolic Syndrome


Nothing strikes fear in your heart quite like the diagnosis of founder or laminitis. Fat horses and ponies are at greatest risk of laminitis and metabolic founder, but it “can” happen to thin, fit horses as well. You have to be aware of the warning signs, and the acute presentation of the condition, and how to treat it. Hopefully this article will address a few of these concerns.

Laminitis vs. Founder Is there a difference? YES! Laminitis refers to inflammation of the sensitive laminae of the hoof. Founder is a nautical term which means “to sink.” A ship that is foundering in the water is losing it’s orientation and buoyancy. Radiographs can determine if your horse has actually foundered, or if only laminitis is present without any rotation or sinking of the bone within the capsule. Laminitis does not always precede founder.

Types of Founder
Founder can be either mechanical or metabolic in nature. Mechanical founder refers to a physical force mechanically separating the hoof wall from the bone, causing trauma, swelling, and subsequent death of sensitive laminae. Another type of mechanical founder is from concussion (too much hard riding on asphalt, for instance, also known as road founder.) Metabolic founder refers to a systemic issue where the body has suffered some type of metabolic insult, whether it be a flood of mycotoxins, sustained high glucose levels in the blood (Insulin Resistance or Cushings Disease) or some other type of inflammation or fever. One way that mares develop founder is through a retained placenta. Founder caused by Insulin Resistance or Cushings Disease can be the most difficult to manage.

What actually happens when a horse founders? There is a tremendous amount of controversy on what “exactly” happens to cause a horse to founder, and what happens during the acute phase. However, one thing most experts agree on is that when a horse founders, there is acute swelling and inflammation inside the hoof capsule causing pain, tissue death, and severe lameness. Circulation is often affected as the distal phalanx (coffin bone) loses adhesion with the hoof wall and migrates from its normal position.
Is your horse this fat??  If so, he might FOUNDER!
Radiograph showing rotation of distal phalanx of a foundered pony.


I found my horse in the founder stance. Now what?!
CALL YOUR VETERINARIAN IMMEDIATELY! Articles and independent research are never an adequate substitute for a qualified Veterinary opinion, diagnosis, and prognosis. The nature of this article is to give you general information, but when your horse is in serious trouble, always call a qualified equine Veterinarian immediately.

After you have called the Veterinarian, it is crucial that you provide the horse with sole support immediately. Any type of firm supportive foam can be used in an emergency. Building supply stores sell sheets of construction grade foam, or you can use garden kneeling pads. Otherwise any type of dense foam chair cushion or a neoprene saddle pad can be cut up. You can also use thick clay poultice packed into the bottom of the foot though the foam is preferred over the poultice. Cut the foam to fit about ¼” larger than the circumference of the hoof, and secure with vet-wrap and duct tape. If you absolutely cannot secure any of these supplies, bed a stall deeply with shavings, and get the horse to stand in there until the Veterinarian arrives.

It is CRUCIAL to limit movement during acute laminitis, especially if pain medications have been given. Excess movement can cause more separation of bone from hoof capsule.

Standing the horse in ice or cold hosing the legs might be beneficial though most experts agree that it is most important to provide complete solar support as the first line of defense.

Your Veterinarian will administer phenylbutazone or banamine, and then instruct you on continued care during the acute phase. Sometimes an IV of DMSO is given to combat severe inflammation inside the hooves. It is important to ask your Veterinarian about lateral radiographs, and when they suggest they be taken. They will likely also instruct you to hire a therapeutic farrier to shoe the horse. Many horses have gotten better without the shoeing process, and left barefoot, but that decision is one only you can make. You will also want to start soaking the horse's hay immediately to remove a lot of the sugar from it. Keep reading to find out more about this!

How aggressively and effectively you treat the horse NOW will help to determine the horse’s long term recovery.

We Survived the Acute Stage, But Now What?
It is extremely important that you identify WHY the horse foundered. If it was mechanical, has the leverage or source of trauma been identified and removed? If it was metabolic, was the source of the insult identified and removed? If the horse got into the feed room and at 25 pounds of sweet feed, it’s fairly safe to say that the horse may not necessarily have a long-standing metabolic disease, but that this was a one time insult. However if the horse foundered on spring grass even after being properly introduced to it, or without a single identifiable insult, then you may have a metabolic horse on your hands that needs proper diagnosis, dietary changes, proper exercise, and possibly medication to keep the horse healthy and as sound as possible.

Insulin Resistance, and Cushings Disease are two metabolic disorders that make horses very likely to suffer laminitis or founder. Talk to your Veterinarian about the appropriate blood tests to identify these diseases.


Dietary and Exercise Changes
The goal of feeding the metabolic equine is to reduce the amount of simple sugars and calories in the diet to keep the weight of the horse at a healthy level. Feeding no-molasses beet pulp or other low sugar, founder safe feed, low NSC (Non Structural Carbohydrates) grass and/or alfalfa hays, and moving the horse to a dry lot are all indicated in the treatment of metabolic founder. In some cases, your veterinarian might prescribe a drug like levothyroxine (thyroid stimulating hormone) to help increases the horse's metabolism and get some pounds off. In addition to a proper diet and exercise as tolerated, this can be a critical part of managing the horse.

The use of ration balancers is very popular with the owners of metabolic horses because they are typically low sugar but high protein and they provide the horse ALL the vitamins and minerals they need. A good vitamin and mineral supplement is important for a horse who cannot eat fresh green grass and has a reduced hay intake and no fortified grain. Higher protein diets in humans has shown beneficial in regulating blood glucose and insulin. It is assumed that this may also be beneficial in horses. Keep in mind that ration balancers tend to be very calorie dense so you do not want to feed more than the minimum recommended amount (typically 1 - 2 pounds.) I like to break this feeding up in half a.m. and p.m. but it's not necessary. Triple Crown 30% and Purina Enrich 32 are very good products in my opinion. I use and recommend both. For a general low starch pellet I have used Purina Wellsolve L/S for many years and have been very happy with it. Whatever you choose to feed, be sure that the horse is not consuming too many calories, and that the dietary fiber needs are being met.

Slowing the consumption of hay for the overweight, metabolic horse is also critical. Especially horses who live on dry lot, their hay may be gone in 30 minutes and then they stand for hours with nothing moving through their digestive system. Using a slow feed hay feeder, or a hay net with small holes, you can slow the hay consumption to make the smaller amount of hay last longer.

Slow feed hay net in use. Slow feed hay net in use. Slow feed hay net in use.


Also, studies have shown that soaking hay in water can significantly reduce the carbohydrate load(1). This is extremely important for Insulin Resistant (IR) horses, PPID (pituitary pars intermedia dysfunction, a.k.a Cushings Disease), horses that have metabolically foundered, and those with chronic or acute laminitis. The needs and management of these horses are similar to humans with Type II Diabetes. When an equine is diagnosed as IR, it means their body is not as responsive to insulin as it should be. The body has to elevate the level of insulin to manage blood glucose. Insulin in itself is a known inflammatory and injections of insulin was shown to induce acute laminitis in a clinical study conducted by a team of researchers at the University of Queensland(2). The management protocol is to tightly manage the level of glucose in the horse's blood by feeding a diet low in simple sugar. When the glucose level is low, the amount of insulin required is also lower. PPID is an endocrine system malfunction in which there is an abnormal growth of cells within the pituitary gland. This causes abnormal hormone levels in the blood, such as ACTH and Cortisol. PPID horses often suffer recurring bouts of acute laminitis, and founder. A tightly managed diet is critical for the treatment of ANY equine metabolic disorder.

Maintaining a diet low in sugars is very important for health and healing, not to mention soundness. Soaking hay is a bit of a chore, but with practice it becomes second nature.
I will describe to you the method that I use most for soaking hay. I’ve tried a lot of different things, and by far, this works the best, and strains your back the least.

  • Buy at least two medium sized plastic storage bins. They cost around $8 each.
  • Buy a small to medium sized concrete block or paver stone to use as a weight the hay as it floats to the top of the water. Or you can use an ice cream pale filled with sand, which works great also.

The toughest part about hay soaking is the water source and drainage. Once you have 20 gallons of water in the tub, it will be very difficult to move it to a place where you can drain it, unless you put it on a cart with wheels, which is another possibility that works well! It’s important to fill it in the same location where you will be able to drain it. This may mean running a hose from the water source to the drainage location. For those of us who live in the frozen tundra, the thought of all that water in January is dreadful. But, there ARE ways to make it easier.

Set the hay on end inside the tub. Laying it flat can leave dry spots inside the hay, and I've found it works better to set the flakes on end. Lay the block on top of the hay to weight it down. Fill the tub with just enough water to cover the hay. No need to run excess water.

Leave the hay to soak for a MINIMUM of 30 to 60 minutes for hot water and 2 hours for cold. Or you can leave the hay overnight, or all day to soak. Don’t leave it longer than this in hot weather, as it can spoil.

When you’re ready to drain it, remove the weight, then grab the tub by one handle and tip it up on end slowly to pour off the water.

Once you’ve drained off all the water, you can drag the tub to the horse. This is easily accomplished by afixing a grass hay string to the handle on one end. Take 3 hay strings and braid them together so you have a nice thick handle that won't cut your hand in two. Leave the wet hay inside the tub to keep it clean. Shavings and dirt will stick to the wet hay and it becomes unappetizing to your horse. Another hay transporting option is to set the tub onto a little cart and wheel it to the horse, if it is too heavy for you to drag, or if you have to drag it halfway across the farm.

While your horse is eating hay from this tub, set up the other tub with hay to be soaking for the next feeding.

If by chance your horse just flat refuses to get used to eating wet hay, you can lay it out flat on a tarp or drying rack for a few hours before feeding, but this is much more work. It’s best if you can slowly accustom the horse to eating wet hay. People have had success sprinkling white table salt throughout the hay (no more than 1 ounce {1 tablespoon} per feeding). Still others sprinkle cinnamon, or ground flax seed on the wet hay. You can also used non-molasses soaked beet pulp, which is very safe for metabolic horses. Soak it thoroughly, then dump it on the hay and mix it throughout. Of course this only works if your horse already eats beet pulp and he likes it. You don't want to wate a tub full of hay and a pound of beet pulp on your experiment, so test it in small quantities first!

Other more technical and complicated methods involve using a large Rubbermaid bin on wheels and drilling a hole in the bottom and installing a plug to drain water. Or placing the hay inside a hay bag and setting the hay bag in the tub full of water, then pulling it out with a pulley system. The problem with this method is that your clothes get soaked while you’re trying to hang the bag, and also the bag weighs about 60 pounds when you’re trying to lift it out of the water. Another method is to place a laundry basket inside the bin full of water then pull out the laundry basket with the hay. Again, this is heavier than just tipping the tub on it’s end to drain, but it’s not as heavy as lifting the bag.

WINTER HAY SOAKING:

In the winter, it is ok to let the hay freeze inside the tub, as long as it is not freezing into a solid block. Horses seem to like the "haysicles" and as long as they have no tooth problems, the frozen hay should not cause them a problem. Place the tub inside a feed room or wash stall if any way possible to protect it from the elements. It will take much longer to freeze this way. But again, make sure it is close to a drain, or close to a place it can be drug and emptied. I soak hay all the way down to -15 below zero with -40 windchills and I have no problem. My feed room drain freezes up in the winter so I must drag the tub outside to drain it. This is best accomplished with the smallest tub possible, or two small tubs with only 2 flakes of hay in each, versus one big tub with all 4 flakes. If you can get the tub on the snow, it drags VERY easily. I've never had a problem with creating an ice slick, as I slightly vary the dumping location every week or so. Some people have actually dug a 12 foot square gravel pit where they dump the water. This lets it drain down and away.

If you have absolutely NO place to safely drain the water during the winter, the best option for you is to find a hay source that sells low NSC (Non Structural Carbohydrate) Hay.


1. http://www.safergrass.org/pdf/SoakReport.pdf --- Kathryn Watts, Research Director, Rocky Mountain Research and Consulting, Inc.

2. The Role of Insulin in Endocrinopathic Laminitis --- University of Queensland, The Veterinary Journal August 2007


Exercise that pony!!
Exercise that pony!!!!

Exercise is essential for the laminitic, foundered or founder-prone horse once they have moved out of the acute phase, and pain is under control. Supportive hoof boots and pads or shoeing is important to keep the horse comfortable during exercise. Even if you can provide 15 minutes per day of walking or jogging, the horse will be better able to utilize insulin. Try to keep the horse on soft footing like grass, even while using hoof boots and pads. Concussion can cause more pain and inflammation.

Trimming/Shoeing for the Long Haul
I am in favor of keeping horses shoeless as much as possible. That’s a whole ‘nother article in itself, but I will summarize it by saying that shoeing should be used when it is clear that it is not possible to keep the horse comfortable while barefoot. I advocate the use of hoof boots and pads as much as possible.

Foundered hooves usually grow differently than normal hooves due to an interrupted blood supply and nerve damage causing the horse to weight the feet differently than she would normally. The heels tend to grow very fast while the toe seems to hardly grow at all. Keeping foundered horses on a short trim cycle – 4 to 5 weeks – is crucial to long term success. The worst thing you can do for a foundered horse, next to a poor diet, is a trimming cycle that is too long. Many foundered horses develop what is known as a laminar wedge. The photo below shows the evidence of this. As the dorsal aspect of the coffin bone rotates downward away from the hoof wall, the void that is left fills with hyperkeratanized laminae. This laminar wedge must be addressed frequently and thoroughly if the horse is to regain optimal hoof form and function. It’s important to work with a trimmer or farrier who has some experience in working with foundered horses.

Fopundered horse, recovering nicely.
Foundered hooves over a 2 1/2 year span


Medications and Supplements
It has been shown that magnesium and chromium supplementation can be very beneficial for the support of metabolically challenged horses. Some sources have reported that their horse’s blood sugar levels improved when fed a teaspoon of cinnamon everyday. This is subjective, but cinnamon makes a great flavoring for no-molasses beet pulp and certainly cannot hurt anything.

Daily or long-term bute therapy carries certain risks including gastric ulcers and right dorsal colitis, so be sure to thoroughly discuss this with your Veterinarian. However, in certain cases this medication will extend the comfort and happiness of the horse for many years. Another option is Equioxx or Previcox (Drug name is firocoxib) or any number of natural pain relievers. And as discussed earlier in the article, a thyroid stimulating hormone such as levothyroxine may be indicated and prescribed by the attending veterinarian. Increasing the thyroid activity can help a stubbornly obese horse with adipose tisssue come down to a more healthy and normal weight.

Summary
No two foundered horses are the same. No two foundered horses are the same. No two foundered horses are the same. What works for one might not work for another. Some foundered horses get better despite lacking good palliative care and some horses deteriorate even under the watchful eyes of the most noted founder experts in the world. NO TWO FOUNDERED HORSES ARE THE SAME!

Be prepared to change little things, such as giving an anti-fatigue mat to stand on while in the crossties, or bedding the stall deeper than normal. Understand that foundered or laminitic horses have difficulty turning tight circles or going down hills. In other words, you may need to rethink many aspects of your horse’s management protocol to be sure that they are comfortable and happy. Most natural hoof care experts agree that once the acute phase is safely behind you, MOVEMENT, low coffin bone angle (short heels), and very frequent trimming are your best allies. I don't like stalling foundered horses any more than necessary. You want to keep circulation at its peak.

Looking good!  Nice weight for a pony.
Exercise for the insulin resistant horse can head of laminitis or founder.





Beet Pulp For Your Metabolic Equine

Beet pulp shreds, pellets, and crumbles.

If you own an equine suffering from some type of metabolic disease, you have undoubtedly wondered about the benefits and risks of feeding beet pulp in lieu of grain products. There are now plenty of good, low NSC (Non Structural Carbohydrates) feed mixes available but many of them are either very expensive, or hard to get and must be special ordered. Some feed mills are reluctant to order, or they require you to buy them in bulk. Feeding beet pulp is a nice alternative for you and your metabolic horse.

Beet pulp comes in a variety of forms – pellets, crumbles, and shreds are the main types available in the United States. You can also find an Alfalfa/Beet Pulp feed called Fibre Beet, which is imported here from the UK. Fibre Beet pellets are square and flat. Whichever form you decide upon, make sure that it is available with NO MOLASSES. Beet pulp is often coated in molasses to increase palatability. It is possible to soak and rinse this variety of beet pulp, but that’s just one more thing you have to do everyday. My preferred brand is Standlee Beet Pulp Pellets. It is affordable and has a guaranteed low NSC of around 6%.

Beet pulp costs around $11-16 per 40 pound bag, which surprisingly lasts a LONG time. Much longer than 40 pounds of grain would last. Beet pulp swells and soaks up water so you have a lot more bulk going into the horse than the same amount of calories made up in grain. This makes it perfect for metabolic horses or those on weight restricted diets because not only does it add beneficial water to the digestive system, but it is very filling and satisfying. Feeding 1 cup of soaked beet pulp (expanded to about 4 cups) is far more satisfying than 1 cup of grain or dry pellets. Traditional grains like corn and oats are NOT safe for the metabolic horse.

The nutrition profile of beet pulp places it squarely on the scale between being a forage and a grain. It is very high in fiber but the caloric count is low. One item to note though is that it is deficient in Vitamin A so good hay or pasture (if the horse can tolerate grass), is also an important part of the diet. Using vitamin supplementation programs, many horses have been successfully maintained for years on beet pulp as the main forage in the diet.

So How Do You Feed This Stuff?? There is a lot of controversy regarding whether to soak it or not soak it. Horses can choke on dry beet pulp but still there is a sect of the horse world that believes horses will only choke on it if they have a history of choke. NOT TRUE. My mother’s horse choked on dry beet pulp so badly that she had to place an emergency call to the veterinarian, and that horse had no prior history. I just say SOAK IT. Beet pulp (in any form) is dry and hard. Some horses eat it dry without any incidents but the benefits of soaking it far outweigh the benefits of feeding it dry, in my opinion.

If you buy the no-molasses form, all you need to do is throw it in a bucket with either hot or cold water and leave it sit for for anywhere for 2 or 3 minutes to a couple of hours. If however the only type available to you is augmented with molasses, you must soak it and then drain it, and preferably rinse it a couple of times to remove all the molasses. This can be accomplished with a large mixing bowl and a colander. It is not too difficult to do it this way, and not very messy, but if you are feeding very large quantities, it could be problematic.

Most horses will readily eat soaked beet pulp, but if your horse has difficulty accepting it, give him only a small amount, mixed with some of his regular grain to start with. Also, adding a teaspoon of ground cinnamon or fenugreek. Some horses accept it with a tablespoon of salt added. The wetness of soaked beet pulp makes it perfect for mixing any other supplements into as well.

Shreds - Crumbles - Pellets
Which should you choose?

 
Beet pulp shreds, pellets, and crumbles, prior to soaking.

When you decide to soak and feed beet pulp, you first need to decide how much to feed your horse per day.  A good place to start is usually about 1 cup of shreds, or 1/2 cup of pellets or crumbles.  You want to start off small and increase later.  Just like any new food, introduce it slowly for the best result.  Eventually a mature, 1,000 pound horse can safely consume up to about 40% of their total fiber needs in soaked beet pulp.  This is something you want to discuss with your veterinarian and equine nutritionist.  Every horse and every situation is different.  You have to be careful not to overfeed beet pulp because it is more calorie dense than the average grass hay. 

The most common questions people new to beet pulp ask is "How much water do I soak it in?"  "How long do I have to soak it?"  "How much will it yield once soaked?"  I conducted a highly scientific experiment......ok so it's not very scientific........on how much water, and how long to soak beet pulp. The type of beet pulp, and the temperature of the water are the two things you must consider.  But I will break it down very easily for you:

To start the experiment, I meausred exactly 1 level measuring cup of shreds, pellets, and crumbles into 3 separate bowls.  Technically the BEST way to measure any kind of equine feed is by WEIGHT, not by cups, scoops, coffee cans, or handfuls.  But the truth is - busy boarding barns and horse owners find it very difficult to weigh everything out on a carefully calibrated scale.  So I have simplified this by simply using the measurement CUP.  (1 level dry measuring cup)

Next I let the tap water run as hot as possible and took the temperature - exactly 110 degrees. 

I added exactly 1 liquid measuring cup of 110 degree tap water to each bowl.

Then I set the timer for 1 minute.

Made a glass of iced tea........stirred each bowl once..........

And this is what the experiment looked like after exactly 1 minute:

Beet pulp shreds, pellets, and crumbles 1 minute after adding 1 cup of 110 degree water

The compressed pellets are the slowest in absorbing water.  Only the outer layer of the pellets has begun to absorb the hot water.  90% of each pellet is still dry and hard as a rock.  The shreds have water standing in the bottom but they have become soft and fluffy enough to eat.  The crumbles has become the consistency of grape nuts cereal but is still somewhat firm and crunchy on the inside of each crumble.

The bowls were left to rest 1 more minute.

Within 2 minutes, both crumbles and shreds have absorbed 100% of the water they were given.  The pellets are still sitting in a pool, though a bit more water has been absorbed.

Next I added 1 additional cup of water measured to be exactly 110 degrees, to each bowl.

I continued checking on the progress of the experiment every 30 seconds for the next 2 minutes or so.

At this point the shreds have stopped absorbing water completely.  The crumbles have absorbed all the water they were given.  The shreds are fluffy and moist all the way through.  The crumbles are now the consistency of hot oatmeal cereal and are thoroughly soft throughout.

The pellets however are still hard and dry in the middle and they have absorbed all the water given.

I added 1 more cup of 110 degree water to the pellets and waited.  And waited and waited and waited.  They absorbed all of that and but a few pellets were still hard and dry in the middle so I gave them an additional 1/2 cup of 110 degree water.

At this point the pellets have expanded so much they had to be transferred to a larger bowl:

Beet pulp pellets transferred to a larger bowl during experiment.

The total time elapsed is 30 minutes before the pellets have FULLY absorbed every bit of water, and are thoroughly fluffed, saturated, and soft.

At this point I checked each bowl and discovered that the shreds were standing in water that was never absorbed.  I drained off the water from the shreds and it measured exactly 2/3 cup.  There was NO additional water in the bottom of the crumbles or the pellets.

YIELD OF SOAKED FLUFFED BEET PULP

Shreds:  2 Cups
Pellets: 5 Cups
Crumbles: 3 Cups

AMOUNT OF WATER ABSORBED

Shreds: 1 1/3 Cups
Pellets: 3 1/2 Cups
Crumbles: 3 Cups

TOTAL TIME NEEDED TO SOAK IN HOT (110 DEGREE) TAP WATER

Shreds: 2 Minutes
Pellets: 25 Minutes
Crumbles: 5 Minutes

SUMMARY

Compressed pellets are the hardest, driest, and take the longest to soak but they absorb the most water and produce the highest yield.  1 level cup of dry fluffs to 5 cups.

The shreds are quickest but absorb the least amount of water and produce the lowest yield.

Crumbles take only a couple minutes longer than shreds to soak but absorbs more water and produces a little higher yield.

Final yield of shreds, pellets, and beet pulp crumbles.

A NOTE ABOUT TANNINS

I have seen people comment about all that "dark sugary water" they drain off their beet pulp shreds.  I just want to clarify that beet pulp is full of tannins, which is the same organic compound which gives tea it's dark color.  Please do not mistake the dark brown water for being molasses.  Even non-molasses beet pulp will yield dark brown tannin laden water when soaking is complete.

Beet pulp water full of TANNINS.

SOAKING IN COLD WATER

In the future I will conduct this experiment again but I will use cold tap water instead.  Beet pulp takes much longer to soak in cold water but exactly how much longer, and how much water is absorbed will be determined in the experiment.  Stay tuned!