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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.
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. 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.
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 dietary needs of a metabolically foundered horse can be intense, expensive, and time consuming. It is best to consult an Equine Nutritionist or Veterinarian who is well advised in the dietary needs of metabolic equines. They can help you to develop a vitamin/mineral supplementation and dietary program to address all the horse’s needs, without increasing the carbohydrate load.
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. It is essential that carbohydrates and sugars in the diet be maintained at the lowest level possible. Non Structural Carbohydrates refers to simple sugars that cause the body to secrete more insulin. Horses that are insulin resistant cannot effectively control their blood glucose levels.
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.
Foundered hooves over a 2 1/2 year span
Medications and Supplements
It has been shown that magnesium and chromium supplementation is very beneficial for the support of metabolically challenged horses. Be sure to talk to your Veterinarian and Equine Nutritionist about this in more detail. A wealth of information is available on the Equine Cushings Group, which is linked on this page. 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 any number of natural pain relievers.
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 my foundered horse any more than necessary. You want to keep circulation at its peak.
Exercise for the insulin resistant horse can head of laminitis or founder.
Beet Pulp for your Metabolic Equine
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, shreds,
cubes. 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.
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 to about 4 times it’s dry weight when soaked in water. 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 about 30
minutes. Experimentation will tell you exactly how much water it will
soak up, but the general rule is 4 parts water to 1 part beet pulp. 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.
Soak Hay - Save A Life
A Rubbermaid bin for soaking hay
Studies have proven 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. Unfortunately this crucial little piece of information is sometimes neglected by the owners of metabolic horses because they either don’t know about it, or it is too much work. I recall a horse I looked at that had deep purple bruises on all 4 of his white hooves. Growth rings, and lameness were also present. The horse was buried chest deep in a round bale, and when I questioned his owner, she told me that she doesn't limit his grass or hay because the vet said laminitis is not curable, so what's the point? That horse was heading for metabolic crisis far worse than what he was already in, but the owner was given faulty information from a veterinary professional. This is so unfortunate it's heartbreaking. This article will hopefully serve to inform you of the danger of non-regulated simple sugar intake and what you can do to make hay safer for your horse. 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 storage bins like the ones shown here. 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. If you do this right, you’re using leverage to lift up the end of the tub, and not brute force. Do NOT strain your back! You are no good to your horse when you're laying crippled in the feed room floor with a seized up muscle. Keep your back flat and straight and squat down to grab the handle, don’t bend over.
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!
Still another experiment to try if the horse refuses to eat the soaked hay - mix in some alfalfa leaves, or soaked alfalfa pellets. Alfalfa is actually lower in total sugar content than most grass hays, though the sugar in alfalfa is primarily glucose rather than fructan. Fructan is a safe sugar, glucose obviously is not. Some metabolic horses can eat a portion of their meals in alfalfa without any problems, others cannot tolerate it. So the decision to use alfalfa should be made with your veterinarian, and your horse's past history of tolerance to it. One of my metabolic horses tolerates alfalfa extremely well, but one does not. Each horse is different and it takes some experimenting. But if you're trying to wean your horse over to eating soaked hay, shaking out some alfalfa leaves into the wet hay can be a good way to convince your horse to eat it. Remember - everything in moderation. Don't dose your horse with large quantities of anything that might be unsafe for him. Try it in small amounts 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, or ulcers, 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
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