29 January 2018

‘He was walking on tiptoes’: one horse’s battle with equine metabolic syndrome

Nathalie van Heesewijk, equine vet at Torch Equine Vets in North Devon, recalls one of her recent challenging cases.

Hamish is a gentle giant who spends his days grazing and hacking out on the lush hills of Devon.

He’s also well known for his impressive appetite and knack for finding sustenance in even the barest looking of paddocks. So, by the start of summer, Hamish had grown a sizeable bottom and belly.

Unfortunately for him, Hamish had also inherited some “hardy” genes from his ancestors so his metabolism couldn’t cope with the combination of having excessive body fat stores, a high daily sugar intake and a rather lazy lifestyle.

The perfect storm was created: Hamish developed Equine Metabolic Syndrome. This is a condition that results in a diabetes-like insulin resistance that can lead to severe laminitis.

As a result, poor Hamish was left having to carry some 750kg of weight on four very inflamed feet.

Worryingly, the sweating, constant weight shifting and bounding pulses in his feet persisted, despite him being kept on soft ground and receiving a high dose of pain killers.

Even more alarming, as Hamish’s feet were under so much stress, he started developing pockets of fluid and pus underneath his sole.

His condition rapidly became critical and we had to act quickly if we were to save poor Hamish from a life of crippling pain.

Coming up with a plan

An emergency summit meeting was called to assemble all the major players: Hamish’s owner –manager and head of feeding; his farrier – head of hoof health and support; and myself, provider of drugs and wielder of diagnostic tests.

We decided to take radiographs of his feet to assess the severity of the situation. The X-rays revealed that severe inflammation and break down of the laminae had allowed Hamish’s pedal bones to rotate and sink within the hoof capsule.

Hamish was effectively left standing on tiptoes, with less than 1cm of sole between the tip of his pedal bones and the ground!

Every aspect of Hamish’s feet was mapped out and measured under X-ray guidance. This enabled Hamish’s farrier, Josh Cottam, to expertly craft a support shoe that’d relieve the colossal pressure exerted upon Hamish’s pedal bones and sole.

Hamish’s owner and I also sat down to create a diet plan. This was a crucial part of the treatment as, unless the underlying Equine Metabolic Syndrome was addressed, the laminitis would just persist or reoccur.

Hamish was in too much pain to be able to burn any calories through exercise, so the challenge was to achieve weight loss through diet alone. A strict high-fibre, low-calorie diet was used in conjunction with metabolism-enhancing drugs and a vitamin and mineral supplement.

Over the following eight months, Hamish took us through every emotion imaginable: joy at seeing him improve, despair as every new abscess developed, frustration when he point blank refused to stay in his stable, pity at the look we got when he received his first diet ration.

However, his bravery as well as all the dieting, poulticing, farriery and hand walking finally paid off when a few weeks ago, I had the extreme pleasure of witnessing Hamish’s first ridden hack.

Hamish’s story reminded me that the key to managing these very difficult cases lies in good communication and teamwork between all parties involved.

Hamish is now very pleased with his new slim waist and has hopefully learned that over-indulgence is just not worth it!

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