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Vet Visit

After months of feeling slightly in-the-dark about what is going on with Sage, and floundering around doing my own research and reading, it was really nice yesterday to finally have the vet out.

I had set up an appointment for Sage to get his spring shots and some acupuncture yesterday, and then had him scheduled with the lameness specialist for Monday. And the farrier for next Tuesday. I know, busy schedule. I'd called my vet a couple of times to discuss Sage's dietary issues and I'm pretty sure he'd been out once last summer while this was going on, but he never really did anything about it or gave me much advice, which had me frustrated.

Well, apparently either we had some miscommunication, or we had his full attention yesterday finally or something. Because we got much better results. Sage is now diagnosed as having 'metabolic syndrome' which is decidedly different from laminitis, and I now (more or less) understand the difference between the two. I'm still a bit frustrated by the chinese medicine approach our vet takes, while also loving him for it, because he seems to really be able to help my horse, and yet I am left analyzing phrases like "your horse has too much ying energy" and wanting another vet out just to explain things to me.

So Sage had acupuncture first. he got 8 needles right on his croup, and he was cranky about each one going in. When had acupuncture last year he got really sleepy and relaxed both times, but yesterday he was kinda twitchy throughout the whole thing. The had 2 more needles in his right hind leg, and one in his shoulder.

Don tested him for pain first. He uses this little pencil-like thingy to push on specific meridians I think, and watches the horse's reaction, and that informs where he puts in the needles. He said that Sage wasn't showing any pain around his sacro-iliac injury and that he feels it's healed on its own over time. (I guess maybe moving him to my mom's for the 24/7 turnout paid off then.) But Sage *did* have a big reaction in his right shoulder, and Don felt his reactions at the mounting block probably have to do with that shoulder being painful. I have to wonder if that's related to his old SI injury...I know sometimes as they compensate for an injury in one place, they get sore in another. But I think its more common for it to be the diagonal leg, not the other leg on the same side.

Sage eventually got a little quieter as the needles worked. He gave Thea her spring shots while we waited, and I told him about Sage's symptoms around grass and we talked about metabolic syndrome. He recommended putting Sage on a fairly high dose of magnesium, and said that with metabolic syndrome, there's glucose everywhere but it's not making it into the cells. And that magnesium helps fix that. ??? More research needed apparently.

Sage has a "yong deficiency" which is a "chi deficiency" along with not enough fiery energy basically. Which Don said matches his inability to digest his food. Then Don felt his ears, and said they were cold. He had me feel Sage's ears and said the first two fingers should be warm, and the next two should be cooler. Then he had me feel Thea's ears for comparison. Yes, Thea's ears really were warmer. Sage's ears both have a noticeably cold patch at the bottom, and actually get a little warmer further up, which is weird. Now all of you, please go feel your horse's ears and report back to me before this guy asks me to start boiling frog's tongues and reading entrails???

Also, Sage's tongue and mouth are really pale pink, and Thea's mouth and tongue were more reddish. Don said that again Sage's mouth being so pale was a sign of metabolic syndrome.

So, all the needles in Sage's bum were to tonify his yong energy I believe...to rebalance him. Sage's hooves were not warm, and the pulse near his hooves was fine and in balance. Don said to absolutely keep him off of pasture until later in the season, and that every horse is different and we were just going to have play around with what works for Sage. He suggested fencing in very small strips of pasture, and really limiting his pasture intake though. He also said there's really not any need to worry about coffin bone rotation as his hooves show no sign of founder (which I knew). he said the fact that they were warm a couple times meant we did need to change things a little, but did not indicate to him any danger of coffin bone rotation.

So we muddle forward, with 2 new supplements; some magnesium in significant quantities, and some rehmania, which I believe is a chinese herb, and Don said it would take at least 3 weeks to see a difference.

Again, I am really thankful to have a vet with a more alternative health viewpoint. But, being somewhat educated as an herbalist myself, I find it annoying and against my overall herbal philosophy (which is use your own environment to find healing, i.e. use the plants around you) to be paying substantial sums for herbs shipped to us FROM CHINA. I suppose I could talk to my herbalism teacher who sort of specializes in treating horses herbally, but I guess for now, we'll try this.

Oh, and, I had actually seen my herbalism teacher that morning for a website meeting, and she gave me a new supplement for Sage called "easy balance" with magnesium and cinnamon and chromium etc. for Sage. Well, Don looked at it and sort of smiled and said "That looks fine." and I looked at him and said "Do you think it will do any good?" and he said he didn't think it had enough of any one thing to really make a difference. He was basically telling me it was ok, as in, it wouldn't harm my horse but he obviously didn't feel it would actually help. The magnesium he's having me use instead is like $3 a pound anyways so I don't really mind giving the Easy Balance back to my herbalism teacher. But I find it interesting that she feels she's had good results with it in other sugar sensitive horses, and Don feels it wouldn't really do much of anything at all.

Sage is okay'd for exercise, although really what I was asking him was not whether or not Sage *could* exercise, but more "how important is it that he [does] exercise?" But Don didn't quite catch that and just told me it was okay to exercise him. Mom feels exercising him is important as in, its nice when I can do that, but not crucially important as in "Move or sell your horse because if you continue owning him and not riding him enough, he's going to be really sick."

I hope she's right.

The short version:

  • Sage has metabolic syndrome, not laminitis. Yay!

  • Sage is okay'd to exercise and the acupuncture got rid of the pain in his shoulder entirely. (He didn't flinch or move away at all after the acupuncture and should now be okay around the mounting block.)

  • He's now on magnesium to help his metabolism. And also rehmania, a chinese herb.

  • His sacro iliac injury did not trigger any pain response, and Don feels it's fully healed.

  • The vet giggled again and wiggled Sage's ribfat. He needs to lose close to 100 lbs. I taped him later at 1085 I think? Crap, now I have to tape him again to make sure. Mom thinks at his build he should be at ~900-950lbs. Let's hope the rehmania and magnesium help him lose weight because he's really not getting that much hay.

Sage also had his coggins pulled and half his spring shots done. Don's coming back in 2 weeks to do other half. And sheath cleaning! After having Sage kick at me half-heartedly and glare at me for months whenever I tried to just *touch* that area, it was interesting to see him be a perfect gentleman while Don applied the excalibur and got the job done. I think it was the acupuncture.

So, I cancelled Sage's appointment with the lameness expert on Monday. Mostly because, even though I would like to have Sage get some chiro if needed, and get another vet's perspective in english! thank you, without some vague terminology like yong deficiency...I also want to just wait and see how he does for the next couple weeks. If the herbs and magnesium really do work, and we keep him off of pasture and he really does stay sound, then there's no need to do anything else except keeping doing what we're doing. Besides, the lameness exams are really *expensive.* Totally worth doing if necessary, and doing in the not-too-distant-future if Sage continues to be lame *at all.* But, I don't mind holding off for now and waiting a couple weeks to see how he does.

What all this means is...I need that new endurance girth like yesterday. Gotta ride Sage and keep him in shape as best I can starting NOW. But I can think of much worse things than your horse needing to be ridden regularly for medical reasons...



(Equine metabolic syndrome is the 2nd half of this pdf.)

This makes me confused again. Clearly exercise IS crucial according to this and some other articles I found on the web. AND it can be related to laminitis. ARGGH!


( 10 comments — Leave a comment )
Apr. 11th, 2009 05:17 pm (UTC)
"The vet giggled again and wiggled Sage's ribfat. He needs to lose close to 100 lbs. I taped him later at 1085 I think? Crap, now I have to tape him again to make sure. Mom thinks at his build he should be at ~900-950lbs. Let's hope the rehmania and magnesium help him lose weight because he's really not getting that much hay.

Holy crap. 1085? Sage looks to be somewhat similar in build to Mitch, Mitch is definitely in the ~900-950 range. I rather like Mitch where he's at because I can't see ribs, but can feel them if I press lightly (which according to the Henneke scale is about right for a horse in 'moderate' weight)

Well, time to get back in the saddle, right?

Mitch has his Happy Fun Needle Day on Monday.
Apr. 11th, 2009 10:15 pm (UTC)
As I understand it EMS is quite a new term, our vets talk to the owner of the horse at our yard who suffers with it as being a "new disease" but I'm sure horses have been suffering with it for a while. From what I can tell it's something like a mild diabetes. Magnesium has a major role in the metabolic chain and it's something that is commonly lacking in the diet of horses- it's certainly something we use in the interests of maintaining their feet. This was particularly important with Joe, who tends to be cresty and a pretty high risk of laminitis, although I don't think he's been badly affected...

So the yin energy is the dark, inner, feminine energy, the yang is the explosive outwards bright energy - when you are learning tai chi, the inhalation is yin and the exhalation is yang. I don't know if that helps, but it's about the extent of my very limited understanding of taoism...
Apr. 11th, 2009 10:37 pm (UTC)
Also, linked a while ago, but probably relevant here: Pete Ramey on feeding the hoof.
Apr. 12th, 2009 12:41 am (UTC)
I will read it. Thank you.
Apr. 12th, 2009 12:41 am (UTC)
Thank you...that actually makes more sense to me than what our vet was saying yesterday.
Apr. 12th, 2009 12:03 am (UTC)
This is just what I've been saying all along, I told you I thought it was metabolic. This term though is just a new one they like to use, or fairly new like IR. And laminitis is a symptom of it as well. And overweight cresty necks and fat deposits. There are dozens of articles and the grass articles all apply still. This is just what Ive been talking about, here is another one.http://www.ker.com/library/EquineReview/2005/HealthLine/HL36.pdf

NO fresh grass, no sweet feed, low carbs,. I'm sure you feel better finally having a vet give you a diagnosis. Echo has been dealing with this for yrs and as Ive said, once we cut out all the sweet stuff, monitered the grass,got her weight down and everything else she has been fine. The weight Loss is very important. Guess I can't really think of anything else, I think ive told you all I know over the last months. I am very happy a vet has told you this and maybe it will help with your mom as well. Watch the exercise though, be very careful about jumping right into it. He does exhibit laminitic symptoms and as you will see in any article that is very common.

They have just recently started separating all these metabolic issues and giving them different names such as metabolic syndrome and insulin resistant. 20 yrs ago they were all just referred to as cushings and now we know there are many. They still all boil down to about hte same things and the same type of horses(heavy, cresty,etc) are the ones who USUALLY but not always get it. Confused as to why you feel laminitis is not an issue, it is with all metabolic problems mostly and we know he has sore feet. Echo did too but it went away never to return once she was on the right track. I don't think they usually consider laminitis a disease itself but more a symptom of many diseases including most all metabolic issues. IT is basically just a term for inflammation of the laminae and that is what causes the sore feet in metabolic , IR problems. And it can become very bad and end in founder. Lots of horses with metabolic problems have founder as you know. Much less chance if the diet is kept low in sugar,starch and weight where it should be.

Im always scared it will progress into diabetes so we have always worked hard to try and keep Echo under control and have been successful once we found out the trouble. And our diagnosis changed as the info discovered did. To begin with it was a problem of easy keepers, then it went on to be called border line IR and metabolic syndrome and even some with diabetes. Now we keep separating the slightly different metabolic issues and naming them thus EMS. There will be more soon Im betting, they still say it is because horses these days are loved to death. These issues are becoming much more prevalent in recent decades with all the new rich feeds and whatnot. New and better medicine is now keeping our animals alive longer too giving chance for illness to develop which they wouldn't have lived long enough to get decades ago too.

I hope you have good luck in controlling it. Not sure why Im getting this feeling, and I very well could be wrong but- This still means his fresh grass intake needs to be monitored but you know that right? They must have discussed that with you. I also would want to still get some sort of radiographs to see what damage the laminitic episodes he has had already have done to his feet if anything. I'd wait until he has lost his weight and his diet has been under control for a while and there have been no more sore foot episodes and then see if there was any damage done and go from there.

I think it was last month or the month before Equus had an article on metabolic issues and laminitis. It is pretty hard to have one and not the other, and it does suck, but this CAN and WILL be gotten under control and don't let yourself forget that. I have great confidence you will get this figured out very soon now and you and Sage will be on your way to great fun and many special adventures.
Apr. 12th, 2009 12:34 am (UTC)
As always thank you for your helpful comment. I honestly understand *more* from your comments here than I understood talking with the vet yesterday. He said laminitis is not related and not a problem, even though Sage's hooves were warm at least twice last year. I didn't feel totally comfortable with that, so I'm glad your comment reaffirms that it is all related and he very well *could* have some issues in his hooves too.

His ggrass intake will still be *very* strictly controlled. I am thinking about *maybe* letting him graze for half an hour to an hour in the early mornings once we hit full summer, but that would only happen if we can really get his weight down on just hay, and I felt like he was out of the woods enough to have a little wiggle room. Being 100 lbs overweight right now...NO GRASS at all. Not even one bite while we're walking. And I'm giving him apples occasionally, because according to the article I read they are low-glycemic enough to be ok, but he isn't allowed any carrots at all.

Yeah, I got that issue of Equus after reading about it in comments here. The article was helpful, but I'm not sure I feel open to grazing muzzles yet, although I plan on buying that issue too just to read it and see.

Its very comforting to know that you and Echo have gone through this and she is ok as long as she is managed. I was looking at Sage today and he is pot-bellied right now. :(

Anyhow, he's on the new supplements, let's hope they help!
(Deleted comment)
Apr. 12th, 2009 12:40 am (UTC)
Thanks for your comment, I am so appreciative of other people's knowledge right now. It wasn't that my vet felt cinnamon didn't help...it was that he felt the supplement didn't have enough of any one thing in it to make a difference. The product is called Easy Balance and has some magnesium in it but not enough. He said it was fine to try it, he doesn't think it will hurt or anything...he just didn't feel it would help much either.

I get into trouble eating anything too refined too. No more cookies for me. :(
Apr. 12th, 2009 10:50 am (UTC)
The big advantage of cinnamon is that it makes your pony's dinner smell lovely...
Apr. 12th, 2009 10:38 pm (UTC)
I have nothing helpful to offer because this is the first I ever heard of this. I did want to let you know I'm thinking of you though and sorry you and Sage are going to have to deal with this. Hopefully once you get a diet and exercise routine worked out you will be able to manage this fairly well. Hang in there!
( 10 comments — Leave a comment )