Club foot vs. laminitis, Cushing's dz.

[CMNewell <reshan@deyr.ultranet.com>]

> Anyway, here's the deal. This horse that we suspect has Cushings is SORE.
> On ALL her feet. 

Not at all uncommon if the mare is Cushingoid. A fair percentage of them
will devlop laminitis.



> She
> has a club foot in front as well and this seems to be the worst. Vet took
> x-rays. There is 10-15 degrees rotation in ONE foot and none in the
> other.

Horses do not necessarily rotate symmetrically.

>  He
> insists that because this foot did not look like this 5 years ago it IS
> founder. I pointed out to him that if it was founder there would be at
> least SOME rotation in the other foot as well.


Not true. There is no rule that  says one must have rotation (or
laminitis, for that matter) in both feet, or that it need be of equal
severity in both feet.


>  He
> insists that is NOT true. Nelson and I believe her soreness is from the
> Cushings/related issues. ALL of her feet have a good pulse, no heat, etc.
> There are NO signs of laminitis. 

Quite likely, as  Cushingoid horses often founder, which makes their
feet sore. What other reason do you propose for sore feet in a Cushingoid
horse? The disease itself does not make their feet sore, rather the
tendency to laminitis does.


> She
> did have an abcess last fall which was resolved (I can't recall if it was
> in one or both front feet). We suggested the owner soak her feet just in
> case. Anyway, couldn't the rotation have been there all along with a club
> foot?


In a club foot the wall is parallel to the coffin bone, There is no
separation unless there is also laminitis.

>  I
> believe this is the first time her feet have ever been x-rayed so we
> cannot compare 5 years ago to now. Besides the vet is going by what they
> looked like from the outside! He states that 5 years ago she had big,
> normal feet. 


Maybe she did.


> Nelson
> has been trimming her feet about 2 years now. They do appear smaller than
> when we started going there and she has always had two different front
> feet. A year ago this vet put her on thyroid meds but no follow up
> thyroid tests were ever done. She got worse, not better and I think it is
> from the thyroid meds.

More likely the thyroid medication was  useless, and the primary
problem simply progressed.


>  I
> am starting to understand that Cushing's is Cushing's.... this vet is
> trying to differentiate between the disease and the syndrome. There is
> none...


There certainly is a difference, but that's neither here nor there in
this discussion.

> it's
> like diabetes. You can be HYPOglycemic and HYPERglycemic but either way
> you are diabetic! 

You can also be hyperglycemic or hypoglycemic without being diabetic.
Beware of equating the symptom with the cause. similar symptoms can have
widely differing causes.



> I am
> going today to take her blood glucose before and after she eats a large
> grain meal (thanks, Linda for that suggestion) ...vet said the bloodwork
> showed it was 79 when he drew blood. 

If the mare is Cushingoid, and if she is a suspect founder case, why on
earth is she being fed large amounts of grain?

As for the glucose level, if the blood was not tested immediately or spun
down in a serum separator tube  shortly after collection,  the
glucose level may well appear lower than it actually was. However, if it
came up as 79, I'd guess that it was likely in the normal range.



> This
> vet is a nice guy but he's mainly a cow vet

And you're not a vet at all. No offense, but you're making a lot of
assumptions and assertions for which you have little concrete  basis
here, so at the least, vis-a-vis this vet, it's a pot and kettle
situation.


>  and
> I'm afraid he is going to freak our client out more than she already is.
> She is already wanting a heartbar. She is terrified of founder (bad
> experience from a previous horse that ended up being put down). I think
> our issue is with the Cushings, not acute laminitis. What do you guys
> think???? HELP! 


I think it's probable that the horse has Cushing's *and* laminitis.

                          
--CMNewell, DVM