Insulin and Laminitis

Insulin and Laminitis

Tuesdays with Tony

Springhill Equine Veterinary Clinic Today has been a good day so far. I wandered around outside, slept in a sunny spot, then moved to a shady spot when it got too warm, enjoyed the sound of birds chirping, and just generally enjoyed the weather! Meanwhile, I have seen pictures from adoring fans around country buried in snow. That’s a hard no from this cat! I have seen as many as 12 flakes of snow at one time, and that was plenty, thank you very much. I have no desire to see more of that cold, wet, white stuff. There’s one small problem with this time of year. All that warm sunshine makes the grass grow, and if you’re a horse with an insulin issue, that grass is going to get you in more trouble than I get in when catnip is involved.


Insulin: Can’t live without it, too much will kill you slowly


Let’s review insulin, and what it does. When you eat anything containing sugar, even small amounts, your pancreas releases insulin. This insulin attaches to cells to tell them, “Hey, there’s sugar here. Come absorb it!” The cells do just that, and either store that sugar for later, or use it right away to power their little cell manufacturing facilities. All this works great until there is way, way more sugar than the cells need, then the body switches to hardcore storage. And that’s where this week’s blog really gets interesting. A vicious circle, not unlike Teanie Cat chasing her tail, is set up with the body releasing insulin so the cells will soak up the sugar, the cells ignoring the insulin, so the body releases more, and the cells ignore the signal even more. This is how we get to what’s known as Insulin Resistance (IR).


All that Insulin floating around


It turns out insulin does way more than just tell the cells of the body to suck up the sugar in the bloodstream. It also gets the growth machinery, mostly a thing called IGF-1, geared up. You see, when there’s extra sugar around, it’s a good time to grow some stuff. Lay down some bone, grow some skin, you know, spruce the body up a bit. Our bodies, cat, human, horse, all of them, aren’t designed for this system to be switched on for long periods of time. We all evolved to handle long periods of, gasp, scarcity of food. The system would experience excess sugar, lay down a lot of fat for the future lean times, fix some stuff that needed fixing, and then use all that fat when food got hard to get. Enter the modern age. We never get to that food is hard to come by period of the year. I will argue this point since I can’t get food whenever I want, and I’m often sure I’m starving, but I will say I get two to three solid meals a day, so there’s that. The growth machinery never, ever shuts down. The insulin just keeps getting pumped out. The cells say no more, even louder. The growth machinery keeps trying to grow stuff. And this is how we get to laminitis.


The L word


I have learned that no one in the horse world likes the word laminitis. For a long time, no one quite understood how or why fat horses got laminitis. For a while it was thought the thyroid gland wasn’t working quite right since other species with bad thyroid glands get fat, and have issues similar to laminitis. The problem was horses with low thyroid levels got skinny, not fat. Back to the drawing board. That drawing board was especially confusing because these fat horses improved on thyroid medications. Eventually the wise humans of the world got a better understanding of what was going on. This would have been figured out long ago if anyone had allowed cats to be involved. We know everything.


It turns out that growth machinery, and the cells ignoring insulin are both to blame for laminitis. The laminae are finger-like projections that come off the hoof capsule side of things, and the bone side of things. They hold each other tight to keep the hoof attached to the leg. In the picture below you can see that normally these are short, rounded fingers with long projections on their sides. On the abnormal side you see they turn long and skinny with short, squat projection along the sides. You can imagine those abnormal lamellae don’t hold on very well.


Springhill Equine Veterinary Clinic


How to make Insulin go down in three easy steps


The good news is insulin can go down, but it ain’t easy! Ask this fat cat how he knows…. No, don’t. I get a little testy when talking about my diet and exercise routine.


Step 1. Increase exercise. Even a little bit. Make sure your horse is exercising more each week than they were the week before. This can be as simple as walking for 10-15 minutes 3-4 times per week to start. Now if you already have laminitis going on, be sure you get one of my Docs to help you with an exercise plan.


Step 2. Decrease calories. Ration balancers, grazing muzzles, and slow feed hay bags are all excellent decrease-food-going-in options. The problem seems to be with you humans applying them. Got questions about the best way to do it? Ask my Docs!


Step 3. Medications to help. Sometimes even with diet and exercise, we need a little help to get things going the right direction. There are some great short term drug and supplement options to help get the diet and exercise going. Guess what? Ask my Docs for help!


It’s a tough time of year to be an easy keeper! Keep on top of your horse’s diet and exercise program, and know my minions are here to help!


Until next week,



P.S. Make sure you scroll down and subscribe if you haven’t already. Don’t rely on Facebook to deliver my blog to you. They’re terribly unreliable about things like that, and my blog is far too important to risk missing!


Also, have you made it to one of my seminars lately? They are a fantastic resource for all you horse people out there. Free food, free information, and free selfies with Your’s Truly. You can’t beat it! You can see the list of upcoming seminars on the front page of my website at .

Tuesdays with Tony is the official blog of Tony the Clinic Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at, or follow us on Facebook!

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Green Grass and Laminitis

Green Grass and Laminitis

Tuesdays with Tony

Teanie and I have been watching the Winter Olympics nightly. I have even been inspired to try my hand at luge down the hallway at the Clinic. It looks like napping because there’s no slope, but I’m hard at work practicing proper technique. In the morning when my trusty staff arrives, I go outside to enjoy Florida Winter. While enjoying the sun and 60’s the other morning I noticed something: green grass. Oh boy, I thought, here comes the fun. And by fun, I mean not fun (because I’m a cat), and by not fun I mean the laminitis cases that come with the first green grass. I really should have written this blog a month ago so you humans could be better prepared, but it’s hard to believe green grass is around the corner when there’s ice falling from the sky (that was a HORRIBLE day). Here we are though. Florida. Mid-February. Mid-80s. Green Grass.

Ahh, the Green Grass Buffet!

Beautiful, horrible, green grass

Let’s start with how awesome it is to have grass in February. Grass means less hay to feed, and, a highlight for my Docs, fewer colics. However, baby grass is very high in sugar which is why it tastes delicious. We also are likely to experience at least a few more days of cold mornings which will make that baby grass concentrate it’s sugar even more. You know how baby vegetables taste better than the big versions? Grass is the same way.

You mean my horse can’t eat the grass?

That’s not quite what I mean. Certain horses need to be monitored very closely this time of year to be sure they can handle high-sugar grasses. Have you found it easy to put weight on your horse, but hard to take it off? Have you noticed bumps on either side of the base of the tail, or behind the shoulders? Those bumps are fat. That fat is the really bad kind of fat, too. This fat releases all sorts of hormones that tell the body to get mad at everything (the Docs get fancy and call this a pro-inflammatory state), and they tell the pancreas to make lots and lots of insulin while telling the cells to ignore the fact that glucose is around. This leads to what’s known as metabolic syndrome, or insulin resistance.  And that’s a bad syndrome to have.

Horses with metabolic syndrome don’t respond correctly to insulin.  Normally, you eat some food, your brain says “Oh, that was sugar,” your pancreas says, “Release the insulin,” the insulin runs to the cells and tells them to grab the sugar. When this goes wrong, the cells stop listening to the insulin, the pancreas releases more insulin to try to make them listen, the sugar level goes up in the blood, and then some not-great stuff happens. The most common thing horse owners see go wrong is laminitis.

Why does sugar cause laminitis?

There are two main places in the horse that absolutely require sugar to work: the feet, and the brain. There are some long-term effects that are seen in the brain (mostly Cushings), but for this blog the most important immediate effect of high sugar is laminitis.

Laminitis happens because the cells that hold the hoof to the body need sugar to keep working. When the cells can’t absorb sugar because they’re busy ignoring insulin, they end up letting go of the hoof. In the worst cases, those cells even die. As those cells let go, the coffin bone rotates in the hoof capsule leading to what you guys call laminitis.

But my horse loves grass!

Never fear, my intrepid Docs are here! Through the wonders of diet, exercise, and, (when needed) medicines, your metabolic syndrome horse can eat grass, just not all the grass he wants. Here’s my simple plan for success:

  1. Start with a low-starch diet. Don’t know if you’re on one? Talk to Beth in the Clinic. She’s a whiz with feed!
  2. Exercise your horse for 10-15 minutes three times per week.
  3. Talk to my Docs about blood testing and X-rays. Not saying your horse needs this, but a conversation with my Docs is always packed full of information you can use!

I’m not just a pretty face when it comes to metabolic problems. Due to my extreme love of food, hatred of exercise, and bad genes, I’m diabetic. My staff has worked on my diet and exercise, and added in a little medicine, and I’m able to practice my luge technique daily! Oh, and monitor all horse trailers and delivery drivers who come to the Clinic, along with the house next door. If I can do it, you can too!!

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Tuesdays with Tony is the official blog of Tony the Office Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. For more information, please call us at (352) 472-1620, visit our website at, or follow us on Facebook!

Tuesdays with Tony – Blessed Be The Old Farts

Tuesdays with Tony – Blessed Be The Old Farts

Blessed be the old farts.  Around here there is a kind of reverence for the older horse.  I will admit to jealousy.  It’s not pretty, I know, but it’s real.  I mean, I’m a cat.  I deserve all the reverence around here.  In an effort to explore the causes for this misguided worship I talked with my minions, I mean humans, about the phenomenon.

Turns out all my humans went with something along the lines of enjoying their horses, learning from them, and feeling appreciative of all the horses gave to them during their athletic careers.  The humans said they wanted to make sure their horses had wonderful retirements since they had earned it.  I was a little confused by the “earned it” thing, since I don’t need to earn anything, but I digress.

What messes up a horse’s retirement?

Do they golf? Do they play Canasta and Bridge?  Apparently no.  They wander around a field and eat. This is a typical day for me if you substitute ‘Clinic’ for ‘field’, so not sure if I’m retired already or how that works.  Anyway, dental issues, lameness, and not feeling so hot are the biggies that interfere with retirees’ ability to wander around and eat.

The Teeth

Let’s start with dental issues.  Horses are this really weird thing called an hypsodont.  It means they have a whole lot of tooth when they are young, which they wear down to nothing over their lifetime.  The super cool thing is you humans are doing such a good job taking care of your horses that they now outlive their teeth.  Sure. that sounds scary, but with good nutrition it’s not a problem.  What it does mean is that you may notice your horse not wanting to eat.  You humans do a pretty darn good job knowing your horses.  When Tiny backs off on feed, don’t worry that we are going to think you’re crazy.  We won’t! We do the exact same thing! What we are going to do is schedule an appointment for one of our Docs to come take a look in Tiny’s mouth.  They might find some teeth that need to be adjusted a little bit or potentially extracted.

The Legs

Moving on to lameness.  This one I identify with.  I have jumped down from high places one too many times and I’m starting to develop a bit of arthritis in my right front paw.  Life catches up with us all.  All those daring feats of athleticism we displayed in our younger years show up as aches and pain in our later years.  Laminitis (same as founder) may rear its ugly head as well.  Once again the signs can be subtle, and you, the awesome human, may notice Flicka is in a different corner of the pasture than normal.  Once again, we won’t think you’re crazy when you tell us this.  We do the exact same thing! In this case our Docs are going to evaluate feet, legs, and the musculoskeletal system in general to identify a cause for the lameness.  If it’s arthritis, they will often recommend NSAIDs (horse aspirin) like bute or Equioxx, and movement, even in small amounts.  If it’s laminitis, a test for Cushings is almost always called for.  This is a test even a dog could pass!  It’s just a blood draw.  They also get on the phone with the farrier to make sure your horse’s entire team has the information they need.

When all of it goes wrong

Next there’s the “not feeling so hot”.  Again, when you call to say Mister isn’t right, but you can’t put your finger on it, we will be nodding our heads. We know that feeling!  This one is a little tougher.  Our Docs will put on their detective hats and start the investigation with you.  They won’t start with you because you are the prime suspect, they will start with you because you are the best source of information.  You know your horse.  You know if Mister ate and drank normally, and has he been sleeping normally? Rolling over? Is he in the same place in the herd hierarchy?  Next they will take your information, combine it with a good physical exam, and determine a course of action.  Usually, this involves some blood tests (remember they’re so easy a dog can pass them), along with an ultrasound of the chest and abdomen.  Only thing difficult about an ultrasound is the cold alcohol they put on your skin.  Based on these easy, peasy tests, our Docs will help you map out the best treatment options.  Lots of times these tests turn up Cushings disease.  Cushings is an endocrine disease which messes with every system there is to mess with.  Good news though: one small pink pill daily is the treatment. And if you schedule an appointment by the end of the week, our monthly special is $10 off this blood test!

Horses are like fine wine, they only grow better with age.  Totally patronizing the humans there, they told me to write that.  Anyway, let your horse live long and prosper with a little TLC.  The humans yak on a lot about Super Seniors, so this is the first in a four part Tuesdays with Tony expose.  Tune in next week for part 2


Tuesdays With Tony


Well Tuesday was so crazy I didn’t manage to catch up until Wednesday! The day after a long weekend is always hard on management. I have spent the weekend ensuring sunbeams are properly tracked across the floor, making sure the chairs don’t move in the office, and knocking any stray papers off the desk. Meanwhile, Dr. Lacher was busy seeing emergencies all weekend. Actually you guys were pretty nice to her and she only had to see a few. Dr. Lacher and Dr. Vurgason don’t really mind emergencies when they are true emergencies. The only time I hear them upset is when the horse has been very sick for a while and the humans wait until 10:30pm on a Saturday night to call but I digress.

One of this weekend’s emergencies was a common Fall problem: laminitis. Why Fall you ask? Well let me answer. This time of year your crazy horses are getting ready for Winter. That’s right: Winter. The brain of the horse is tuned to seasons in a very particular way. It has to change the metabolism, hair growth, foot growth, and a million other little tweaks so that the system is ready for whatever the coming season will require. Horses, having evolved in cold climates, start getting ready for Winter around August 15th. To do this the pituitary gland increases its production of about 5,000 different hormones. All is fine and dandy unless your horse also has Cushing’s or is pre-Cushingoid. If that’s the case too many hormones are released and voila!! Laminitis happens.

The good news is these laminitis episodes are relatively minor, even if sometimes they don’t look that way, and are quickly controlled with some anti-inflammatories like bute or previcox, a little help from some thyroid hormones, and changes in trimming or shoeing. Knowing your horse’s ACTH levels if they are a suspected Cushing’s horse helps the Docs manage these guys if they experience a flare up.

In other goings on this week, Dr. Vurgason treated another one of those things called a pig at the office. They really are rather adorable until they open their mouths. I was grateful she anesthetized him so that she could perform a castration. Dr. Lacher saw several horses for lameness, along with a few dentals and other routine health stuff. I think she might get some kind of perverse pleasure from making her technicians run around in circles since she makes them do that a lot! She claims this is so she can watch the horses move after stressing different parts of their bodies but I have my doubts.

The Naughty Pony  August Edition

The Naughty Pony August Edition

 legsPlease be sure to check your trailer floor for rotten areas.  Many of you saw this horse on our Facebook, Instagram, and Twitter feeds.  Dr. Lacher and Charly pieced him back together and now begins the healing.  He is looking at several months of bandaging but with some luck he will be back to good soon.

Main Topic:
The sun is just peeking over the horizon in the morning as you head out to feed your horse. You open the feed can, scoop out the morning ration, and dump it in the feed bucket. As you walk away you hear a dry, raspy cough. “Probably just the dusty grain,” you think and remind yourself to ask Springhill Equine about it the next time they come out to the farm. What does that cough really mean? Allergic airway disease.
Allergic airway disease has had a bit of an identity crisis over the years. It has been called: Heaves, asthma, Chronic Obstructive Pulmonary Disease (COPD), heaves (again), and currently Recurrent Airway Obstruction (RAO). All of these are our fancy names for constriction of the small airways in the lungs due to allergies. The allergic response causes an increase in mucous in the airway and makes the muscles around those same airways tighten up. It’s an unfair combination which makes it very difficult to breath.
So why the dry cough? These horses typically breathe in fairly well but can’t breathe out without pushing extra hard. We call this abdominal breathing. One way these horses manage to get a good breath out is by coughing.   The other thing that leads to coughing is called airway hyper-reactivity. This means anything that touches the airway causes a coughing fit. Dust from grain and/or hay is the most common cause of coughing at feeding time for allergic horses.
Recently there has been a lot of research on these allergic airway horses. Sadly much of it has not progressed to finding new treatments, but we are learning more about the genetics behind allergies, what different symptoms mean, and how well currently available treatments do work. Most older research focused on the effects of allergic airway disease on the racehorse only. Here are the highlights of a few recent papers. If you hear your horse coughing on a regular basis chances are very good they have allergic airway disease. Allergic airway horses are statistically way more likely to have hit this wonderful genetic trifecta: allergic airway disease, allergic skin, and Anhidrosis (non-sweating). Dexamethasone works well in most allergic airway horses but not all. For the horses Dexamethasone does not work on, inhalers provide a safe and viable option.
Treatment is targeted at reducing the allergic response. Dexamethasone is a short acting (about 24 hours) steroid that can be given by injection or orally. Especially during the summer Springhill Equine Doctors will usually start horses on Dexamethasone to get symptoms under control. Typically the dose starts very high and tapers every few days until we find what makes your horse happy. Changes in the weather, pollen levels, and dustiness of hay or grain may require a brief increase in Dexamethasone dosages.
For horses who are unable to tolerate Dexamethasone or don’t respond to it, metered dose inhalers can be used. Steroid inhalers are used most commonly for human asthma. Inhalers present some challenges for horse owners. First how do you get your horse to breathe deeply when you want them to? Answer: you don’t. Second, inhalers can be very expensive and time consuming. To solve the first problem we use an extender which seals over one nostril that allows us to time the “puffs” with the horse’s breathing. For the second problem we discuss options with you, the horse owner, and come up with the best solution.
Once winter comes around Intradermal Allergy Testing can be performed. Allergy testing allows us to identify what allergens bother your horse. Once we know what bothers your horse most we can begin shots, which over time teach the immune system to tolerate those allergens. Allergy shots can offer real help to allergic airway horses but it takes time. It is generally well towards the middle of the second year of therapy before we see benefits.   But those are fantastic benefits. We are able to reduce the length of time and dosages of drug therapy these horses are on.
Moral of the story: if you heard a cough, give us a call. The better we control allergic airway disease the longer your horse stays happy, healthy, and ride-able.
Erica’s Corner
Whew! There I did it. I took a breath!!! I am very glad to have Dr. Vurgason here and settled in. It means I get to sneak away to the beach for a long weekend. I am ready for slightly cooler weather so my non-sweater starts sweating again and a little less rain so her constant rain rot can catch a break but such is summer in Florida. The extra breathing room has also meant my two younger horses are getting ridden more. I have seen this as a blessing and a curse all at the same time. I love the way younger horses advance so quickly as they learn the big lessons of life but I hate teaching them! They are sometimes painful lessons for the rider…..
 Tech Spot       
Springhill Equine is here to help you through any and all lameness issues your horse might be having, whether it is painfully obvious or ever so subtle, we can help! Dr. Lacher’s extensive background in performance horse lameness coupled with all of our new technology makes Springhill Equine your one stop solution for lame horses and ponies. After performing a lameness exam, flexing and blocking if necessary we also can utilize our digital X-ray and ultrasound machines to pin point the issue and develop the quickest most effective rehab program for your horse. Once the source of the issue is revealed there are several new procedures we are performing to help speed up the recovery process and keep our horses performing longer including IRAP, PRP, and FES. If you are at all concerned about one of your’s limping or even just feeling a little funny please don’t hesitate to call!
Part 2: Everything You Need to Know About Your Horses Feet

Part 2: Everything You Need to Know About Your Horses Feet

Part 2: Everything You Need to Know About Your Horse’s Feet

So they made me do a little work between blogs but here is Part 2 of my exclusive report from the All You Need to Know About Your Horse’s Foot Seminar.

When you hear ‘break-over’ you should think of thunderclouds parting and the sun coming out, angels singing, a drink of water when you are really thirsty.  It’s that important.  Horses have multiple break-overs, but we are going to concentrate on the one at the front of the foot for now.  A break-over is exactly what it sounds like.  It’s the point at which the hoof comes off the ground during movement.  The moment of break over is the hardest on the hoof structures.  Every bit of that force is trying to tear the foot apart.

A good trim, according to the guidelines I talked about in Part I, will set up a good break-over.  This point should be about ½” to ¾” in front of the tip of the coffin bone.  Wait a minute… how is my farrier supposed to know where the tip of the coffin bone is located?? I don’t think they come equipped with x-ray vision!  Most of the time your farrier will set the break-over at a point about ½” to ¾” in front of the tip of the frog.  Sometimes the foot doesn’t seem to be doing what your farrier expects.  X-rays of the foot will help your farrier see what the bones are doing inside the hoof.  X-rays let us see if there is arthritis, injuries, or laminitis going on which may require special shoeing.

Visual Aids!

Let’s look at some feet and see if you can spot the problem.  First up:

Bad Shoeing 1

This guy definitely doesn’t have his heels back to the widest part of his frog and that’s with the shoe on.  And if you look at the branches of the shoe you will see they aren’t even.  The shoe is twisted on the foot. His break-over is also too far forward.

Next up:

bad shoeing 2

A line drawn down the center of this foot definitely won’t give you half inside and half outside.

This shoe…..Unless half this shoe was on one foot and half was on another foot it doesn’t make sense.

bad shoeing 3

Now for the fun stuff.  What happens when the foot has been trimmed and we can’t get the alignment the way we want it? We put a shoe on it!! So in answer to the barefoot question.  Your horse can go barefoot if two things can happen: the foot can be balanced with a trim, and the work the horse is doing doesn’t unbalance the foot faster than it can grow to compensate.

breakover shoe

This shoe is an extreme example of break-over manipulation.  It starts with a regular shoe.  Bar stock is then welded to the inside.  Then the shoe is nailed to the foot.  The end result is a shoe that allows this horse to break-over anywhere he wants.

arab shoeing

This horse is an example of the opposite end of the spectrum.  This foot has been allowed to grow long to bring the break-over forward but notice the principles have still been applied.  Now this foot is extra long since this horse is due to be shod but notice the foot is balanced and well supported.  We can manipulate feet to make gaits we find appealing but it must be done correctly or we jeopardize the horse.

flip flop

Ever get tired of your young horse pulling shoes? Or have a horse with really sore heels?  This shoe, affectionately called the flip flop, fully supports the foot but is very forgiving of the hind foot grab.  Most short coupled young horses go through a shoe pulling phase until they learn to wear shoes.  It’s normal and should not be blamed on your farrier.  Sore-heeled horses need some support since they hurt too bad to not have a shoe underneath them, but metal shoes can be too hard on them.  The heels on these shoes offer them soft support.

tendon support

This shoe is an example of the compromises we have to make sometimes.  This horse has a torn deep digital flexor tendon.  This injury will heal best if we can take some of the tension off the tendon.  A shoe like this helps reduce that tension but it has moved that pressure to the heels.  Notice how the heel is curving under.  This shoe can’t be used long term without causing significant hoof problems.

A quick note on some common Florida problems.  This beautiful abscess is secondary to all the very wet weather we have been having.  Using durasole, thrush buster, keratex hoof hardener or something similar on the foot will help it handle all that excess moisture.  Sometimes no matter what we use on the foot they just stay way too wet.  In that situation shoes may be the answer if only temporarily.


Along with abscesses, thrush is a common problem.  The cattle mastitis ointment Today applied to the affected areas daily for a week and then every few days for three weeks will help clear it up.  We have also recently started using a product called Keramend on some really really really bad thrush horses and have been very pleased with the results.

Our horses rely on a good foundation to stay happy and comfortable.  I know I learned a lot about feet at this seminar, but Dr. Lacher and the entire Springhill Equine crew are happy to talk feet anytime!  This is Tony saying may your food bowl be full and your litter box clean!!