Hi, am needing advice here on the grey areas of Mickys RF hoof,  should I be getting a sample and having it lab tested? Or what to do? 

Ive never seen anything like this, the foot isn't smelly, kept spotless changing boots every day, has been limping the past 4 days had trim last Thursday, trimmer coming back this Friday to check him.  Have put pic in case history ECIR main. Or do I need to send it through to ECIR hoof if so can I have email address please much appreciated 

Many thanks 

--
Kath & Micky 
Yinnar Australia

Kath,

https://ecir.groups.io/g/CaseHistory/album?id=9614

Would it be possible to take a clearer picture? Sorry, I can't really see enough to even hazard a guess.

Thanks.

--
Lavinia

Moderator/ECIR Support

-- Thanks for getting back to me Lavinia, I ended up going over  to the vet, he said infection and gave me  antibiotics called sulprim  he also mixed up this black stuff has tar on it  he said this stuff works, see pics in album , I think what's happened  Mickys been growing lots of sole,  as remember we had 12 months of bruising coming down as trimmer hasn't touched sole til last trim, done last Thursday. Trimmer still comes 2 weekly to check Micky. 

I think from letting the sole grow some how  infection has got in under there 

You can still see a tiny bit  of bruising nearly all gone now yay. That's 1 positive 

Am getting a swab done Friday and sending it to lab,

Will try and get clearer picture and will put in album.  

Its wet and horrible here it's  winter, Boots  are washed and dried ,  changed daily still in stable in  on dry  clean shavings at night. 
Kath & Micky 
Yinnar Australia

HI Kath,

Just as an FYI, if there is an infection of some type deep inside the hoof capsule, oral antibiotics of any type have very limited efficacy as the perfusion rate is minimal so they don 't reach therapeutic levels. Better route to take is to do a Regional Limb Perfusion:

https://ecir.groups.io/g/main/files/Regional%20Limb%20Perfusion

Need to do further diagnostics to determine where the possible infection is located so you can make more informed decisions.

--
Lavinia

Moderator/ECIR Support

Hi Ellen,  have been treating with white lightning 3 times a week, dry cow previously no success, Mickys sheared heel isn't helping matters,  long story as trimmer was trying to prevent further  bruising on medial side   which has worked, so  far trimmer was letting the medial side heel  get longer on that side at the back of the foot to take the weight off the middle medial side  trimmer  came this morning dug into the central sulcus and got some good samples these are at the vets now to be tested.  Whether the test will show what type of bacteria it is
-- then to get the right antiobiotic right up in there to work. I have metrobdozole tablets that were prescribed for myself  they are 400mg per tablet I never used them , from what I have read you can crush them then mix with 10  percent benzoyl peroxide and pack it in with a  monojet  plunger  maybe that might be worth trying if I knew how many to mix up

unfortunately being soft tissue Rads don't show it, ultrasound maybe , if dr 
kellon and Lavinia could chime in here please, vet still hasn't returned my call  wasn't there when I took sample in, so I couldn't ask about the regional limb perfusion. I ended up crushing the sulprim and got trimmer to pack it in this morning.  

Sorry again my photos aren't good, and very hard when Micky can't hold his foot up for  long, I should have got one when trimmer was here but between holding the paste sulprim and helping him I forgot
to get  the photo damn. 
Positive boot pad is still even both sides not worn down . 

Will talk to vet abit the regional limb perfusion  when he rings. 
Kath & Micky 
Yinnar Australia

Sorry for my more than likely stupid intervention but is not that grey area de only one that has not been trimmed, hence it's natural color? 

María Durán.

Questions aren't stupid, Maria.

That is a white foot and has never had any darker pigmented areas before. It looks like there might be a partial shadow being cast across part of the sole and also looks like there may be some type of hole in the sole but the picture itself is just too blurry to be able to tell for sure or make any other worthwhile observations.

--
Lavinia

Moderator/ECIR Support

Thank you Lavinia for your understanding and clarification 

-------- Mensaje original --------
De: Lavinia Fiscaletti <shilohmom@...>
Fecha: 14/06/2019 19:21 (GMT+01:00)
Para: Hoof@ECIR.groups.io
Asunto: Re: [ECIR+Hoof] Grey Area on hoof

Questions aren't stupid, Maria.

That is a white foot and has never had any darker pigmented areas before. It looks like there might be a partial shadow being cast across part of the sole and also looks like there may be some type of hole in the sole but the picture itself is just too blurry to be able to tell for sure or make any other worthwhile observations.

--
Lavinia

Moderator/ECIR Support

-- Nothing showed in culture unfortunately have organised for more Rads, and ultrasound, and CBC to be done, the hard part is showing the medial side lateral cartridge I think that is likely where there is possible infection again.  Also pedal bone  medial side there could be a bone fragment that has chipped off also, as had 25 percent bone loss medial side back aug  2018 Rads. 

I'm trying  to find the link  on ECIR to radiographs and play doe,  can someone send to me please, need  to show up everything can't afford MRI because of the pergolide expense. High dose.
Would appreciate any suggestions on views that will show up the medial side and lateral cartridge, digital cushion area is there any position that could show this up.  Our problem before the Rads just aren't showing up where the infection is. Vet refuses to do regional perfusion until there is drainage, not wanting the hoof wall medial side to fall apart again, I can see this happening if the abscess blows out the coronet, would appreciate any suggestions, thinking dry poultice, took Elastoplast pad and sulprim out last night sole looks dry clean, medial wall looks weak  again from bandage, I put sulprim in foot put on clean pad clean boots and dry shavings in stable last night. trimmer said he isn't wanting to take anymore from RF foot as he is worried by trimming it will make the pedal bone vulnerable to rotation, he said it's almost like Mickys body is rejecting the pedal bone, positive no more bruising but foot to me looks destroyed and my thoughts are he has rotated. But still walking, eating, but hobbling on RF. very sore. Like another episode last June, July 2018. :-( appreciate thoughts on what you would do. Thanks again. 
Kath & Micky 
Yinnar Australia

-- add on last message  I found link to how to do Rads correctly,  
Would appreciate thoughts thinking maybe trying navicular rad this time might show more, as well as the other views like aug 2018 rads, also apologies typo last message where I wrote destroyed I meant distorted :( my thoughts are  toe looks like it needs to come back, trimmer won't trim til Rads are done. Also I didn't say in last message vet wants me to wet poultice, get drainage happening.  Vet hasn't seen Micky just looked at photos  and my photos aren't good  as you know. 
Kath & Micky 
Yinnar Australia

Hi Ellen, they grew culture for 4 days then tested for fungal and bacteria nothing showed. 
--
Kath & Micky 
Yinnar Australia

No rad is going to show cartilage or digital cushion. Infections/abscesses may show as areas of darkness where there shouldn't be any or as cloudiness along bone margins because the bone itself has been affected but that's about it. Need to go with an imaging technique that is meant to show soft tissue - Ultrasound, MRI. There have been some suspicions that there may be an infection lurking somewhere in that RF for quite some time. Need to aggressively go about finding out whether this is true or not.

The RF toe definitely needs to come back more - don't need a rad to tell you that but having them done is a good idea at this point because there are so many questions and there have been so many changes to the feet since the last ones were done. Trimming to set the breakover in the right location absolutely will NOT make the pedal bone vulnerable to rotation but leaving the excessive lever forces there most certainly will cause issues, esp. to a bone that is already compromised. Micky's body is NOT rejecting the pedal bone - that is one of the oddest "diagnoses" I've ever heard.

Sorry, but waiting to do a RLP until there is actual drainage yet prescribing oral antibiotics to treat a suspected infection makes absolutely no sense. Why would the medial wall fall apart from treating an infection? If there is one and it doesn't get treated, then you are virtually guaranteeing that the wall will fall apart.

Need to get an ACTH done so you know where you stand on that issue. Raising his pergolide dose for no reason is just throwing money away. 

--
Lavinia

Moderator/ECIR Support

thanks Lavinia, well said, feeling we are screwed at the minute, yes believe me I the expense of the pergolide is killing me, Raisin toast for my tea last night lol,  but  pergolide mysteriously has kept him walking , would much rather be spending money on diagnostics,  But do I take the risk of sending him into full mechanical failure again  . ACTHs mostly sit in the 30s most times, even with increases can't get it  under 28, I put 2 more pics in album looks like there's been another episode  end of may it has to be another abscess. When I treated foot back September to get those three abscesses out, it was aggressive soaking, poulticing, in the blew  3 them out,  they are so deep because they came out where they did the hoof wall weakened to the point it had to be glued together otherwise the foot was going to fall apart  be good if I had alternative to stop it , from getting that far I'm aware that collections need to drain  but trying find the safest way to achieve this I don't know what is best I need really good vet that will work with me not against him .Micky is loading his Hinds again pointing RF foot again  local vet won't come said will ring me Monday, trimmer won't trim foot insists on X-ray. Oh geez what next try and borrow float and go to Melbourne like august last year get ultrasound, , I get Rads they are not showing it up, local vet centre said RLP wont go down to hoof,  I thought it did, there must be a way of getting it in.
No vet will do RLP til there's a diagnosis of I could get antibiotics if something like 200mg per ml oxytetricycline could work topically  squirt it in through frog. Noticed lateral side of cloud pad fractionally worn down at the quarter back of pad, swelling has gone down in medial side coronet foot looks dryer as Elastoplast bandage was causing medial the medial wall. I just packed sulprim powder in to back of foot last night clean dry pads and diaper cut to size of pad. Still think more going on further up leg. Could be gut related, could be ongoing  infection  on foot smouldering causing flare ups,  could be mechanical further up legs,  as you know sadly there has never been a diagnosis to the main cause. Positive can't see much bruising on sole anymore, and frog is looking straighter it was bent Jan, feb this year.  The trimming well bruising as you know has been coming down this has stopped for now. The trimming has proved even aligned with  previous Rads hadn't worked, frustrating and sad. 
Kath & Micky 
Yinnar Australia

Ellen

N. Alabama USA

 

Was the sample that was cultured taken before or after you started the Sulprim and "black tar" packing the vet gave you?

--
Lavinia

Moderator/ECIR Support

Thanks Lavinia, Got sulprim and black tar from vet on 2019-06-12 Wednesday  chose not to put black tar in, washed foot with  Epsom salts, clean pads, gave 1 dose  sulprim orally Wednesday night, another dose orally thurs  morning, another dose orally thurs day night,   As per vets instructions trimmer came Friday morning took lab sample, and said the sulprim needs to be put in foot  as orally won't work, as you said also, so made a paste in a plunger and squirted it in through the heel, before trimmer did this he  gently put a tiny metal thing  not pointy through the crack and said look at this back of the foot was wobbling like there was a hole going all the way through from the but crack .

Ive come up with an idea that might work, 
there is no way I can get Micky to Melbourne, but can float him to traralgon vet centre, they did nov 2016 Rads, vet there wants to put Micky down he wanted to put micky down down when he had sarcoids many years ago and November 2016.

If if I could get you and dr kellon to email a
-a letter to traralgon vet centre, iit could help vet to co-operate, I know if I floated him there he could do acth, ultrasound, and Rads , RLP could be done here at home, traralgon vet is 20 minutes from here, then could send Rads to Melb vet to mark up sole depth and measurements unless you  or dr kellon could do it , could possibly do it , -Melbourne orthopaedic vet south eastern veterinary  centre would do it.  Also I look at the back of Micky foot there is an edge on lateral side wall  at the back of foot that looks rather uncomfortable it looks like that bit needs to be trimmed off. And toe needs to come back 
Kath & Micky 
Yinnar Australia

https://ecir.groups.io/g/CaseHistory/photo/9614/146?p=pcreated,,,50,2,100,0--
Have replied to your message Lavinia, no response, 
First time I have added link Lavinia , I hope this works
Pic is meant to  be of DP X-ray dated 2018-11-05 there's a  shadow under the bone looks like soft tissue  area  your thoughts please, I'm thinking could well have been ongoing infection there where shadow is , but surely vet and farrier would have seen it before bar shoe was put on???  Last November. 

I also could ring orthopaedic vet that did this rad
in Melbourne and get him to phone local vet to co-operate and do ultrasound and rad  Maybe that might work.

when I phoned local vet centre I said I wanted to book vet, receptionist said did he phone you and tell you his not coming, I said no, she said she would check and he said he would phone me Monday 
likely to tell me he isn't coming.  Ready to scream. Kath & Micky 
Yinnar Australia

--Damn didn't work try this link 

Kath & Micky 
Yinnar Australiahttps://ecir.groups.io/g/CaseHistory/photo/9614/147?p=pcreated,,,50,2,100,0