-- infection or tearing of the laminae? Need urgent response please. 
is gentimycin safe for PPID horses. Vet giving it tomorrow   Have sent several messages no response . 
Kath & Micky 
Yinnar Australia

On Tue, Jun 25, 2019 at 01:13 PM, Kath Chase wrote:

-- infection or tearing of the laminae? Need urgent response please. 

There's no way to tell them apart.

is gentimycin safe for PPID horses.

Yes.

 
--
Dr. K

Thanks Dr K. is RLP safe if Micky is having laminitis flare up.  I don't know unlikely but is possible Local vet says tearing of laminae November  rad . Local vet refusing  to do X-ray despite instructions from  Melbourne vet 
-- my thoughts are infection but am unsure  Melbourne vet thinks infection,  but has requested X-rays from local vet, Daisy picking thinks infection, Pete Ramey thinks solar abscesses  from thin soles. Lavinia thinks infection.  Diagnostics will only show rotation they are not showing previous abscesses,  Your thoughts please appreciate this. Vet coming in 2 hours many thanks. 
Kath & Micky 
Yinnar Australia

UPDATE new Rads are done both fronts  RLP done RF  today will post when they are emailed through to me they will be sent to south eastern for measurements. 

RF No dark area medial side that I can see  like november rad relief,   on DP viiew that 

Sole depth RF looks frightening thin to me, solar view medial side remodelling doesn't look to be  as severe as September 2018 maybe I just didn't look hard enough.

There is likely  more changes given Micky has had coronary displacement in heels so you guys no what to look for I am still learning and am not a  vet. Appreciate your input for tomorrow 

Biggest  problem vet insisted on sedating micky for the Rads, he could barely stand up, so some are terrible, I had to demand that he stand with both fronts on blocks as vet originally only put one foot on the block, no barium paste as requested he did put thumb tack at apex of frog I queried ithe safety factor of thumb tack given minimal sole depth  Rads look clear but not up to standard as last ones unfortunately. Still no ACTH yet, ultrasound  yet many thanks I was a stressful mess last night couldn't sleep. Also they told me to remove bandage which I have done the area were IV went in was shaved. Should I be putting antiseptic and another bandage on?  Also felt sorry for Micky he had to stand for a long time on soft rubber mats without his boots on both fronts while they did RLP I hope we don't get more sole  bruising because of this. The really weird part is after sedation wore off Micky walked much much better, there is no way is there that RLP could start to work that quickly, just unexplainable unless the 5ml of bute this morning finally kicked in all I know is he is walking better late this afternoon than he has for quite awhile. Terrific to see. Will sleep better tonight knowing that I have managed to get two important s things done today appreciate all your support many thanks will  keep you updated. Had a pretty rough time trying to convince him to do it the correct way. but got much better views, I'm hoping you's guys may see something, my feeling is more diagnostics are needed. 
--
Kath & Micky 
Yinnar Australia

Thanks for the update, Kath. Please let us know when the latest rads are up. Good that you were able to get them done in spite of the difficulties.

Thin sole on the RF is not surprising given the trim issues and will certainly make him sore. Coronary displacement only means the coronary band is being pushed/pulled out of place due to hoof wall distortions = trim problems. Fix them and the coronary band returns to it's proper location - sometimes within minutes. If he wasn't walking around, just standing on a level surface will not cause bruising due to thin soles.

Generally, you don't need to bandage the shaved area unless there is an open wound. If you are concerned, you can recover it for another day.

--
Lavinia

Moderator/ECIR Support

Rads are up no measurements yet Lavinia  geez thumb tack apex frog worries me, vet just sent it through just posted it up in case history  thanks for explains coronary displacement for me Micky walking but still lame today no bute. He is standing squarw with both fronts even sometimes today then points the RF what do you advise with sheared heel for trim tomorrow. There isn't that much sole depth at the back of the foot in DP rad. 
--
Kath & Micky 
Yinnar Australia

Kath,

Would you please include the links to the photo album and case history in your signature to make them simple to find.

Thanks for the help.

--
Lavinia

Moderator/ECIR Support

All done , Hope this works has been awhile 
--
Kath & Micky 
Yinnar Australia
https://ecir.groups.io/g/CaseHistory/album?id=9614&p=pcreated,,,50,2,0,0

That works.

Thanks, Kath.

--
Lavinia

Moderator/ECIR Support

Hi Kath,

Thanks for adding the latest rads to Micky's album.
For future reference, sedating a horse to the point that he can barely stand is counter-productive if your goal is to be able to take appropriate radiographs of his feet. Next time, if he cannot stand comfortably due to pain just use nerve blocks so that he cannot feel the pain but is perfectly aware and able to maintain his balance. Nerve blocks wear off quickly so there are no lingering effects.

As we already knew, his toes are way too far out ahead of where they need to be, soles are much thinner than is optimal. His coffin bones are sitting ground parallel so absolutely nothing off the heels with the EXCEPTION of that RF medial heel. That excess height is tipping him forward onto the front half of that foot, possibly causing bruising, plus is adding twisting and tearing forces to the already weak wall on that medial side. The sharp, upward bulge in the coronary band is a red flag that a quarter crack could start in that location if the imbalances aren't rectified.  NOTHING off the soles.

Placing that tack into the sole without shortening the stem was .......
The frog is stretched forward, which goes along with the toes being too long.

--
Lavinia

Moderator/ECIR Support

On Fri, Jun 28, 2019 at 09:23 AM, Lavinia Fiscaletti wrote:

Hi Kath,

Thanks for adding the latest rads to Micky's album.
For future reference, sedating a horse to the point that he can barely stand is counter-productive if your goal is to be able to take appropriate radiographs of his feet. Next time, if he cannot stand comfortably due to pain just use nerve blocks so that he cannot feel the pain but is perfectly aware and able to maintain his balance. Nerve blocks wear off quickly so there are no lingering effects.

As we already knew, his toes are way too far out ahead of where they need to be, soles are much thinner than is optimal. His coffin bones are sitting ground parallel so absolutely nothing off the heels with the EXCEPTION of that RF medial heel. That excess height is tipping him forward onto the front half of that foot, possibly causing bruising, plus is adding twisting and tearing forces to the already weak wall on that medial side. The sharp, upward bulge in the coronary band is a red flag that a quarter crack could start in that location if the imbalances aren't rectified.  NOTHING off the soles.

Placing that tack into the sole without shortening the stem was .......
The frog is stretched forward, which goes along with the toes being too long.

--
Lavinia

Moderator/ECIR Support

 On Fri, Jun 28, 2019 at 09:23 AM, Lavinia Fiscaletti wrote:
Hi Kath,

Thanks for adding the latest rads to Micky's album.
For future reference, sedating a horse to the point that he can barely stand is counter-productive if your goal is to be able to take appropriate radiographs of his feet. Next time, if he cannot stand comfortably due to pain just use nerve blocks so that he cannot feel the pain but is perfectly aware and able to maintain his balance. Nerve blocks wear off quickly so there are no lingering effects.

As we already knew, his toes are way too far out ahead of where they need to be, soles are much thinner than is optimal. His coffin bones are sitting ground parallel so absolutely nothing off the heels with the EXCEPTION of that RF medial heel. That excess height is tipping him forward onto the front half of that foot, possibly causing bruising, plus is adding twisting and tearing forces to the already weak wall on that medial side. The sharp, upward bulge in the coronary band is a red flag that a quarter crack could start in that location if the imbalances aren't rectified.  NOTHING off the soles.

Placing that tack into the sole without shortening the stem was .......
The frog is stretched forward, which goes along with the toes being too long.

--
Lavinia

Moderator/ECIR Support

 Hi Lavinia , can you just have another look at the recent  Right front DP X-ray please, it looks to me  X-ray  DP right front lateral side is longer on that side not medial confused????  Can you mark it up exactly where please 
--
Micky wasn't in  such pain, he could have easily have stood on those blocks straight. I had given 5ml bute that morning. It was the crazy local vet again. Refused to do a nerve block, said he was having RLP so he will sedate, it was a nightmare he sorted with putting two blocks under one foot and none under the other I flipped it and said he needed to stand Evenly, then he said I didn't know what I was talking about, then I bursted into tears  then he said alright I'll do what you want as the first Rads were all crooked I told him to dele them they are hopeless,  Micky of course  was uncomfortable  the only thing he would be not being sedated, is try to point right foot , that's it,  south eastern vet she is lovely kind sympathetic brilliant vet but can't get down she is liasing instructing local vet, she said possibly still serum in the foot or infection  she said hard to tell,  has recommended more regional limb perfusion, still waiting on local vet, likely doesn't want to do it. Agree totally with soles, that was my fault this time I asked farrier to trim him I think weeks ago   Farrier didn't want to,  I was worried then Micky was going into mechanical failure again , see 31 May pic, my mistake, yesterday no trim decided to leave trim  for now, til I heard from you or hoof rehab.

South eastern  vet said yesterday  the remodelling looks more rounded solar medial side now also. 

Still feel like I'm going in circles and not getting to the answer I need. Yes I know he needs sole we have tried many times to grow it 

Is is it possible Mickys RF pedal bone was never normal to begin with ? 

is it possible  realignment trims 2017  2018  didn't work, still kept going lame   Is serum stuck in festering causing infection?

We have tried to grow the sole as you know,  but foot keeps growing distorted . Why? 

Yes trims did did look better 2017 3018 but have had 12 months bruising. 

THERE IS NO BRUISING ON SOLE now, I did say in one message I thought medial side was longer I think it looked longer because of the shearing. 

Looking ar latest rad  lateral side looks longer.  Remember medial lateral balance 2917 2018 was bang on, Micky kept going lame 12 months of bruising. I'm missing something why?  There's no bruising now toes do look to long I agree? But we have that remodelling spike sitting out the front  if toe cut too short and it was short 2017 3018 cause bruising? I feel like I've got to find the right answers. Why won't the pedal go back to where it should be ? Those trims 2017 2018 I thought were correct? Were they ? 

Kath & Micky 
Yinnar Australia
https://ecir.groups.io/g/CaseHistory/album?id=9614&p=pcreated,,,50,2,0,0

HIi Lavinia, Thanks

Continueing on from last message  you said MEDIAL SIDE WALL LONGER TIPPING HIM ONTO MEDIAL SIDE TOE CAUSING BRUISING??? coming down for past 12months.

I am very confused???  WE HAVE NO BRUISING NOW

looking at new rad  DP which was taken straight remember Mickys right leg has always been slightly crooked. LATERAL SIDE IS LONGER???  November rad DP lateral side is slightly longer too. 

i really appreciate your help, im just trying to find answers,  Yes sole shouldnt be touched i totally agree.  is it it ongoing infection happening here causing distortion why didnt the bone go back with those 2017 2018 relalignment trims? why was micky lame on and off after those trims? many thanks for being so patient with me i know its incredibly frustrsting and difficult for you.

We have tried short toes, why did he keep going lame?

We have had medial laterlaL balance pretty bang on 2017/ to mid 2018 why did he keep going lame and have bruising?

Why didnt the pedal bone go back to correct position 2017/2018 with those trims?

There is more here going on? it looks to me at present Micky looks like he is trying to grow normal grey frog, but is growing hoof wall on lateral side back of frog why is it because he sore there is there pressure there? look at at 2017/2018 pictures his frog didnt look normal there was no central sulcus, it looks like he is trying to grow central sulcus now. if you look at photos 2018 february you will start seeing changes happening in the centre back of the foot where he has bum crack now but bu,m crack now doesnt look as bad will try and get more photos for you.


--
Kath & Micky 
Yinnar Australia
https://ecir.groups.io/g/CaseHistory/album?id=9614&p=pcreated,,,50,2,0,0

-- also go back phots 2017  he has always had that quarter crack LINE  since 2017 trims. Is there you need to really look medial side, that line has showed weakness that medial side all the way along . that line may even have been there prior need to find more photos.

Kath & Micky 
Yinnar Australia
https://ecir.groups.io/g/CaseHistory/album?id=9614&p=pcreated,,,50,2,0,0

see previous messages if we do as you say by trimming medial wall shorter yes it could fix the sheared heel twisted hoof problem, looking at recent DP rad LATERAL side hoof wall is longer???? not medial . confused.   if we do as you say my thinking is then the lateral side of bone will raise up fractionally so all looks great bone wise from behind but my concern is if we do this, then he might weight bear causing BRUISING again.  repeat again we have no bruising now. im not wanting to make more mistakes. wrong descisions. Could you check DP rad again please and mark up.  Many thanks, What if back of pedal  bone was never even to begin with we dont know.
--
Kath & Micky 
Yinnar Australia
https://ecir.groups.io/g/CaseHistory/album?id=9614&p=pcreated,,,50,2,0,0

HI Kath,

Please take a deep breath and slow down a tad.

If you re-read what I wrote, I said the medial HEEL is taller, not the medial wall. That's the sheared heel problem going on. Need to work on getting that corrected. I also said that it might cause bruising if it isn't corrected but that's not something you will know until further down. The lateral heel is underrun, which is adding to the problem by dropping the overall height in the back quarter of that RF hoof. The Nov 2018 rad shows similar situation but the trim was even worse at that point as the medial wall had been allowed to flare heavily (that view was also shot thru the block so distorts the view).

The lateral wall may be a tad too high overall but hard to say for sure as the rad cut off the bottom of the wall on that side.

"why didnt the bone go back with those 2017 2018 relalignment trims?" "Why didnt the pedal bone go back to correct position 2017/2018 with those trims?"

Sorry, don't understand what you mean here.

While technically the medial-lateral balance of the bony column in the rads wasn't too bad, the hoof capsule itself was a mess. Many times, the M-L balance was achieved by "accident" as several trim issues happened to keep the bony column even but weren't healthy or correct for growing an actually strong and solid hoof capsule itself. That weakness in the medial quarter has been there for a long time - that entire wall completely collapsed at one point - and the ramifications from that damage will likely be an issue for a long time due to the extent of that damage. Need to remember that his trims (thru NO fault of your own) were abysmal long before that time in 2016 when it all came to a head. The trim vacillating all over the place on a regular basis now is not helping to move things forward.

There was a point when the toes got taken back correctly and the overall trim was starting to look much better. But the soles kept getting pared away, which meant Micky never developed proper sole depth nor calloused sole/frog. That was a sure recipe for tenderness and bruising. The best parts of that trim also weren't maintained long enough for the entire hoof capsule to grow out from top to bottom so that you had complete stronger attachments and he could gain the most benefit from the improvements.

The frog is much softer tissue than the hoof wall, so any issues with how the walls/bars/heels are growing will displace and/or distort the frog. Both heels are supposed to be even with each other and with the back of the frog. In Micky's case, the RF lateral heel buttress has run forward of it's actual location but the atrophied frog has not. Because of the total collapse of the medial wall, underrunning of the lateral heel, long toes and various other trim issues over time, the entire hoof capsule has twisted medially to some degree. That "bum crack" is because the heel bulbs are underrun, just as the heels are. It will heal, and the central sulcus will become more properly defined, only after the toes get brought back, the breakover gets set in the correct location, the sheared heel issue is corrected. Only after the hoof capsule "stands up" so that all the structures are in their proper relationship to one another and are squarely situated under the bony column so everything is supported properly will you be able to truly see what Micky's soundness is going to be.

That will all take time to correct but all the time in the world won't do any good if the trim doesn't get squared away and maintained optimally at all times. That is the part that has not yet happened in all the time we've been working on this.

--
Lavinia

Moderator/ECIR Support