Re: EMERGENCY


Sherry Morse
 

Hi Anne,

Could you please update your signature with your Case History link:

As far as the medication, you can't stop NSAIDs (Bute) without doing a taper.  To stop it after the extended period Nemo has been on it could result in a rebound effect which will cause him more pain.  To taper off the NSAIDs we recommend the following schedule:

Start tapering by keeping the current dose the same but stretching out the intervals between doses. E.g.:START: 2 grams bute once a day
DAY 1 through 3 of Taper: 2 grams every 36 hours
DAY 4 through 6 of Taper: 2 grams every 48 hours
DAY 7: 1.5 grams every 48 hours
DAY 8: 1.0 gram every 48 hours 
DAY 9: 0.5 gram once, then stop
 
The isox you can stop without an issue though.

Looking at your bloodwork results Nemo is IR as well as PPID.  The elevated ACTH can drive up insulin levels and an insulin level of 80+ is in the danger zone for laminitis so getting his IR and PPID under control as well as his trim in order is going to be key to getting Nemo more comfortable. 

I do not see any indication in your CH that Nemo is being treated for his PPID at this point in time.  I would suspect that's because the vet thought his level wasn't particularly high, but given his other metabolic results I would want to make sure I was covering all angles and would be treating the elevated ACTH. 

As far as the diet - with an ideal weight of 1000lbs Nemo should be eating 20lbs of hay and concentrates a day.  Is the hay amount you have listed an actual measured weight per day?  Have you been soaking the hay?  Is the beet pulp he's being fed molasses free and rinsed/soaked/rinsed?  As previously mentioned, the Purina balancer isn't suitable for an IR horse and should be stopped. 

We've certainly seen horses with worse hoof issues here, but getting Nemo's toes brought back to where they should be will probably go a long way to making him more comfortable.  His right front has a bit of a ski tip on the coffin bone and there's something going on with P2 that may be arthritis or something else. Lavinia is our hoof expert and can comment more on what needs to be fixed.  The best way to catch her attention is with a new email with a title like 'Trim Advice Needed' so she knows it's specifically aimed at her.

If you could get pictures as outlined in the Wiki: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help that would be really helpful for getting specific trim advice but this is going to be a year long marathon to get Nemo a completely new hoof that's properly trimmed from the coronary band down.  You can help make sure what's growing down doesn't get deformed on the way, but there's a lot of damage that needs to grow out during this process and it's probably going to be pretty ugly for much of the journey.



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