Jalila almost managed?

Nancy K.

I redid Jalila's case history document and added detail, while maintaining the integrity of what was previously in the Apple Pages debacle. It's now in the Word/PDF format so it should be readable. I also added a new blood work report, front foot x-rays, and photos of feet and body to our Case History and Photo Album files.
I have some questions and need help understanding where Jalila and I stand in the process of managing this EMS/IR.
X-rays & Feet & Exercise
Jalila's x-rays are not as bad as I expected. My farrier was able to be with us when the vet came to do them and he trimmed her immediately after. It looks like she has good attachment between her bony column and hoof wall to a little over half way down. That's where the changes in the hoof show from post-laminitis and switching to the EVIR Emergency Diet, which added minerals, Vitamin E, and flax. My understanding is that if we keep the flares from leveraging the "good" growth will continue and repair will complete.
On her 2021-07-05 LF Sole shot, there is a little hole/pocket. It showed up post trim. Is that an old abscess pocket or is it showing separation at the toe? She is mobile and sound at the walk. her soles are thin and she is definitely off and heel landing if she trots. Should she be exercising? (Hand walking on level ground in sand arena) In the next three weeks or so, she will be totally off alfalfa, which I understand might contribute to foot soreness. How does iron figure into this? Will a custom mineral balance for my new crop of hay regulate that possible factor?
EMS/IR Calculator & Diet
Could someone please walk me through what those numbers mean? It appears she is a bad case. The March numbers were possible skewed by the fact that she was still laminitic and, likely, abscessing when we drew the blood sample. The blood work report from June 25 showed an extreme insulin level (>200) My vet and the lab at Cornell insist Jalila must have had a carbo load just prior to the draw. That is highly unlikely. I timed her breakfast, 6 lbs. of hay in a nibble net, so she would finish 45 minutes to an hour before the vet arrived and there is nothing else to eat in her dry lot. Whatever, since the June 25 test (blood was drawn on the 21st) was not the same as the March test, and lacked the T4 & ACTH numbers, we reran a test with a blood draw on the 27th (Test result on the 29th).  Do I need to get onto the grass hay, get a custom mineral mix and give her some time before I panic?
She has lost a lot of weight, but her weight loss has slowed and she needs to lose more. I cut a pound of hay from her rations, went from 18 lbs. to 17 lbs., about 3 weeks ago. Should I wait to adjust again until after the grass hay arrives or cut another pound now?
Finally, thanks to everyone for being so supportive and helpful.

-Nancy K. with Jalila & Shiraz

March 2021, Blaine county Idaho

Case Histories: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Jalila

Jalila’s Photos: https://ecir.groups.io/g/CaseHistory/album?id=262313
Shiraz's Photos: 


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