Re: Help for Mare following extreme over-trimming to sole


Sherry Morse
 

Hi Makendra,

Considering the x-rays I'm not surprised she wouldn't want a heel wedge.  It sounds like there are now 4 vets involved - are they all from the same practice? Is one taking the lead?  

Was the IV fluids just saline or something else?  

So as a reminder of some basics: Bute is contraindicated if the pain is due to laminitis due to elevated insulin.  If it's not doing any good (ie: she was still laying down for extended periods and not wanting to move while on it) it might as well be stopped, but you do need to wean her off of it.  Details here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf.  Bute can be replaced with Phytoquench with Devil's Claw as outlined here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Pain%20control,%20switching%20from%20Bute%20to%20Phyto-Quench.pdf

Why was the mare put on Thyro-L?  If the hope is it will be bring insulin down there is no evidence it works on that.  If her thyroid numbers are out of the reference range we have found that getting IR under control usually corrects that.  Since Thyro-L replaces regular thyroid function she'll need to be waned off of that as well.  Information on doing that: Re: Need help ASAP - painful mini (groups.io)

Metformin does not work in all horses but for those it does work in you can see a difference in bloodwork 7 - 10 days after starting.  If the next blood draw is on the 11th that gives her a week to get the vets on board with prescribing metformin if the insulin comes back as still elevated.  You might want to reference any of the studies of Metformin showing it does work in the files:  https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin

As far as where to get Metformin - it's one of the most commonly prescribed drugs for human diabetics so pretty much any pharmacy will carry it.  If they want to use a compounder for some reason I'm fairly certain Wedgewood or Dorneyville could both compound it.

Pentoxifylline has been discussed on the list frequently and as Dr. Kellon most recently recounted, it doesn't work: Re: Banamine/Gabapentin/Pentoxifylline (groups.io)

We really need a full case history on this mare but as always, now that there's a DIAGNOSIS, the TRIM is being addressed and she's on medication for the PPID and she can't be EXERCISED, the missing piece is DIET and MEDICATION for the IR if diet and weight reduction alone have not brought down her insulin.  MEDICATION would be Metformin and if that doesn't work, Invokana.  



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