Re: Update on Granite


Gulp!  We have a lot of work to do!!!

Oh my, Lavinia.  This was so much work for you!!!  Thank you so much!

I need a bit more time to digest all of this, but I'll get to work on things very soon.

I will say, I'm not exactly sure why, perhaps it's the J-herb, but he is feeling so, so much better.  Yesterday I put him out for a short while, and when I went to bring him in I called to him.  He cantered (eeks!!!) to greet me..... yikes!  I think staying in the stall is a good plan for a while now!  I will admit I smiled huge as I put him in though.... he hasn't felt this good in months!

Dee, Granite and Saphira
Aroostook County, ME - 9/06
Case History:


Re: Need some help-COLD AGG TEST

Eleanor Kellon, VMD

I'm not surprised these tests aren't readily available commercially. It's a rare problem.

The definitive test requires heated tubes and centrifuge to collect, clot and spin blood under body temp conditions.  Serum is then serially diluted and reacted with equine red cells under cold conditions.  There's a more simple screening test but it would have to be done right there.  Blood is collected into a warmed EDTA tube and kept warm until a smear is made on a warmed slide then repeated on a cold slide.  If positive there will be obvious agglutination on the cold slide.

Not sure if this test would be available either but there is a cold indirect Coombs test.  I think that would work too. You would have to check with a small animal hematology lab to see if that is possible anywhere. (Coombs testing is more commonly done in dogs.)

Cold agglutinin IMHA involves IgM antibodies which have a much shorter life span than IgG. It's possible she would already test negative.  Most of her anemia may have occurred before most of the blood tests we have - back when you could see the blood agglutinating in the sample tubes -and before then.  There hasn't been enough going on since then to show any big spikes in bilirubins.

Regardless, if she's improving like it sounds she is I'm sure you'll take it!

Eleanor in PA   2 for 1 continued until January 31
EC Co-owner
Feb 2001

Re: Update on Granite

Lavinia Fiscaletti

Hi Dee,

I've added mark-ups to Granite's album here:

You've made a good start on addressing the areas that need attention with backing the toes and starting to move the heels back a bit. The general goals are to back the toes hard in the horizontal plane, move the heels back considerably to get his base of support back under him (esp. behind) and pull the flares in. I'm assuming  the small, white bead on each of the xrays is marking the location of the coronary band. Based on that, there is distal descent (aka sinking) evident in all feet. This also means that although it appears as if there is a lot of excess vertical height to work with, there really isn't . Sole depth is barely adequate so need to preserve it when making adjustments. The hoof-pastern axis is just slightly broken forward on all four with the rears being worse than the front. This means the heels need to be lowered just a bit in relation to the front half of the foot. The medial-lateral balance appears to be pretty good all around.

RF lateral xray: Yellow lines are the coronary band (1) and the extensor process(2) and should align or be close together. The distance between them denotes the sinking. Green line follows the angle of the new growth of the hoof capsule under the coronary band and where the toe needs to be backed and beveled under to provide the proper breakover for the coffin bone. Blue is where the heel needs to be lowered.

RF lateral: Green is following the angle of new growth. Blue is where the heels need to lowered. Red is the area on the bottom NOT TO LOWER when working on the heels. The idea is to tilt the foot rearward to realign the hoof capsule to the internal structures. If you follow the current trim plane there is no net change. WHite area is an idea of what needs to be removed. Rasp the toe back from the top, perpendicular to the current angle of the hoof capsule at the toe and bevel under. Advise leaving the excess dorsal wall above/back from this point alone and allowing it to grow out over time. The current material in this area is laminar wedge, sort of like scar tissue, that isn't as organized or strong as healthy wall connections are. Thinning it to make the hoof capsule appear pretty and normal removes some protection and stability from an area that is already compromised.

RF lateral adjusted: This is an idea of what the hoof capsule should actually look like as opposed to it's current conformation.

RF lateral oblique: Green is an idea of where the excess material is. At ground level, everything in front of this line is causing lever forces to tear apart the laminar connections with every step that Granite takes.Blue is where the heel buttresses are currently located, Yellow is where they should be - even with the widest part of the back of the frog.

RF sole: Yellow is a general idea of where the actual hoof print should be. Toe needs to come back considerably and flares need to be brought inward. Preferably, do this from the top so as to only bring things back and in rather than lower them. Align the breakover with the center of the canon bone and pastern to stay true to the bony column alignment. Red is about where the true tip of the frog is. The frog has migrated forward along with the heels, following the pull of the overly long toe. Just need to note this event rather than necessarily chop off the excess unless it is just dangling there. Green is where the heel buttresses are now, blue is where they need to be. This is going to be done over time as there isn't enough vertical height available to just fix this in one trim now. There is overgrown frog and cuticle hiding the actual heels toward the back - as the heels are moved rearward, this material will wear off, sometimes it may need some gentle encouragement from you as well. Let Granite tell you how much he can tolerate in any one session. Best is to do small amounts regularly (weekly) as opposed to trying to move them back in large amounts every 5-6 weeks. Purple is the overgrown bars, curving outward, pooling over the sole and melding with the outside walls to cover the true juncture of the bar and sole in the heels. As you rasp the heels backward, also gently work to open up the area between the bar and wall to find the buried sole underneath. There is a twist to the hoof capsule. likely due to the heels running forward unevenly over time. As the heels are corrected and the toes brought back into alignment with the correct breakover point, this should also correct.

LF: Same idea as RF but without the twist.

RH/LH lateral xrays: Same as RF but there is a bit more forward tilt to the coffin bone.

LH dorsal: Yellow arrows are where the walls are flaring considerably, more so medially than laterally. Green is a bulge in the excess toe that needs to be brought relatively further back than the adjacent areas when backing the toe as it is creating more pressure.

LH sole oblique: Yellow lines folow the angle of the horn tubules as they are growing out and all the lines are aligned at the top with the same "growth ring". Note how far forward the heels are and that they are growing almost horizontally. Also note how compressed the growth at the toe is from the pressure of the excess toe length. The new growth is so finely compressed that it is dificult to see how steep the angle really is compared to the older wall beneath. Purple is where the heels are now, blue is closer to where they need to be. You can really see the frog overlapping the hoof capsule and the heel wall buried underneath.

LH sole: Green is about where the hoof should be (actually, further back than that in once things get more functional). Need to bring the toe back considerably and the flares inward as well. Purple are the current buttress locations, blue are where they need to be. Red is the true tip of the frog. Pink are the bars pooling and burying the sole, pushing the walls to flare outward in the rear of the foot and hiding the true location of the heel-bar juncture.

Saphira (working on her pix now) has similar issues but her heels in front are considerably more under run and the hoof capsules show markedly more twisting.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team


Case History:


Re: New to this and need some help


---In EquineCushings@..., <drkellon@...> wrote :

As for the three B vitamins Nanc mentioned, the research was actually in athletes and those three can push the muscle cell to depend heavily on glucose

- - - - - - -

Do you have more information on this study (a link, name of the study, authors etc.)? I am especially interested in the result of supplementing thiamine since there is a group of people in Sweden who are recommending thiamine supplementation to IR horses. They claim thiamine will improve insulin sensitivity, but can’t provide any references to studies that show this. Only a lot of references to studies on human diabetics showing lowered glucose values.

Sweden, July 2008

Re: Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID



Thank you so much for responding with all that information! I have asked the vet to add the glucose test and a prescription. I think he just wanted to sell me the Prascend, but I like the idea of the apple-flavored encapsulated powder from Thriving Pets. It seems like that might set us up for a higher probability of success in getting it down Darcy's throat. :D

I will also get my hands on the APF. I want to make the transition as easy as possible for Darcy (and the barn staff).

Also, thank you for the information on exercising her. I had looked around, but I never quite laid my eyes on any definitive suggestions. (I think I'm on info overload though, so I may have missed it.) My round penning has been gentle, and I'm not asking for turns. Mostly, I just had her walking in a large circle around me and then cutting across the middle. I will adjust my plans accordingly. I didn't realize how careful I needed to be with those feet. Thank you again!

I have been gradually adjusting my trim to meet the vet's suggestions from the radiographs. I didn't want to take back the toe too much at once, so they are still "in progress." Will those pictures be enough to help?

Also, I need to do another hay analysis. Is there a link to a resource for hay corers? I am going to need one.

Jennifer and Darcy in SC
October 2011

Re: Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID


Well, Jennifer, I am replying to my own post to you, LOL!  You are probably wondering why I included "More reading on the seasonal rise can be found here:"  Complete brain fart!  We are NOT in the seasonal rise, but save that link!  You will want it when we get closer, late summer, early fall.  Sorry if I confused you!  

Maggie, Chancey and Spiral in VA

Re: Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID


Hi Jennifer,

Happy to hear that Darcy is feeling better.  Great job on updated Darcy's CH!  And thanks for the link to it.  If you could include that in your signature every time you post, it helps us to find it faster.  Thanks!  

I have a couple of suggestions and a couple of questions.  First of all, I am guessing that your vet did not order the glucose.  It's always the first thing that comes back when I do my labs and also does not say "pending" on the copy of your Cornell labwork.  When you contact him, ask him to call Cornell and have them add it.  They will still have your blood sample, so it shouldn't be an issue.  You should be getting the leptin back any day now.  It's always the last thing to come back, for me anyway.

When you start the pergolide, you want to wean Darcy on to it slowly to avoid the pergolide veil (depression, lack of appetite) that some, but not all horses experience when first starting the drug.  We recommend that you start with 0.25mg for 3-4 days and increase by 0.25mg every 3-4 days until you reach your target dose, often 1 mg to start.  Once at your target dose for 3 weeks then you will want to retest the ACTH to see if that dose is controlling the ACTH.  The goal is to get the ACTH down into the low to mid 20's.  More reading on the seasonal rise can be found here:  If you are using compounded pergolide, you can order 0.25mg tabs to wean on.  If you are using Prascend, they are scored to break in half, but not recommended to break into quarters.  In that case, you can break one in half, which is 0.5mg, and dissolve half in 10 cc of water.  Administer half of that (0.25mg) and save the other half in the frig for the next days dose.

Another really helpful thing to avoid the pergolide veil is a product called APF.  You can buy it at some local tack and feed stores, online, and also on their website:  You may want to have some on hand before you start the pergolide.  I see in your CH that Darcy has periods of poor appetite.  I bet that has more to do with her PPID than boredom with her low sugar diet, and that once her ACTH is under control, you will probably see a resolution of that as well as the rain rot. 

I don't see a current hay analysis in your CH folder, so don't have that to go by, but I see that for your trace minerals you are supplementing 18mg of of Cu.  That seems an unusually low amount of Cu to me and I don't see any mention of Zn supplementation.  I could be totally off base, since my hay is always high in iron and I have to supplement lots of Cu and Zn to balance it.  But just curious how you are balancing.  IR and PPID horses benefit from a really tightly balanced diet, so if you post your hay analysis we can help you to evaluate that.

I see that Lavinia suggested that you post pictures of Darcy's feet in the PHOTOS section so she could have a look and see if you have an optimum trim in place.  Also see that you do your own trimming.  IMO, it's always great to have an extra set of eyes evaluating my trim, so it would be great if you could post both pictures of Darcy's feet, and those radio graphs that you are waiting for.  Here's a site that shows how to take good hoof photos:   You can just start an album in the PHOTOS section of ECH6 to put the pics and xrays in.

I also see in your CH that you are doing round pen work and riding Darcy in the RP.  We highly recommend that you don't ride or do round pen work/lunging until half to 2/3 of the laminitic foot is grown out.  The reason for this is that those tight turns of RP work and the extra weight of a rider can damage the fragile new laminae as they grown in.  Hand walking in long straight lines with no tight turns is recommended until the damaged hoof grows out sufficiently.

If you have any trouble getting Darcy to eat her pergolide, just do a search of the archived messages.  TONS of posts on this in the past!  And also don't forget about the picky eaters checklist in the ECHorsekeeping files!

Maggie, Chancey and Spiral in VA
March 2011
EC moderator/Primary Response 

Re: Need some help-COLD AGG TEST

tara sullivan

Hi Dr. Kellon.  Dr. G will be out of town for the next several days.  And she has left me with half of the inventory on her truck....just in case.  But, she set me up with tubes for lab work.  And gave me the green light to figure out what test we need and where to send it. 

May I ask your help with this??  Dr. G was not able to find this test at Idexx or one was familiar with what she requested.  Any and all guidance is greatly appreciated! 

Just cold agg.  classified as intra vascular??  Am I correct in that the urine could tell us if  the anemia is intra or extra vascular??

BTW   In anticipation of pulling blood for this test today...I took the boots off of Divina when I turned her out this morning.  Her 6am temp was 100.6-very good.  It stayed that way all day until 2pm-101.3.  I put the boots back on and at 5pm her temp was 100.9.  This is really unusual because I have been taking her temp for 2 months now.  And it has never dropped down in the evening after rising in the afternoon. 
Could it be the magic boots?????

Also want to shout out to Jaini...Thanks for havin my back! 

With much gratitude to this group- The support I receive here has been a life line.

Tara and Divina
NY 2015

Re: question on phyto quench and preicox

lj friedman

I bought some phyto quench to have in hand.. I'm trying to get a handle on when to use PQ  and how powerful it is,compared to prevacox .  For ex. if a vet prescribes prevacox., would we consider PQ  before trying the prevacox?  or use prevacox for a while.. then change to PQ?  questions like this..  lj friedman san diego 

Re: Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID


I have updated Darcy's case history to include her current diet, schedule, exercise, and test results. Here's the link: ECHistory6


Also, I've alerted the barn owner that some changes will becoming for Darcy's medication needs. Now, I just have to figure out pergolide dosing for her needs and this tapering thing. Plus, how to get the meds down my picky eater's gullet. :D

Jennifer and Darcy in SC

Re: serious weight loss

Maryse S

Okay, thank you.  I joined 10+ years ago but will have suggested blood panels sent to Cornell & follow up here with my info.  Thanks so much.
Maryse Shank
Phoenix, Az

Re: Update on Annie


Hi, Candace - Thanks for the info on Annie, and keep working on that case history!

You still don't have a clear diagnosis.   Insulin Resistance and Cushing's show many overlapping symptoms, and poor hair coat can have many causes.  While trialing Pergolide is reasonable in some cases, I don't think Annie's symptoms are obvious enough for this, considering we don't have an ACTH on her to confirm.

The protocol for this group, that has worked over and over again and has strong science- and evidence-based documentation, is Diagnosis, Diet, Trim and Exercise.

Diagnosis:  To determine if the laminitis is due to IR or PPID (Cushing's), one needs a single, non-fasting blood pull in a quiet barn.  Have hay in front of the horse for at least 4 hours before the vet comes, but don't feed any concentrates.  Don't trailer for the blood pull, because that can falsely elevate the ACTH for up to 48 hours.  Get blood for insulin, glucose, leptin and ACTH.  The ACTH is pulled into the purple-topped tubes, the insulin, leptin and glucose into serum-separator or red-topped tubes,  All tubes are then kept in a cooler or similar (to keep them cold - don't put them directly on ice), and spun and separated as soon as possible. (within 2 hours). Freeze, and send to Cornell by overnight courier.  More info for your vet here:

(and don't forget to ask for glucose)

And here:

Basically, if the ACTH is out of range, you are dealing with Cushings.  If insulin is high, you are dealing with IR. If both are high, you are dealing with both.  If the leptin is low, then it is likely the high insulin is being driven by Cushings; if the leptin is high, then she is IR at baseline.

Diet:  The very best thing to do for Annie right now is to start her on the Temporary Emergency Diet:

  Hay soaked for 1 hour in cold water (or 30 minutes in hot), water drained where the horses can't get at it

 3 ounces stabilized, ground flax (for the Omega 3's);

 2,000 IU Vitamin E from capsules containing soy oil (Vitamin E needs to be touching oil in order to be properly utilized). Liquid Vitamin E such as that sold by Uckele, which has the E micronized with the oil:

1 tablespoon of iodized table salt:

1/2 tsp of magnesium oxide.

Use a small amount of TC Lite to add these supplements to, or use rinsed/soaked/rinsed beet pulp, soy hulls, Ontario Dehy Timothy Balance Cubes, or Nuzu Stabul 1.  TC Chopped Forage works, too, or LMF Low NSC.

No grazing; no weed-eating; no carrots etc.

Try that for a week, and let us know how you get on.  Do get those blood tests, otherwise you don't know what you are treating.

Hope that helps!





Jaini (BVSc),Merlin,Maggie,Gypsy

---In equinecushings@..., <candace.costis@...> wrote :

Here is a copy of the history I am writing to put in the files....

Re: update on princess sue


Hi, Sue - thanks for the update!  I am glad Princess is feeling well, and am looking forward to the x-rays.

 ..he was very happy to see she was doing so good.....
Sue & princess
oh 6/11

Re: Need some help with my mare


Hi, Candace  - Fever of Unkown Origin (or Pyrexia of Unknown Origin) is in fact not common. The term is used to designate a chronic fever, with a certain number of differentials (cancers, chronic disease such as Lyme, and auto-immune diseases primarily), the diagnosis of which require more work than the common-or-garden fevers due to bite wounds, other trauma, GI disorders and so on.  When a veterinarian uses or sees the term PUO, it gives everyone a heads-up that the condition is complicated and not obvious.

Short-lived undiagnosed fevers are in fact very common.  They either clear up on their own, or respond to antibiotics.  The reason most of these fevers are undiagnosed is because in the first instance, if there is no obvious wound or abscess present, and the animal is fairly bright (or if you are in a place where you can't run week-end blood-work), then a reasonable approach is to start antibiotics (geared towards the species of animal, and toward the body system most suspected of being the problem). If the animal gets better, well and good.  If not, then further work-up and tests are clearly indicated.

I think you got lucky with your Airedale.  Tara's response to you is perfect - Divina's case is very unusual and very complicated, and she and her team are doing a fabulous job.

---In equinecushings@..., <candace.costis@...> wrote :

I'll just throw in my two cents. My Airedale had FUO - fever of unknown origin. Apparently it is common.

Re: Update on Annie

Lorna Cane

>Here is a copy of the history I am writing to put in the files.

Good start for your own files.
Put this information into the Case History form,so that it is easy to read and track.There are specific columns for dates,feed stuffs,meds, tests,and so fifth.
There is room at the end of the form for paragraph-type entries.

Be sure to add the Case history link  to your signature.

Re: Update on Annie

Candace Costis

Here is a copy of the history I am writing to put in the files.

Annie, born 1998, weaned far too early by breeder. Filly just put into a dark stall. She looked like she would die.

Subsequent huge intake of water. Had her looked at by vet, perhaps tested for liver or kidney dysfunction. No positive results. Still drinks huge amounts of water.

No real issues for many years. As a yearling she did try to jump off a cliff with the goats … once. Has had 4 foals. 

Around 2005 moved from limestone cliffs to flat rich pasture with less exercise. Problems with weight. Controlled with amount of food.

Symptoms of Cushings began to appear. Fat pads above tail, enlarged area near udder. About 2 years ago began to have a cresty neck. Also had structural issues by catching her hip on a corner post a couple of times. Pain with rider. Work done to try and get her structural issues resolved. At this time she began having “spells” from overeating Hypochaeris radicata (false daisy) – lethargy and unsteady gait in the Summer. Also suspected heat stroke.

Spring 2015 she did not lose her winter coat and I began to change her diet to Triple Crown Lite and increase her time in a bare area. I also treated her for sand colic thinking that was causing her tubbiness. Meanwhile I was recovering from my own injuries and one of the other horses got an ocular herpes virus infections which took a very long time to correctly diagnose while treating for a fungal infection. No other changes where made to Annie’s food or schedule.  During a cool rainy winter, Annie began eating the false daisy to the near exclusion of all other pasture forage and her crest became rock hard. I got the other horse's eye infection under control in early January 2016 and turned my attention to Annie, she was walking very slowly with lethargy and then had a laminitic event. I immediately put her in a small bare paddock and restricted her diet to hay and Triple Crown Lite. Bute had no real effect on her sore feet. Pergolide at the prescribed 1 mg a day made her very sick so cut back to ½ then ¼. Began cranial sacral work to begin to adjust Annie’s structural issues and administered zeolite. Annie’s crest regained flexibility very quickly but she remained sore footed regardless of whether she had Bute or not. Took her to get her feet xrayed on Jan 18 2016 which showed she had slight rotation from the “event” and arthritis in the coronary joint. Vet thinks this is causing her sore feet. He told me to increase the Pergolide to ½ mg and gave me Equioxx for her feet. This made her manic and anxious but did not have too much effect on her feet – she is avoiding putting weight on her front toes. He gave me an exercise program to start when she was no longer sore. I lunged her briefly because she was so manic and she walked quickly trying to avoid putting pressure on her front toes with trembling of her front cannons. She is likely very weak from being relatively immobile for two weeks. Another appt at vets in another two weeks. Waiting for his call about the mania/anxiety and avoiding pressure on her toes.


Oct 15

NE of AutinTx



Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID


Hi everyone,

I got some of Darcy's blood work results back today, and her ACTH number was 59.4 pg/ml. I have an insulin number (17.49 uIU/ml), but no glucose or leptin yet. Not sure why. But I have contacted him for those values.

The vet recommends pergolide @ 1 mg daily for one month followed by retesting the Endo ACTH at the end of that month.

Even though I knew a diagnosis of PPID was likely, I'm a little overwhelmed and upset. I'll be researching the files for how to proceed, but any additional advice is greatly appreciated.

I am also waiting for copies of the radiographs I had done on her front feet. According to him, he saw no evidence of long-term, low-grade hoof pain or any rotation. He suggested taking the toes back more, which I have already addressed.

She has been moving great and even showed a lot of spunk today.  I hope that continues as long as possible.

Thanks in advance,
Jennifer and Darcy in SC

Re: Need some help/COLD AGG. BLOOD TEST??

tara sullivan

Hi Dr. Kellon,
Can you tell me the name of the test we need??  No luck at Idexx or Cornell.

Thank you,
Tara and Divina
NY 2015

Update on Annie

Candace Costis

I thought I'd pass this on. This mare has a taste for this weed  and has strange episodes when this weed is prevalent. It causes their tongues to get black patches. I've tried keeping them away from this and it's at the top or our elimination list.

"False dandelion (Hypochaeris radicata), also known as flatweed, has been incriminated as a major cause of Australian stringhalt. New cases often manifest in late summer or fall, frequently in horses grazing on poor-quality pastures abundant with weeds."

I'm working on filling out my history form and getting it posted. Have been to the vet and she has rheumatism in her coronary joints. Some slight coffin rotation from the initial laminitic event.

Found a collection of early posts which I had not seen earlier which have been very helpful especially one by merlin5clougher 



NE of AustinTx

update on princess sue

sue wolf <wolffarm4@...>

Hello everyone,
I had a new vet out to take a fresh look at princess. he also took new x-rays. I should have them today and will post as soon as I can. these are around 2 week after her trim.. he was very happy to see she was doing so good. he seen photos in oct before the good trim and after..  he was expecting to see a gooey. infected abscess hoofs. that is not the case, no infection or abscessing. you can see were there was one at one time/ abscess track. but no infections.. I credit it to the ozone I'm doing. he has another horse that is bad like princess and wants them to do the ozone on it. I would have to do it since he does not have a machine..
Sue & princess
oh 6/11

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