Date   

Re: Trim questions waiting

 

thanks Lavinia for the markups - glad you sent the photo of the backed up toe - it is way different that I envisioned.

You show these markups - but you say you need to "keep" removing - so - question is - are we talking about doing this amount of changes over months, weeks....how many trims??

And should I try to back the toes again by just filing straight down now - before the x-rays are done....and do I take off about 1/4 inch at a time?

She is still sore on right front especially. I tried walking her on soft grass without boots yesterday.....she didn't like that at all, quite lame.

Will the boots/pads prevent the old sole from exfoliating?
--
Sharon P, Elsa  April 2016

Courtenay, BC Canada

Elsa, Case History, Photo Album

 





Compounding Pharmacies

Tara Sullivan
 

Hi.  I can't seem to find the list of Pharmacies in the files section of the main page.  Wasn't there once a list??

Thank you.

Tara from NY



Re: Elevated ACTH for reason other than cushings??

Tara Sullivan
 

Don't you guys ever sleep or unplug?? I never expected such a response on a weekend....you guys are wonderful.   Lavinia, you are right...I am still adjusting to a Mareless life.  The boys are just living theirs'  as it comes.  In talking with Dr. G (my vet), we just really couldn't put a quantity on how stressful the alone time is for Elf now.  But you all have answered my questions.  And, it is not hard for me to believe that he has cushings.  He doesn't look like a cusings horse-he has lots of muscle, great feet, and good energy.  His only "sympton" is a heavy coat and, over the last year, I have notice less concavity in his hooves.  They arent flat by any means, but since I have been doing his feet for 15 years....they have changed a wee bit.  Talking about feet-both of my boys have a ring on their hooves from the day we let Divina go.....It is more than half way down their hooves now, and I can't wait for the day to trim that off!  I hate seeing it!

I am going to forward Dr. G the info about  TRH.  She is on board with prescribing pergolide for cushings positive.  Divina seemed to take her doses more reliably when I switched her to the compounded capsules.  So I am inclined to just start him on a compounded med.  I was using Thriving Pets but see a not-so-satisfied post about them.  Any input on that??

And, I am really trying to be the smart human being in this relationship and do what is necessary to get the weight off of Elf.  It's hard because the answer is to separate them...and they BOTH make me feel bad.  But, I am doing it....

Much thanks from all of us.

Tara and Elf

Febr 2015

https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Elf/Sullivan%20Tara.pdf



Re: High blood glucose question

Eleanor Kellon, VMD
 

You're definitely on the right track!  Some of that glucose is getting in, just not as much as normally (workers aren't moving as much as they should).  The excess glucose goes into cells that do not require insulin to take up glucose (only muscle and fat do), and excess also goes out in the urine.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Trim questions waiting

Lavinia Fiscaletti
 

Hi Sharon,

Sorry, I've been tied up with a few things on the home front so have had limited time to work on pix. Thanks for adding the latest trim photos.

How is Elsa doing?

I've added a few mark-ups to her album:

https://ecir.groups.io/g/CaseHistory/album?id=987

In each, the green lines follow the pastern angle toward the ground. I "erased" the excess horizontal toe length to try to give you and idea of where things need to go. The yellow lines are highlighting the growth of the horn tubules, which should be parallel to the pastern angle. As you can see, they are much shallower. As you can't just squish the hoof back into the correct form, you need to keep removing the old , distorted growth while providing a template for the new growth that allows it to come in free from the distorting pressures created by the old, damaged hoof capsule.

The yellow arrows on the RF lateral point to the area of the newest growth. Note how much steeper it is than the adjoining, older growth - it's pretty significant. On the sole view, the arrows are indicating the need to bring the flaring wall material in all the way around the hoof capsule. At the toe, this means back it up to remove horizontal length at ground level.

To provide a visual of what I mean, I also added a picture of a backed toe, with the wall flares brought in as well.

The rasping you did on the RF toe-sole is showing some old, nasty damage in the old white line that is growing down and out. It would have been better to find it by backing the toe and seeing it from the front rather than losing the depth underneath.

If the budget allows, because there have been several people working on her feet and there have been some significant changes made, it would be helpful if you could get some new xrays done (laterals of the fronts). If you could get the vet to clearly mark the dorsal wall and tip of frog, it would be extremely helpful. Have a read here for a better explanation of how to get the most benefit when having xrays done:

https://ecir.groups.io/g/Hoof/files/X-Rays%20and%20Radiographs/Getting%20Good%20Xrays.pdf
--

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Re: High blood glucose question

Maxine McArthur
 

I think I understand now. Could one of the mods please correct me if I've got it wrong?

For whatever reason, Indy's BG is high. For whatever reason, her insulin production is not coping.

This means that the glucose is not reaching into her cells because the there aren't enough workers to move the boxes into the rooms from the halls (thank you Robin). If she keeps eating high-sugar/starch feed, all I am doing is increasing the number of boxes. She can't access the energy and will be lethargic and lose weight. If this continues, the body will start to try to use fat for energy (not quite clear on this process), leading to hyperlipidemia. 

However, horses have alternate pathways for energy to enter the cells, such as acetate from fermentation. So if we feed them a diet high in low-sugar fermentable fibre, they don't need to stress the insulin pathway. Could we say that another group of workers is moving the boxes into the rooms from a back door? 

I'm still not sure what happens to all the boxes stacked in the hall--I guess the insulin workers can take their time putting them into the rooms because more boxes aren't stacking up all the time? 

I think I'm clear now on the rationale for the low s/s high fermentable fibre regime in the case of high BG--it's to make sure the cells can get enough energy without relying on the insufficient insulin production. 

Please tell me I'm on the right track!


--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933



Re: High blood glucose question

Maxine McArthur
 

So -- her insulin production is not keeping up with the glucose production. This is new, as in March her BG was normal. What could be suppressing her insulin? It's not the increased pergolide, because she was high before we upped the dose from 0.75mg to 1.5mg. But on that test she had had a feed of bp and soaked hay, and her insulin was 12mmol/L. She is definitely a CUshings horse with an ACTH of 117 in mid-winter, so it's not like I'm giving pergolide to a non-PPID horse.

I'm feeding Alcar for muscle tightness and insulin sensitivity--should I stop this? 

Is there anything I should be particularly concerned about with management? e.g. keeping food in front of her constantly? This is going to be really hard at our current agistment unless she's on grass, which we want to avoid because of the unknown sugar/starch content--yes? The correct amount of soaked hay and beet pulp is what we want to feed--am I right? She is not losing weight at present. She was lacking energy but seems to have improved a little, possibly because of the increased pergolide and because I am feeding her a bit more.

Is there anything I should look out for in case the condition worsens--weight loss? Lack of energy? Should I check for liver function next time the vet draws blood? (in around 2 weeks)

Just when I think I've got it all in place, something changes. 

Off to do another archives search... 





--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933



Trim questions waiting

 

Hi Everyone - I'm assuming that Lavinia is taking some well deserved holidays....she had asked me to take more photos which I did and I also rasped off some more toe and did not hear back.

The message string topic is

Trim done - please comment on the new photos

My trimmer wanted me to take off more heel, but I really don't want to do more of anything until I hear back from you guys!

If I should wait for her return just let me know

thanks for ALL your help.


--
Sharon P, Elsa  April 2016

Courtenay, BC Canada

Elsa, Case History, Photo Album

 





Re: Hoof radiographs uploaded

Stephanie Stout
 

Thank you for looking, Dr. Kellon. Would you also recommend Natural Balance shoes for him? The farrier is coming on Tuesday to reset, and start the process. 

I will get some HA from My Best Horse since it looks to be pure HA. Where do I get the Devil's Claw? I did give him 1/4 Previcox this morning until I can get the Devil's Claw and get his shoes/angles reset. 

What are the multiple points on the very tip of his P3? Is that arthritis/ringbone or ?

Thank you again so much. 

--
Stephanie & King
October 2014
Oregon
Case History 


Re: Elevated ACTH for reason other than cushings??

Eleanor Kellon, VMD
 

The TRH response test will cause a rise in ACTH if the horse has PPID but not if it is normal.  However, unless there was a clear acutely stressful event with 5 to 25 minutes of the sample this rise is probably not stress related. 
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Elevated ACTH for reason other than cushings??

Nancy C
 

Hi Tara

You can send your vet a copy of Dr Kellon's 2013 proceeding on Diagnosing IR and PPID which goes in to all the tests currently available.

Here's a bit about TRH from that: TRH (thyrotropin releasing hormone) Stimulation is an older test, first introduced to assess the rise in cortisol. It has since been modified to look at ACTH, which is more accurate than looking at cortisol. TRH stimulates ACTH production. The response is much higher in PPID horses.

TRH is more sensitive and gives higher false positives than ACTH.

Seasonal rise is one reason for elevated ACTH. Stress can also have an influence but individuals will vary greatly.

If he were here and I needed more confirmation, I would retest ACTH making sure all stress issues had been removed if possible.

Here's the link to proceedings: 2013 proceedings


--
Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
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ecirhorse.org



Re: Elevated ACTH for reason other than cushings??

Lavinia Fiscaletti
 

Hi Tara,

Know how difficult it was for you to lose Divina and how that hole takes a long time to heal. Thankfully, our horses deal with these losses more practically than we do and readjust much more quickly. They are able to live more in-the-moment so her loss is not a daily stressor for them at this point.

Elf's reaction to your taking Vig away is perfectly normal. He is a bit anxious that his buddy is gone but he handles it well. This has no bearing on his ACTH results unless the blood pull happened to have occurred while Vig was away or within an hour of his return. Exercise, trailering, stressful events have a transient effect on the ACTH levels - hours, not days/weeks/months.

Here is what Dr Kellon said at the 2013 No Laminitis conference wrt the TRH test:


"TRH stimulation results in more positive results (sensitivity). However, compared to baseline ACTH testing the specificity is much lower, which means there are more false positives. This means more horses being put on pergolide/Prascend than should be. We all want horses that need treatment to get it, but not at the cost of false positives."

And here is the Liphook link to a further explanation of the TRH test:  

http://liphookequinehospital.co.uk/wp-content/uploads/Endocrinopathic-Laminitis-what-to-test-for-and-when.pdf 

You already have a reliable diagnosis that is supported by age so starting treatment with Prascend (pergolide) is the most logical next step.

Elf's been overweight and severely IR since at least 2008 per his case history. He was "recently stiff" in Feb of 2015 - a red flag for lamintis in an individual who is normally energetic and athletic. He should not be allowed to have any pasture access except for exercise and companionship. This means if he's on grass he should be in a sealed muzzle. You said that Vig will harass him into movement so sulking when with his "big buddy" should not be an issue. These little guys have an ingenious sense of how to make us feel sorry for them so they can get what they want. Trouble is, they don't know what is best for their health any more than a child does - we need to set up and enforce guidelines that are in their own best interests. NOTHING is worth the pain of laminitis/founder.
--

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Elevated ACTH for reason other than cushings??

Tara Sullivan
 

Hi.  I wrote earlier about my pony Elf and his recent labs.  His ACTH has come back elevated at 73.1 pg/ml.  So-it appears that he is cushings positive.  But, in talking with my vet, we wondered the possibility of the rise due to another cause.  I did lose my Mare this past winter and we are all still adjusting.  So, the resident equines are now my 10 yr old tb gelding (Viggy) and Elf (20yr welsh/tb).  These boys definitely prefer to be with one another, but they are not buddies.  They are equal in status as to who is dominant over what and that changes with whatever it is.  For example-Elf is totally food dominant and can chase Vig from the hay.  But, Vig is very playful and can run and harass Elf and make him move.  I train and compete Vig and take him off the property regularly.  Elf is very good about being left alone.  He does not get frantic or excited and he can be left out....but he doesn't like it.  My husband tells me that he calls out regularly and will sometimes walk the fence.  I have never come home to a pony that I felt was in distress.  But....this doesn't mean that it is not stressful.  So, how do I prove or disprove the reason as to why the rise in his acth??


My Vet is researching a test for TRH response.....What is this??

Much thanks to all of you for your dedication to this site and the never ending compassion.

Tara and Elf

Feb. 2015

https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Elf/Sullivan%20Tara.pdf


Re: High blood glucose question

Eleanor Kellon, VMD
 

Yes, she's diabetic.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Hoof radiographs uploaded

Eleanor Kellon, VMD
 

Toe is good but heels eventually have to be much lower if possible.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Hoof radiographs uploaded

Eleanor Kellon, VMD
 

On Fri, Jul 29, 2016 at 03:40 pm, Stephanie Stout wrote:

Is there a specific reason why gradual lowering by slowly lowering the wedges at each reset doesn't work?

If the heels have been high for a prolonged period, especially if there is also pain involved, the tendon-muscle unit is often shortened.  When you add injury and possible scarring it's even more complicated.  Shaving a bit off the heels every few days may be easier for the horse to take than a 3 to 5 degree change every 4 to 6 weeks, although honestly there is no guarantee that would work either.

The vet also said that she would like King in Natural Balance shoes with the wedge pads - agree or disagree? Would you reset every 4 weeks? 

There is a lot we don't know about his feet and haven't even seen photos from all angles so I don't feel comfortable saying much beyond general principles.  Why does he need pads and shoes?  Has he always had long upright feet?  Any abscessing?  What is the nature of the tendon injury?  Why was he so lame recently?  A natural balance shoe without a natural balance trim is not helpful.  The heels have to come down to a normal height and P3 in about a 5 degree angle with the ground before that system can be effective.

Where would I get the Devil's Claw that is IR safe? I know the local feed store has BL Solution/Bute-Less that has Devil's Claw but it also has Yucca in it.

Phyto-Quench is now Devil's Claw based.

Should I give both Previcox and Devil's Claw at the same time?

No.

Where would I get pure H/A also?

You were getting it from My Best Horse before.

Also, he is on J-herb, and ALCAR so should I take him off the herbs? 

Jiaogulan won't work with Previcox.  The ALCar is for neuropathic pain and can be continued.

On the film, the tip of his P3 has 2-3 'tips' instead of one solid point. What are those different tips? Is that arthritis?

Movement artifact and/or remodeling. Arthritis occurs at joints.


 
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: panting and heat and cushings

Eleanor Kellon, VMD
 

It sounds like he's panting because of anhidrosis, inability to sweat and therefore inability to cool himself normally.  Anhidrosis can be a symptom of PPID but can also occur without it.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: panting and heat and cushings

Donna Powell
 


Hello, have you checked for being over heated? I too live where the temps. have actually reached 100. My draft was not sweating and would pant. Also a respiratory allergy will make them pant big time, more so than being over heated. Both have happened to my horse. Start by taking his temperature calling a vet too. 
Donna, Beaufort, SC, NRCPlus0213, NRCTherapy0413
HISTORY 8-will find new link shortly

On Fri, Jul 29, 2016 at 22:44, LJ Friedman via Groups.io
<luke4275@...> wrote:
Can a horse in no work that just stays in his  breezeway stall due to blindness, pant just because of uncontrolled cushings?   ( it his hot.. 90 plus degrees in so cal.) I know cold/heat regulation is affected by cushings.. I'm not sure if panting w/o sweating can be another sign of uncontrolled ppid... ( Jesse never panted so I have no experience with lack of cushings control and panting..
--

LJ Friedman San Diego Nov 2014


Re: panting and heat and cushings

Lorna Cane
 

I can't speak to the panting,with so few details.

But I've had 2 blind horses .They were able to be out with their friends. Maybe this horse would benefit from being able to move around.

We need to  move this to Horsekeeping if  the 'blindness' issue is continued.

There are also several groups for Blind Horses.


--

Lorna in Eastern Ontario,Canada
ECIR Moderator 2002



https://ecir.groups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf



Re: High blood glucose question

Maxine McArthur
 

On Fri, Jul 29, 2016 at 02:38 pm, Eleanor Kellon, VMD wrote:

Rise in blood glucose with PPID is secondary to the insulin resistance that it causes.  If the insulin resistance is not completely compensated for by increased insulin levels, glucose will be elevated.

Although I agree this level is higher than it should be, it's not high enough to cause any panic.  In fact, the only consequence of elevated BG I've consistently noted in horses is weight loss.  If there are other hyperglycemic consequences occurring they are not being noticed but it's also worth pointing out that human diabetics can run BG considerably higher than what the horses do.  I don't recall any horses being 200 or higher.

 Thank you, Dr Kellon. I think I'm getting a glimmering of understanding about this. I very much appreciate your advice.
--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933


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