Date   

Re: Sugar updated hoof photos

Lavinia Fiscaletti
 
Edited

Hi Melanie,
I've added the mark-ups to Sugar's album:

https://ecir.groups.io/g/CaseHistory/album?id=5903&p=pcreated,,,20,2,0,0

As we talked about before, the toes are too long at ground level, there was some rotation - both bony column and capsular - slight sinking and some ringbone. The long toes have been an issue for quite some time as they are present in the earlier xrays. The ringbone was also present in the earlier xrays - long toes are contributing to it, if not the primary cause. No way to really judge the sole depth on the current xrays so for now I would stay conservative and don't remove any material from the bottom of the front half of the feet. Frogs are stretched forward and heels are run under - fairly common issues.

Composite xrays: The lime lines follow the angle of the new growth and highlight the excess length and dorsal wall dishing. It appears as if there MIGHT be some erosion of the tip of the coffin bones but again, that's merely an observation as I can't be sure due to the quality issues with the xrays (sorry). Need to back the toes, making sure that the length at ground level is reduced, not just a thinning of the dorsal walls to remove the dished profile. The HPA (hoof-pastern axis) is broken forward, meaning the bony column doesn't align properly and is bending toward the front (pink line). The fuzzy areas on the dorsal surface of P2 (purple circles) are areas of inflammation/ringbone. Orange (brown?) lines are where the heels need to come down a bit to lower the height of the back half of the feet to realign the bony column.

LF composite: The green line in the LF lateral follows the angle of the new growth toward the ground. Although there has been some work on the toe length, it has mostly thinned the dorsal wall an eliminated much of the dishing without actually removing the excess length at ground level. The "white out" area is about what needs to be removed to move the break over back to where the bony column needs it to be. Leave the dorsal wall above this area alone and concentrate on just moving the toe back. Do it from the top, rasping the toe between 10 and 2, perpendicular to the ground/current growth to remove the length at ground level. The resulting toe will look thick and flat - like it has run into a wall. That's fine - this is rehab, not a beauty contest. Thinning the rest of the wall to match the new angle will get done over time as it grows down.
Heel-toe: Brown line is where to lower the heels to - from about the middle of the foot back. Everything forward of that point gets left as is. This will result in the foot not being flat at ground level - which is correct. You need to preserve the height in the front half while lowering only the back half in order to realign the bony column. DO NOT rasp the entire bottom flat as if a shoe were going to be applied.
Sole: Orange (brown) is where the heel buttresses are now, purple is where they need to be - even with each other and with the widest part of the frog. Green is where the healthy foot would be - everything outside this "template" is damaged, stretched, detached wall. Bring the toe back and the walls inward from the top then finish with a bevel to remove this detached material from weight bearing. Red chevron is about where the true tip of the frog is, everything beyond it is stretched forward frog that has been dragged forward by the pull of the long toes. Leave it alone for now as it will detach once the overall hoof mechanics improve and you can snip it off at that point. Light blue are the bars that have over grown and pushed outward, pressuring the heels and walls to also bulge out. They will need to be be GRADUALLY brought inward, working from the leading edge and only removing any loose/cracked/broken pieces. They are more structurally important now as they are heavily supplementing the support of the bony column while the rest of the foot is compromised. If you remove too much at this point, Sugar will be extremely sore as all her internal structures will be left without any external support system.

Composite RF: Same as the LF.

Composite hinds: Back the toes, RH appears as if it may have a tad longer toe than the right hind. There is likely more sole depth in the hinds than the fronts.

Use whatever boots+pads combo that Sugar finds comfortable whenever she needs them. If she is comfortable without them, fine to leave them off.

--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Mineral Balance - Temporarily Balance with Glycocemic EQ??

 

Hi Dr. Kellon,
We purchased twice tested orchard grass for Toons. The analysis is in Hay folder with my Case History). I am out of the balanced minerals prepared for our previous hay. I have Glycocemic EQ on hand and am wondering if I can use it until I get minerals balanced and purchased. I am supplementing many of the ingredients found in this product by mixing on my own: Iodine, selenium, vitamin E, Thyro-L and L'Carnitine. 

Toons is uncompensated IR (high everything, but T4, which was significantly low when last tested). 
P.S.Two local vets talked met out of trying Metformin as their clients have not had positive results. They suggested giving Toons some time to adjust to Thyro-L and soaking more hay. 
I will probably end up trying it if I cannot get his Insulin, Glucose and Leptin numbers down as he will be laid up for at least two months with hand walking only 15 to 20 minutes for next two weeks, adding 5 minutes every other week.
This week the poor boy experienced burned skin from chorhex scrub pre-IRAP injections in stifle and hocks. His blood sugar and insulin levels are probably through the roof from the soreness and discomfort. 
Thanks, 
Robyn
--
Robyn & Toons 

North Bay, CA
April 2016

https://ecir.groups.io/g/CaseHistory/files/Robyn%20and%20Toons



 


Re: Metaforim

ferne fedeli
 

I have been buying my ODTB cubes at Rivertown in Petaluma since I twisted Don's arm & convinced him to start carrying them.  I always soak them in warm water for a few minutes before using them as a carrier, but also break them apart & use them as treats too.  The last year or so they have been much softer than they used to be.
--

Ferne Fedeli

No. California

Regional Members Database Coordinator

 - see who is near you

Add your contact information if you want to help out/meet ECIR members in your area.

Case History


Re: Trim evaluation please

Sandy Carr
 

Alrighty...thanks so much!
--
Sandy

 

March 2017, Corona, New Mexico, USA

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Andy . 
                        https://ecir.groups.io/g/CaseHistory/album?id=6171 .


Re: Trim evaluation please

Lavinia Fiscaletti
 

Hi Sandy,

Buy the boots to fit the horse correctly, they are sized to use pads in them. As his trim progresses, the feet will get smaller too. Too big is one of the main reasons you get rubs.
Use the boots anytime he isn't comfortable barefoot. Just air them out daily if he's in them all day. He may be OK on some surfaces, not on others. This will be a learning process and it changes as his mechanics and comfort change.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


adding calories

 

http://www.thehorse.com/articles/39245/feeding-the-endocrine-challenged-horse?utm_source=Newsletter&utm_medium=nutrition&utm_campaign=05-29-2017

I was feeling pretty good about this article until I got to this part:

"Metabolically challenged horses that have trouble maintaining weight (such as those with PPID) should get their extra calories from fat, not carbohydrates." 

Thoughts or comments to rebut this if it is poor advice.  I recall caution in feeding fat from both this group and the various course notes. 

Debora, Montana 

Joined 2/7/12

CIR 0113/0615, NRC+1112,  NAT, MPG 0911 (and others.  I need to update my sig) 


Re: DP Xray & hoof photo added NOW: New radiographs added

Eleanor Kellon, VMD
 

The diagnosis can't be made from radiographs alone but he has considerable bone loss and findings consistent with osteomyelitis - bone infection.  If that is the case, you could try regional limb perfusion with antibiotics. The alternative is surgery to biopsy and culture the bone, possibly sterile maggot therapy or implantation of antibiotic beads (or both).  You could see what your vet thinks about the possibility of osteomyelitis or getting a second opinion even if just by a reading of the radiographs and history.  You can see how much of the reluctance to put his foot down is pain vs contracture with nerve blocks.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Judy and Rudy

Eleanor Kellon, VMD
 

Hi Judy,

Have you done a case history?
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Re: Wedgewood Pharmacy

Eleanor Kellon, VMD
 

On Mon, May 29, 2017 at 12:04 pm, Claudia Goodman wrote:
I had a long conversation with a PHP pharmacist last week who reiterated what is stated on the capsule vial label: the date of compounding is day one of their stability claim of 6 months.

 The "head"/supervising pharmacist told me the same thing end of last week and that it is based on independent stability testing of their pergolide in oil. I haven't seen the actual paperwork yet, but will be able to and will report back. He also said stability testing on the capsules was in progress and they were doing it because of recent customer inquiries.

Some history that might put things in perspective a bit more. Before Permax was pulled off the market most compounded pergolide was liquid and liquid (not oil, water) is the only form for which there are existing USP compounding guidelines.  Compounders are not required to do potency or stability over time testing. Fast forward to Permax being pulled off the market, compounding being the only source, BI being behind stability testing of formulations of compounded liquid, powder vs capsule so they could point to it when talking up Prascend.

Compounding is envisioned by the FDA as something that happens on an individual basis, not a situation where you would have potentially hundreds or thousands of people getting the same compounded drug. There's nothing wrong with doing potency and stability testing of course, but not reasonable to expect for a single prescription.

Except for Jaini/Dr. Clougher's Canadian pharmacy, PHP is the only pharmacy I am aware of that has taken the initiative to do any testing. The others are relying on the USP's **estimated** stabilities.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Re: Wedgewood Pharmacy

Claudia Goodman
 

On Mon, May 29, 2017 at 11:45 am, macivor macivor wrote:
I’m guessing that the (6 month?) expiration date is from when the bulk pergolide mesylate is manufactured, not the date it is purchased by the compounding pharmacy and also not the date the pharmacy puts it into capsules?

casey oregon 1014
Casey, 
I had a long conversation with a PHP pharmacist last week who reiterated what is stated on the capsule vial label: the date of compounding is day one of their stability claim of 6 months.
The question of how "old" the bulk pergolide might be was not discussed, however, there was a mention in that phone conversation that the bulk pergolide mesylate had good stability (which is also in question for me).
Further, PHP states the capsules can be stored at room temp. (How are do they store their capsule inventory in the pharmacy? - I didn't ask.)

 --

Claudia & Silhouette  02/2014

California Central Coast 

Silhouette Case History


Re: DP Xray & hoof photo added NOW: New radiographs added

Stephanie Stout
 

Hi Dr. K and Lavinia, 

I got new radiographs of King (hopefully the correct views) so you can see what you need. He quit abscess draining about 3 weeks ago, and has been dry since. He still won't put his hoof down horizontal with the ground(as you can see in the films) which is possibly a combination of hoof, and tendon problems. What do you recommend I do to help him get his hoof more horizontal? Shoes with special pads? Or ? I do have Soft Ride boots for him but he hates them as they shift, and slide part way off when he gets up and down. 

https://ecir.groups.io/g/CaseHistory/photo/1402/4?p=Name,,,20,1,0,0
https://ecir.groups.io/g/CaseHistory/photo/1402/5?p=Name,,,20,1,0,0
https://ecir.groups.io/g/CaseHistory/photo/1402/6?p=Name,,,20,1,0,0 (The vet had a hard time getting this one as he won't put his foot completely flat)

Thank you very much!!!
--

Stephanie & King
October 2014
Oregon
Case History 


Re: Wedgewood Pharmacy

Eleanor Kellon, VMD
 

Thriving Pets is not a pharmacy and does not do the compounding. Questions about compounding should be directed only to, and answered only by, the licensed pharmacist. In fact, that's the law. Otherwise you may get incorrect information. Your label information should always include both a "beyond use date" (expiration date) and a "date compounded" date
.
There are reasons other than changing pharmacies for ACTH to go up, although that is certainly one explanation.We haven't had any other reports of ACTH skyrocketing up after a change of pharmacies though.

Comments regarding pharmacies should be limited to matters of public record, like this one:

http://www.dora.state.co.us/pls/real/DDMS_Public.Display_Document?p_section=DPO&p_doc_id=484335&p_source=ROD&p_doc_key=4A17F85764AABA9BF791C15AB9446ADF    

Best of all would be results of potency and stability testing. That's really the only thing that will answer these questions.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Re: Wedgewood Pharmacy

macivor macivor <macivor19@...>
 

I’m guessing that the (6 month?) expiration date is from when the bulk pergolide mesylate is manufactured, not the date it is purchased by the compounding pharmacy and also not the date the pharmacy puts it into capsules?

casey oregon 1014

On May 29, 2017, at 6:49 AM, beverly meyer <bmeyer@gvtc.com> wrote:

I just reordered from Thriving Pets again as they told me the same thing about freshness. Maybe the Pergolide database could get updated to include this latest info on some of the pharmacies?
Thanks,
Beverly Texas 2014




Re: Trim evaluation please

Sandy Carr
 

Lavinia....before I read and view more I just want to thank you from the bottom of my, and Andy's, heart!  SO comprehensive!  I think I will make copies of all of this and send them on to the vet and the farrier so they have time to read.  If it were me, I would be so thankful for your expertise ahead of the trim date.  Thank you, thank you!  I will be back in touch with the results of the first trim.

I am ordering Easy Boot Clouds today.  They may be too big, as I don't have a fresh trim to measure from...but they are 20% off on Riding Warehouse until midnight tonight.  I'll add a few pairs of pads too.  (I can exchange for the perfect size if these don't fit...no charge.)  In the meantime I will be using the borrowed Cavallos Simples (I think).  

Should boots be on 24/7?  He walks almost perfectly with them on (heel-toe)...although he is still on Equioxx.  Hopefully we can move to Jioagulan soon.

OH...in ordering the correct size...should you go up a size so that padding around heels, etc. has room to fit?  Or is there usually enough wiggle room for things like that?
--
Sandy

 

March 2017, Corona, New Mexico, USA

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Andy . 
                        https://ecir.groups.io/g/CaseHistory/album?id=6171 .


Re: Trim evaluation please

Sandy Carr
 

Oh thank you Lorna....your last line put it completely in perspective.  :-)
--
Sandy

 

March 2017, Corona, New Mexico, USA

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Andy . 
                        https://ecir.groups.io/g/CaseHistory/album?id=6171 .


Re: Wedgewood Pharmacy

beverly meyer
 

I just reordered from Thriving Pets again as they told me the same thing about freshness. Maybe the Pergolide database could get updated to include this latest info on some of the pharmacies?
Thanks,
Beverly Texas 2014


Re: Hard ODTBC / WAS Metaforim

Lorna Cane
 

I used to take a hammer to those hard ones......on concrete floor,over another surface, plastic or something.
So happy I haven't seen any of those for many months.

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

 

 


Re: Metaforim

 

In Northern CA, Where Triple Crown is the distributor, the ODTBC cubes are rock hard. They have to be soaked. I spoke to Aurelio the other day about this as I believe someone in our group mentioned feeding a cube as a treat. And yet another suggested if the cubes were rock hard, I should contact the feed store. I contacted the company instead. The cubes do soften pretty quickly and bulk up with water nicely. Aurelio said 1/2 hour or longer soak is common. He also said that it is better to soak in warm water.
--
Robyn & Toons 

 

North Bay, CA

April 2016

https://ecir.groups.io/g/CaseHistory/files/Robyn%20and%20Toons



 


Re: Trim evaluation please

Lavinia Fiscaletti
 

Hi Sandy,

Nice to have a tech-savvy husband. I can see some of the problems with the angles the shots were taken from but had no idea why they were so grainy and distorted. You're quite right about the "awe" factor. Amazing how competent we can be when we're in our comfort zone, but step outside it a bit and suddenly you feel like you left the house wearing only your birthday suit :)

I've added some mark-ups to Andy's album:

https://ecir.groups.io/g/CaseHistory/photo/6171/0?p=pcreated,,,20,2,0,0

The general issues are the ones common to just about every horse that we see - toes are too long at ground level in the horizontal plane, heels are under run. This is part of what is causing the broken back HPA and the thinner-than-ideal soles. Because of the problems with the xrays, I can't say for sure whether there is sinking or not but the excess vertical height yet thin soles really points in that direction. There is side bone evident on both feet, worse on the RF. Frogs are stretched, atrophied and don't appear to be in ground contact. This is all fixable by putting a good realigning trim into place and maintaining it. No more than 4 weeks between adjustments, with 2 weeks initially being even better. That doesn't have to mean getting the farrier out every two weeks if you can take a rasp to the toes in between to keep them from shooting back out.

Composite of the xrays: Green lines are following the angle of the new growth toward the ground. Note that the RF is more upright than the LF. Yellow (LF)/blue (RF) lines are where to back the toes to in order to set the breakover in line with where the bony column needs it to be. Just remove that excess perpendicular to the current angle of the dorsal wall. Brown is the sole depth - somewhat thinner than would be optimal. Pink line is how the bony column should line up, purple is where it is now - dipping back/downward away from its proper location. LF is worse than the RF. Last xray of RF - maroon circle is where there appears to be some fuzziness along the dorsal border of P2. This is indicative of inflammation and likely some degree of  ringbone.

LF composite: Green lines on the dorsal view are where the walls are flaring outward. Need to bring this in from the top, then bevel under to keep the detached wall out of weight bearing until it can regrow tightly attached.
Green line in the lateral view again follows the angle of tightly attached new growth toward the ground. The dishing in the dorsal wall is a red flag that the toes are too long. Whited out area is the excess toe length that needs to be removed. Again, back them only form the top, with NO sole removal as there isn't any to spare.
Orange lines follow the angle of the horn tubules from coronary band toward the ground. Note how run forward they are compared to angle of the new growth. Yellow line follows the coronary band - note the arch. This is due to the heels having been pulled forward and they have in turn dragged the coronary band down and forward in the rear of the foot causing the distortion. Purple line is about where the heels should actually be located, red line is the "missing support" from the heels being ahead of where they need to be.
In the sole view, purple circles are where the heel buttresses should be - even with the widest part of the frog and with each other. Orange is where they are now, with the lateral appearing to be slightly forward of the medial. This is in turn causing more of a flare in the lateral wall. Red is about where the true tip of the frog is. Blue areas are where the bars have leaned outward and grown over/onto the sole. They will need to be SLOWLY brought back inward, working only from the outward leading edge in toward the frog. Only remove any broken/cracked/detached material for now as they are currently doing extra duty supporting the bony column due to the damage in the walls, displaced heels and under developed frog/digital cushion. NOTHING can come off the heels or the sole at this time as the HPA is already tilted too far back and down and the soles are thinner than they should be.
Green is about where the actual hoof capsule should be - everything outside of this line is excess, flaring material. Back the toe to the line and bring the sides inward.

RF composite: On the dorsal view, green is again where the flares are, lateral greater than medial. The wall is laterally high - yellow is the current balance while pink lines are level. Need to lower the lateral side.
Lateral view is same as the LF. Note that the RF is somewhat more upright than the LF. This is known as High-Low syndrome. In the majority of cases this is a trim issue, not a conformational one. Back the toe to the blue line  - "greyed out" the excess toe length.
Sole view: Same as LF.

LH composite: Same as fronts. Backing the toes and lowering the height in the front half of the foot with relation to the rear half is going to be the goal over time. Again, can't move the heels back at this time as there likely isn't any excess height to work with in the back half of the foot. Concentrate on backing the toes.

RH composite: The dorsal view shows the medial side is taller than the lateral so need to lower it - yellow vs. pink lines.
Lateral view shows that there is a steeper angle change in the horn tubules moving from front to back. Heels are further under while the height in the front half of the foot is more exaggerated in relation to the back. This generally means the coffin bone is likely to be ground parallel or may even be negative plane. Again, back the toe but be careful not to remove any sole depth unless it is evident that the sole is not too thin in the front half of the foot.

Use boots and pads at ANY time Andy is not comfortable as they will provide both protection and increase his ability to use himself correctly. You are looking to encourage heel first landings - toe first is a big problem.

--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Re: Metaforim

Lavinia Fiscaletti
 

But to use them as a carrier for minerals, they need to be at least wetted to some degree to make things stick :(
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

68761 - 68780 of 273795