Date   

Re: Pulses

 

Jaini,

Thank you.

I don't seem to be able to find the maxillary one either.  But if the heart rate with a stethoscope works, then I'm on it.  I have one of those!  :D
--

Laurie and Atticus and Diamond - 05 2016
Collegeville, PA
Atticus Case History - https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Atticus/Atticus%20Case%20History/Atticus%20Case%20History.docx.pdf

Diamond Case History - https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Atticus/Diamond%20Case%20History/Diamond%27s%20Case%20History.pdf 
Atticus  Current Hay Analysis - https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Atticus/Hay%20Analysis/Hay%20Analysis%209-8-17.pdf

Atticus Photos - https://ecir.groups.io/g/CaseHistory/album?id=42693&p=Name,,,20,1,0,0 


 

 

 


Re: Pergolide doseages

Eleanor Kellon, VMD
 

p.s. Improvement 3 weeks into the low dose pergolide with this timing could easily have been from ACTH levels dropping anyway rather than a drug effect.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Pergolide doseages

Eleanor Kellon, VMD
 

To try to sort through the PPID issue, I would suggest tapering off pergolide in December and doing a TRH stimulation in February.  If positive, you have an early PPID. If negative, you have an IR horse that is sensitive to the seasonal rise effects so know you at least need pergolide seasonally.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


"Clown Shoes"

Bonnie
 

Recent discussions of long toes reminded me of the phrase "clown shoes" which has been used over the years. back in 2006 for example Judy A. said this " My personal description to folks is this... YOU go and put on a pair of comical clown shoes the size of about 18's, then walk around for the day. How do you think you're legs and feet will feel?"
Maybe we need a visual description of "levering forces", such as a diagram or video.
(Is anyone into computer animation? Have a teenager who is?)
--
Bonnie and Lad
North Ontario
Dec 2008
 


Re: Upcoming testing

 

Hi, Patricia, 

Huge kudos to you!  You have done an amazing job with Miss Dancer. 

I would get an ACTH as well; in my horses, they actually seem to peak in late Oct - mid November (apparently they didn't get the memo about when the seasonal rise is), so I think it would be prudent to get that as well.

Thanks for the update on the case history.  :)
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Re: Pulses

 

Hi, Laurie - you are not alone!  In fact, digital pulses on a horse should be hard to find.  Here is a good explanation:  http://www.ironfreehoof.com/equine-digital-pulses.html    

 If you want to monitor pulse rate, you can also use the maxillary artery, under the jaw (I like this one, because I don't have to bend over :) ).  https://equimed.com/health-centers/first-aid/articles/four-ways-to-take-your-horses-pulse  ; or you can count heartbeats using a stethoscope. 


--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Re: Pergolide doseages

Cheryl Oickle
 

Sorry need to read the pergolide suggestion in the response too quick to respond.   I hav a trimmer coming out nov 14 or 15 and will acquire hoof pics with a high grade camera at that time for posting and evaluation.   Specializes in issues as this
--
Cheryl and Jewel
Oct 2018

https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel


Re: Sadie's trim...Jaini, Dr. Kellon, Others please comment on this if you can. This is where the disagreement is.

 

Hi, June. I am sorry to be the bearer of bad news, but it is time for a new trimmer. The proof of the pudding is in the eating, and the feet are not only not improving, they are getting worse with each trim.
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Re: Pergolide doseages

Cheryl Oickle
 

Just one correction her hay IS tested and less than 10% ESC  actually 7.1 and starch is 1.2 %.  Sorry if I wasn’t clear on that.   The prascend dose? Thoughts should it stay at 0.5 or should I try again to increase to 1.0 mg
--
Cheryl and Jewel
Oct 2018

https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel


Re: Savannah’s new trim pics uploaded

 

Hi, Pat - the only real way to tell if there has been damage to the circulation is by doing a venogram, which is very expensive, and so is out of the question. 

I know this is tough for you. I really think you need to pull out all the stops and find a new vet. Alternatively, ask if you can sign a waiver stating that there is no fault coming to the vet clinic if a higher dose of compounded pergolide causes any issues.  You can also have a look at the file Getting Your Veterinarian on Board (scroll down)  https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together   
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Re: Need help assessing progress, please advise. Lavinia may I please have mark-ups by Tuesday 11-06?

 

Hi, Patty - Penny certainly is lovely!  I am just adding my complete agreement with Lavinia. Not only are the toes still too long, they are much, much too long. X-rays on the next visits are strongly recommended, so that your trimmer can see that a ton of toe has to come off. 

I hate to say it, but  the trim "progress" since March (a full 7 months, which should be half a growth cycle) is not progressing, but seems even to be moving backward a bit. After 7 months, assuming all the triggers for the laminitis were removed, it should look like half of a normal hoof sitting inside the growing-out damaged area, kind of like a person wearing galoshes.  With the long toes and high heels, the new foot doesn't get to grow down very far before it is distorted by the mechanics of the trim, so, as Lavinia says, the problem is just perpetuating itself.

The proof of the pudding is in the eating. Might be time to find a new trimmer.
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Re: Sadie's trim...Jaini, Dr. Kellon, Others please comment on this if you can. This is where the disagreement is.

 

 hi Denise, I am aware of Pete Ramey and actually my trimmer is a Pete Ramey follower and trims according to his protocol supposedly. I do have the DVD series but have not watched all of it and some of it is beyond my understanding.   my trimmer continues to believe that she is trimming according to Pete Ramey's protocol so I don't know what else I can do about that part of it.
--
June
Oregon, USA
Oct 2012
Case Histories for Sadie and Chip
Sadie's Photos 
Chip's Photos 
Ω


Re: Lavinia, Could you review my new Xrays and Pictures we took yesterday 11/2/18 ?

Heidi Wright
 

Thank you for that feedback Lavinia.  My hoof pic upload must have failed, so am uploading dorsal and lateral views right now.   I didn't get sole plane but will get those tomorrow.  

Yes, the first farrier that worked on him thought "bevel" meant thin dorsal wall.  I started bringing the toe back this morning and noticed the wedge material is pinkish/reddish, like stained with blood.  Is that normal?  And do I need to do just a little at a time on the toe or can I go for it in one session?

My plan was to take a little off the LF heel every few days.  At what point should I get a fresh set of xrays?

Thanks much.

Heidi



He is moving well now but I can tell he is still sore as he gets uncomfortable when I trim him and he has to weight one front leg.  I would be interested in the team's thoughts on when it would be useful to hand walk him,  Given he has obvious gaps in his hoof wall and possible abscess spots, should I wait till that part of the hoof has grown out before walking even though he is walking sound?


Heidi Wright
joined Aug 15, 2018
5130 State Route 38
Malta, IL  60150
815-761-2341

https://ecir.groups.io/g/CaseHistory/files/Heidi%20and%20Skyler 

https://ecir.groups.io/g/CaseHistory/album?id=69604


Re: Pergolide doseages

 

This from Cheryl:  

"Her pergolide dose of 0.5 mg seemed to improved her foot pain approximately 3 weeks into the doseage.  The increase to the 1 mg only lasted 4 days due to the  change in her behaviour at day 7-11 of introducing the drug. I am at day 22 of the drug at 0.5 mg and her pain waxes and wanes  I am  having difficulty getting the actual levels of her blood work from the September draw.  All I know is that the "normal" range is 0-10 and her marker was at 13 but the specimen was thawed upon arrival to the lab.  This is in whatever Canadian Units they use.  I am not too techy so having trouble updating my Case History.  Cheryl"

And, from the case history (I didn't scroll down far enough - sorry!) :

"Very reluctant to move in September but ?? Oct 1 variable amounts of pain between rt and left front. Seems to move from foot to foot. No effect from analgesic. Started on pergolide at 0.5 mg Oct 5 no pergolide veil noted. Increased to 1.0 mg Oct 21… became very agitated and aggressive 3/7 later. Dose decreased and settled in 3 days. Maintained on 0.5 mg at present 2018 10 27 "

So, just to make sure we are all on the same page:

Jewel had laminitis in June of 2010 at age 9.  She had white line disease in October of 2017, farrier did a resection. She had another bout of laminitis in June of 2018 (age 17), which seemed to resolve in about a month, and now her current bout which started in September of this year, and is not resolving, with continued foot pain.

She was on 0.5 mg of pergolide for 3 weeks, starting on October 5; foot pain seemed to reduce about 3 weeks into the dose. That doesn't quite make sense, since the dose was increased 16 days after starting. The dose was increased up to 1 mg on October 21; on or about October 25th, her dose was reduced to 0.5 mg again, and her demeanor returned to normal.

Chaste tree berry was started July 15th, and discontinued October 10th.

Her most recent ACTH was 13.0 pmol/L  (normal 2-10 pmol/L) , in September, before she started the pergolide.

She is getting hay; not tested, and not soaked.

I have some ideas, but please do let me know if the above synopsis is incorrect, or I am missing something! :)

 Her ACTH of 13.0 pmol/L in September puts her squarely in the "grey" area. She might have Cushing's (PPID); or she might not. There is certainly a high index of suspicion, given that she had foot issues two Octobers in a row.

I don't know if you are able to get the hay tested, or if you can soak it?  

Here is what I would do, if Jewel were mine. First, start a journal. Assign a number from 1 to 10 for each of : foot comfort, demeanor (attitude), size of udder, size and firmness of crest. Make a quick note every day of what those things look like.

Second, soak the hay, if at all possible.

Third, start her back up on the Chaste Tree Berry. It won't control ACTH (but I do wonder if it was having some effect, since she was on it when the blood was taken in September).  CTB can help with a lot of clinical signs of Cushing's, and it also has a slight opioid effect, which might make her feel better.

Fourth, order some Ginseng from Rainey Ginseng: https://raineyginseng.com/  Get the powdered stuff, and feed at a rate of about 20-30 grams per day (I don't know what that is in teaspoons, sorry - if anyone has done a weight to volume measurement, please let me know!)

Once the ginseng has arrived, and she has been on it for 2 or 3 days, increase the pergolide to 0.75 mg daily. To do this, you will have to dissolve half a tablet in a measured amount of water (like 4 cc, for example); Draw up half the mixed solution into each of two syringes (dosing syringes from the drug store are ideal). Give half one day, and put the other half in the fridge for the next day. Repeat. After 4 doses of that, go up to 1 mg again, and see what happens. Don't forget to keep notes in the journal.

So, going back to Diagnosis, Diet, Trim and Exercise (which is a non-starter at the moment):  We have a tentative diagnosis of Cushing's (PPID), or at least a high index of suspicion. We don't know what the insulin or glucose looks like. It seems prudent to use Prascend (pergolide) and chaste tree berry at this time. Use an adaptogen (the North American ginseng) for increases in pergolide dose.

We will have to keep mare issues in the backs of our minds.

Diet: if we don't know for sure that the hay is below 10% ESC and starch, it is best to soak it. One hour in cold water, or 30 minutes in hot water, water drained where the horses can't get at it.
         Since she is at a boarding barn, double-check that she isn't getting illicit treats or feed.

Trim: Once you get the hoof pictures up, let us know. This could be a big missing piece of the puzzle.

Regarding case history (and thank you for getting that done!), you should be able to edit the Word version you have on your computer, and then upload it into your case history folder. Once that is done, you can delete the old case history.

Hang in there, and keep up the good work!

 
 
 
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


NEW CASE HISTORY DOWNLOADED, HELP AND ADIVSE PLEASE.

mybutch12@...
 

Hello. I am trying to learn how to use this website with limited time to research and comprehend how all of this works. I believe I successfully completed the CH and downloaded it on Oct. 19th. , but not sure how to get any personalized feedback with respect to caring for my mare, "Sunday", who went into severe, acute laminitis Sept., 15th. I am trying to follow through and incorporate the info I have found on this website
with respect to emergency diet additions and removals. Sunday has improved over the initial onset of the laminitis but it's been approx.  6 plus weeks now and she is still sore and slow moving. I am giving her
1 mg per day of Prascend (split into a.m./p.m.dose) and she seems depressed but eating. Every time I try to increase the dose by 1/8 mg, she quits eating the small amount of hay cubes and soaked,rinsed beet
pulp I am giving her in order to get meds/supplements down. I would so appreciate feedback, and advice, if possible. I have taken some pictures of her and a couple short videos of her moving (with my iphone)
and wonder if it's possible to download these to your site?
--
GAIL


More notes on the laminar aka lamellar wedge

Eleanor Kellon, VMD
 

The wedge is not an inevitable consequence of laminitis.  It is a form of scar tissue that develops in response to traction on the damaged, weakened laminae.

The wedge forms from the bottom/weightbearing surface up.  It extends for variable distances up the wall inside the hoof but the point is it does not start at the top or even have equal thickness throughout the hoof.  The severity of the leverage from the toe and from weightbearing determines how much wedge forms.

If the toe is in an optimal position and the wall beveled out of weightbearing, wedge formation will stop or be prevented in the first place.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Lavinia, Could you review my new Xrays and Pictures we took yesterday 11/2/18 ?

Eleanor Kellon, VMD
 

This photo album is a good one for everyone to review.

The films from February are before laminitis. Notice the distance from the edge of the bone to the hoof wall on the lateral/side view.  This is the horn lamellar zone.  Look how much it has increased on the later films.  The dark line inside that area, parallel to the bone, on the October and Nov films is the junction between the hoof wall and the laminar wedge.  The laminar wedge is all that material between the bone and the hoof wall.  If you look at the sole view of the RF from 9-10, the last photo, it looks like you can't take the toe back any further but the radiographs show that's not the case. Under that dead sole at the toe is lamellar wedge, not live tissue.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Lavinia, Could you review my new Xrays and Pictures we took yesterday 11/2/18 ?

Lavinia Fiscaletti
 
Edited

I see the latest rads but no hoof pix.

Definitely some increase in the LF sole depth - good.

Looks like the the dorsal wall on both has been thinned so the thickness of the laminar wedge has been reduced but no real change in the toe length at ground level. Need to actually shorten the horizontal length of the foot at ground level so that the breakover moves back.

The LF still has the same amount of slight bony column rotation - no change there - so yes, the heels need to be lowered slightly. But only the heels, leave the rest of the bottom of tat foot alone. Bringing the toe back correctly never makes the sole thinner - it will only help increase the sole depth.

There are two dark lines on the RF  - one in the dorsal wall, the second in the sole, running horizontally just below and ahead of the tip of the coffin bone. These may be air pockets or possible abscess tracks. The sole one has increased in size from what was present on the 10-2018 rads.

Never mind about what the measurement of the palmer angle is - the correct angle is whatever it takes for the bony column to be correctly aligned in that particular horse's case. In general, that ballpark number is 3-5 degrees.

You should definitely be optimistic :)

I can get you some mark-ups if you please post a full set of hoof pix for all four feet. Check here for what's needed:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


Re: Sadie's trim...Jaini, Dr. Kellon, Others please comment on this if you can. This is where the disagreement is.

Lavinia Fiscaletti
 

June,

Check out this link for getting rads done:

https://ecir.groups.io/g/main/wiki/Getting-Good-X-rays

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


Re: Need help assessing progress, please advise. Lavinia may I please have mark-ups by Tuesday 11-06?

Lavinia Fiscaletti
 

Hi Patty,

Yes, her toes are still too long. Her heels are underrun as well. Setting the breakover in the correct location needs to be done asap - the longer you wait, the longer the horse deals with ongoing damage that the lever forces from the too-long-toes create. Gradual removal of laminar wedge generally translates into "never happens" because the wedge just keeps growing, outpacing the conservative efforts to control it.

Extending the trim interval to 5 weeks at this time is a mistake IMO because the trim isn't anywhere near where it should be to put the horse on a maintenance trim interval.

I can get you mark-ups in time for Tues if you will get a few retakes of some needed shots and add the missing ones: need sole planes of both hinds, all laterals need to be true laterals - they are currently obliques, meaning the lens is aimed at an angle that is more forward of the side. Also, if you move a bit further away so that the shot is clear and includes the lower cannon bone and pastern that would be really helpful. Having her standing square is also needed otherwise the leg and pastern angles get distorted.

Check out this link for the specifics:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

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