Hi Lara,

As has already been mentioned, there really isn't any appreciable difference in the trim from what was happening in Aug 2020 to now. Both sets of rads show really horizontally long toes, underrun heels, sinking and thin soles. The only way the soles are going to improve is if the trim gets much more aggressive with fixing these issues. The frogs are narrow and elongated, with central sulci that have split all the way up into the hairline. This is going to be painful and make it unlikely that Callisto will be able to land heel-first even if the mechanics of the trim encourage it. Treat the cracks with 50-50 ACV+water soaks, then fill the cracks with a mix of 50/50 athlete's foot cream and triple antibiotic cream that contains a pain-killing ingredient, poke some cotton into the crack to keep the medication in and keep some of the dirt out. This will help heal them while the trim works to restore healthier foot mechanisms.

If you would like mark-ups to help guide the trims, I'll need a full set of hoof photos (all four feet). Please include part of the cannon bone in the lateral views. Also need to know the date of the next farrier visit.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Hi Marsha,

Sorry that Buzzy is still having such a tough time of it. It is definitely encouraging that he is willing to walk around by himself.

His elevated insulin is driving continued laminitis to some degree. Until that is controlled, you will have limited success getting him more comfortable. Gabapentin won't help with that. Still don't know why he has been prescribed cypro, as it has no effect on insulin and there's zero research in combining it with pergolide to treat PPID. It was an older drug used to treat PPID before pergolide was available and it was found not to be effective. Metformin or Invokana would be the way to go at this point if his insulin number isn't improving. His ACTH appears to be OK, so his pergolide dose doesn't need to be adjusted. Jiaogulan can be added to help with increasing circulation, which will also speed up foot growth. It wil also tend to mobilize any abscess material that may be trapped within the hoof capsules.

Have you had his hay analyzed and mineral balanced? OR, just use straight ODTBC, at least temporarily, so that all you need to add is salt, vit E and flax to have a safe, mineral balanced diet. As others have noted, Insulinwise has not been seen to work in most cases.

The rads showed thin soles, sinking, long toes and some slight bony column rotation. His heels are underrun. Until the trim is tightened up, it will continue to keep the soles thin as the long toes stretch the sole. The sinking adds more pressure onto the already thin soles, compounding the problem. Being a mini is a bonus, as his size means gravity isn't your worst enemy as it is in larger breeds. Make sure his boots have strong bevels added to the treads at the toes and heels to optimize the breakover for him.They usually rebound quite quickly to getting the trim corrected and insulin controlled.

Blanketing plus socks inside of his boots, along with wraps or shipping boots over his legs (I know, makes him look like a mummy) whenever the temps drop into the 40's or below will help with any cold-induced pain.

If you can post a full set of hoof photos from after yesterday's trim, with the hair secured away from his coronary bands to they are visible, I can see how the trim is evolving.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

I see. So the anterior lobe (in a normal horse) does the everyday job of producing ACTH, while the median lobe jumps in for special occasions, so to speak? And in a PPID horse, the over-production from the median lobe drowns out (or does it actually prevent?) the normal production from anterior lobe. 

Sorry to over-simplify, I do realise other hormones are involved. Just trying to get the mechanism clear in my mind. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 

Yes, it's safe.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Marsha,

I would get him back on LaminOx, half the horse dose twice a day and make sure he has heavy socks on inside the boots.

However, getting that insulin down is critical. Re InsulinWise, please see https://ecir.groups.io/g/main/message/249832?p=,,,20,0,0,0::Created,,InsulinWise+%2B+Eleanor,20,2,0,29018987 . The study is here https://www.sciencedirect.com/science/article/pii/S0737080620300216 . No one on this group has had positive results with it and some have worsened. I would try metformin or Invokana,

Why is he on cyproheptadine?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi,

My last message was over looked, so  this one will be short and sweet.  

Can anyone tell me if this is safe to give my IR horse with ulcers. 

AbSucralfate Granules (Sachet)

•  Each 7.2g sachet of film-coated granules contains sucralfate BP 5.0g.
•  Treatment dosage of 30mg/kg (13mg/lb) of horse's bodyweight.

I have already started Ulcer treatment for my IR/cushing horse but wanted to double check  on this

Thanks, 
Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson

Thank you Martha for replying.  I will get his case history updated as soon as I can.  Also, I'll work on the phots so they are easier for you all.
To answer your questions:
!. We think he is around 20 at this time.  He was dumped by someone and left in a field for 3 yrs before he was rescued. so it's all a guess!
2. His diet is 5.5 lbs ODTBC, 1.5 cups dry measure beet pulp which is RSR and divided into 3 feedings, 1/3 scoop Uckele Laminox( bid), 1/2 scoop Insulin Wise (bid),
    1/2 tsp salt (bid), 2TBS TC ground flax (bid). His hay is aprox. 1/2 lb  (1/2 flake) which is soaked and rinsed and drained. 
3. We have not tried metformin.  I asked vet and she wanted to give the Insulin Wise a little longer, but that was 10 days after he started it.
4. I've been in touch with Lavinia and I passed on her comments to our trimmer.  Our trimmer said she couldn't at that time take anymore off his toes as they just weren't growing.  I'm like you,          thinking maybe due to winter and his laminitis?? 
I appreciate your thoughts!!! Thank you!
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797

Thanks for your post, Cheryl.  I went to look at Lara’s hay analyses and found that the starch is quite low, less than 1%.  While sugars can be soaked out to some extent, starches cannot.  

What puzzled me about Lara’s hay analyses is the level of sugar in the soaked hay (ESC=8.93%) which seems high to me.  Did you do an analysis of the unsoaked version of the same hay?  The two hays you have tested appear to be from different cuttings or at least have different dates in the names.
--

Hi Sherry,
I think there may have been some serious brain fog making the rounds.  Here, we might call it cabin fever.
Weaning off pergolide before testing won’t really tell you anything.  Your initial test is diagnostic for PPID, even pre TRH.  The post TRH result confirms it.  There is no reason to repeat that.  Dr. Kellon posted recently that there is no research to guide us in what to expect when giving TRH stimulation to a horse already on PPID.  I would suggest doing only the endogenous ACTH test and not the TRH stimulation.  With respect to the other testing, I would do insulin and glucose, skipping the leptin and T4, unless you have a particular interest in following those.  You can share Dr. Kellon’s post with your vet if you think it would help in avoiding the unnecessary added cost of the TRH stim test.

The free fecal water you describe in your case history is more age related than PPID, I think.  The condition has attracted considerable attention recently as I read about it quite often.  I have an occasional issue with it with one of mine.  I thought soaking his hay might help but it didn’t.  Mine seems to do best on Timothy balance cubes with added hay.  Pre/pro biotics are thought to be helpful.  

--

--
Cheryl and Jewel
Oct 2018
Port Alberni BC Canada
https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel
https://ecir.groups.io/g/CaseHistory/album?id=81063

Can I forego the Glucose and T4?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 

Hi Martha,

His first test came back at 32.9 ACTH and his post TRH was 527.   So is it best to leave him on pergolide and get reg ACTH or take him off for 3 weeks and do TRH?  Or do I take him off for 3 weeks for either test?  I'm sorry, I'm having serious brain fog.  And should I do the whole ACTH, Insulin, Leptin, Glucose, and T4 again?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 

Hi Marsha,
I’m hoping you can rename your photos according to instructions midway down this page.  The dates are a really important aspect of the name and most helpful for understanding the timing and progression.  I realize they are on each photo once you open it but that takes more time.  If you don’t follow the naming protocol exactly, some characters may prevent the photo from downloading.  Hoof growth generally slows down in winter so that’s not a surprise.
I also went through your case history and noticed some things that need your attention.  You tell us his age would be a guess but not what your guess is.  Is he 5, 10, 15 etc?  There are no weights for the hay you are feeding and the soaking needs to be included in his CH as well.  I understand that his weight is good but from my experience minis can be hard to judge.  How much beet pulp is he being fed?  You state that you have tightened up his diet but, from his CH, I’m not sure what that included.  Have you tried metformin?  I’m not surprised Insulinwise has not been effective as others have noted the same.

It’s not clear to me whether you’ve made progress with his trim.  Someone else may have a better eye that I.  Have you asked Lavinia for her help with mark ups for a trim?

Just mentioning these points as things you might look into and modify your CH to reflect.  Much better than putting all the info in a post which will soon be ‘lost’.

--

Yes,Kirsten,I agree about 'soaking' the soy hull pellets. If the water is warm it takes less than 5 minutes, cold not too much longer.
As long as the moisture is there I don't think they have to be soaked through....in my experience.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Hi Lara,
Welcome!  I’d like to encourage you to change the location in your signature to include ‘Vancouver Island’.  We’ve had a number of members from that area.  I don’t know how many are active now but I know of at least one.  Also, including that in a subject heading might attract some attention as well, as Kirsten suggested.  
--

We are still struggling with Buzzy.  He seemed to be doing slightly better and the cold weather hit, which in turn seemed to affect him quite a bit. I wrapped his legs and kept him blanketed through the extreme cold. It has been 2 weeks since the trimmer was here and at that time she didn't see much progress with growth. Today we are going to see if we can address his toes and rasp a little, not touching his sole!  We also were going to try to apply hoof armour to his soles, if he can tolerate it.  This morning he did come out of his stall, but is toe walking especially on his RF with his boots on.  I don't know what to do as far as making him comfortable and not as painful.  This has been going on since mid Dec! This morning I gave him some Equiox so we can hopefully rasp his toes at noon. He is almost through the 2 lb container of Insulin Wise. I asked the vet about trying something else about 10 days into it, but she wanted to try the insulin wise a little longer.   Can you suggest what our next step should be.  Should we retest his insulin levels to see if it has improved?  I have tightened up his diet and keep cking his wt to be sure we are on target. His teff hay is being soaked and drained.  The vet gave refills on gabapentin and cyproheptadine, which he has been off for a couple weeks now.  Should I refill and keep that going?  I am trying to keep telling myself this is going to take time, but hate seeing him hurting.  He is eating and walking at will in the barn which makes me hopeful. I keep remembering "this is a marathon, not a sprint" comment!  Thank you so much!  You all are a wonderful, educated support system! 
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797

I didn't mean to imply the hay you have is not going to work.  You can very likely feed it if you soak it.  Callisto's insulin isn't THAT high on it and soaking it might bring his insulin down to the "normal" range.  You will see a reduction in pain within a day or 2 if it's related, but even if it doesn't improve his hoof pain I would soak the hay anyways to get his insulin as low as you can and give him a chance to grow his best hooves.  With thin soles he will be tender on hard or rough surfaces until they thicken up.  I don't know how long that will take, it depends on the horse, the trim, the diet, etc.  For now you just have to support him with boots and pads and work on his trim.  Part of the pain could be the long toes applying a levering force on his laminae with every step...something to consider and ask your trimmer about.

The new hay you've found might be quite stemmy as most hays with protein below 6% are over-mature.  So try a few bales out and mix it in with your current hay, and watch to see if Callisto eats it.  If it's unpalatable and he doesn't eat it or if he gets free fecal water from trying to digest it, you probably won't want to buy too much of it.

Sounds like the dust in the grass hay pellets was bothering the horses!  The soy hull pellets I buy are about the same size as the Mad Barn Amino Trace pellets, almost indistinguishable in fact!, but definitely feed them wet (even dampened they seem to fall apart) if you are worried about choke (thanks Lorna!)...they just need to soak about 20 min before feeding so they are quite easy.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Funny you mention that. I recently took over the morning barn chores at my barn because I'm micromanaging my two rehabs and noticed all 3 horses in the barn coughing quite 
heavily on different occasions.  I started wetting the pellets and it stopped!  I had never noticed before bcs I don't live at the barn.

--
Lara W. in BC 2021
Callisto Case History
Photo Album