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Re: AVRIO Pharmacy - Change in capsules

Joy V
 

Aaaand  now I can't get a call to go through to Avrio.  One ring and then nothing or a straight busy signal.  This is definitely not a great first impression all around.



--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526


Re: AVRIO Pharmacy - Change in capsules

Joy V
 

Thanks for your reply Laura.  I'm just nervous to change *anything* because it's taken almost 2 years to get my horse at his current condition.  

Also, the adaptor sent for the bottle to syringe the dose out is too big for the bottle.  There's no way it will fit.  This is frustrating.


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526


Re: Setback: need advice on X-rays

Lavinia Fiscaletti
 

Hi Joan,

Thanks for creating a photo album and adding Ranger's radiographs.

There was no bony column rotation back in Dec 2020 but there was some sinking. The HPAs were broken back, significantly on the RF. The feet did show capsular rotation, which is when the hoof capsule pulls away from its tight attachment to the coffin bone. This can be due just from toes that are being let too far out ahead of where they should be and/or from laminitis. As there is a ski tip on the LF, it's likely the toes have been too long horizontally for some time. Need to fix the trim to address this, which means taking the toes back so the breakover is set where the bony column needs it to be. Sole s were thin and heels were underrun..

The latest rads from 9-2021 showed that the HPA on the RF had improved and that the sole depth on both feet was slightly better. Heels were still underrun.The toes, however, had gotten longer and further ahead of where they needed to be vs. the  6-2021 rads, so were putting leverage on the hoof capsules. Sinking appears to have increased as well. It's possible the post-trim soreness was due to his soles and/or heels being trimmed more than they should have been. Running in the mud could have strained tendons/ligaments so added to his discomfort. As Kirsten mentioned, this is the time of year when an EMS/Ir horse can get into trouble with rising ACTH/insulin numbers due to the seasonal rise effect - in essence, he may be the victim of the "perfect storm" of assaults.

Because the there wan no trim done, his toes are definitely still too far out ahead of where they need to be so agree with you that getting the farrier out to get the trim optimized is a good idea. would suggest pulling the shoes and going back to the padded boots as shoes aren't going to solve this, nor will they solve any possible elevated insulin/ACTH which could be the driving factor(s) underlying his bouts of laminitis. Only way to know if these are a problem is to have blood work run now. Agree with you that getting the farrier out to get the trim optimized is a good idea.

If you want, I can mark-up the rads to help guide the trimming. Would be helpful to see a full set of hoof photos of the hind feet as well:

https://ecir.groups.io/g/main/wiki/1472

GreenGuard muzzles make us feel better about putting a muzzle on our horses but they do little to prevent the horse from consuming as much grass as it wants to - too may large holes that they can easily get grass thru, esp. if the grass is shorter. Need a sealed muzzle to be effective.

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


Re: AVRIO Pharmacy - Change in capsules

Laura Risley
 

Hi Joy!

I'm sorry that I did not update earlier on the change in oil-base and that you weren't told when you placed your order.  I want to reassure you, and the others, that we are indeed using an oil base - MCT (medium-chain trigylceride) oil.  it is the preferred oil here.  The suspension will be white rather than cloudy.  If the particles you are seeing are darkish in color, that is actually the powdered molasses flavoring.  We have ordered an oil-based liquid flavor for the future that will mix better. I took a look at a couple orders in lab and they are mixing well - except for the flavoring settling out - the liquid does appear milky and thinner.   

I hope this helps!  Please let me know if you have other questions!

--
Laura Risley, PharmD
Pharmacist at Avrio Pharmacy (Pet Health division)
Owner of Bo and Sid
Phoenix, AZ 
Joined 2021


Dr Kellon Micro Current

Qhgirl
 

Hello Dr Kellon, 
would it be beneficial to use micro current on Chicy's legs?  I know they must be tired and her rear legs are stocking up at times. I have a small portable machine with leg wraps for horses. Thank you. 
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Uploaded new x-rays and hoof pics

Lavinia Fiscaletti
 

Hi Marcy,

Good that she does have access to some turnout.

Although it appears as if the heels need to move back more, lowering them was not correct as that resulted in the palmer angle being lowered - which it didn't need as the bony column was well-aligned in the rads. Now, the HPA will be somewhat broken back.

The toes are what needed to be brought back, which they still need. I tend to agree with the farrier who thought that groove is likely an injury due to its shape; it would have taken a large abscess to create a crack that long and you wouldn't have missed it when it drained.

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


Re: AVRIO Pharmacy - Change in capsules

Joy V
 

FYI:  There is also a change in the liquid compounded pergolide now.  The suspension oil is milky and very watery (I thought it was water) and there are visible particles that settle and separate very quickly.  I'm pretty stressed out about this because 1) this change was not mentioned when I called in for my refill, 2) it is extremely concerning how quickly the particles in this settle/separate because what if too many or too little of them end up in each dose?? and mostly 3) this is the rise right now and I REALLY don't want any changes to anything in his routine, let alone the formulation of his medication.  

I called and spoke to a pharmacist and was told it's the exact same RX, which I believe, and that the suspension oil is just different.  This does nothing to diminish my concern about those particles.  It would have been nice to know that they were going to change the suspension oil w/ the change in location. 

I guess I will be testing his ACTH earlier than I had planned to make sure this works.   I am uploading a photo that shows what I mean about the particles in the RX.  

sigh

--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526


Re: Chicy's 3rd trim in 9 days - Lavinia please help - sole pics uploaded on all fours

Qhgirl
 

Thank you. Is there enough toe left on all 4 feet to just back the toe up a little more? Will this achieve taking the pressure off the toe and give her a better angle with a rocker toe? Can I rocker her heel at all?  I do not know what to do about the flares on her quarters. Any advice?  And I feel her foot is so unbalanced. Can I balance more by removing more at front sides by toes or should I wait on that?
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Need advice on blood testing rechecks/protocol

liisaacson
 

Thank you, Sherry.

My vet was thinking the seasonal rise (a bit early, but we are far north) was causing the July 27 readings. Are you saying that even during the rise, the boys should be within "normal" range from Cornell?  

Secondly, if you were me, would you just increase both to two tabs now? Would there be a rollback to the current level after the rise? Would i retest ACTH before doing so in December?

Thanks 
Lisa
--
Lisa and Haven, Danny, Courage & Cam
Independence, MN
2015

Haven's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Haven 

Haven's photos: https://ecir.groups.io/g/CaseHistory/album?id=261155 

Danny's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Danny
Danny's photos: https://ecir.groups.io/g/CaseHistory/album?id=268488

Courage's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Courage


Re: Chicy's 3rd trim in 9 days - Lavinia please help - sole pics uploaded on all fours

Qhgirl
 

Farrier has explained his training and options. I do not want to lose him as farriers and vets in my area not taking on née customers. That is why I requested he be here when vet comes. Vet knows I want her barefoot and to use therapy boots. He is okay with that. I need to get vet on board with this trim so he will tell farrier what to do. I am not ready for more ex rays now. This visit is to determine if her foal is still alive with ultrasound and complete trim that will get her on right track. Will have vet back in a couple of weeks for new ex rays to see if any progress made. All I can ask vet to do it take ex rays as if being sent to board certified vets to be read. 

I have limited funds so cannot get new ex rays every week are two. 
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Story won't eat supplements

Bendhorsetalk@...
 

Thanks! The Stabul1 arrived and she ate it (!)...day 1. It smells a little like maple syrup to me. Considering the alfalfa pellets didn't entice her much, this is a win so far. I wonder if the powder is available from bulk supplements?
--
Shera Felde, Central Oregon, 2020
https://ecir.groups.io/g/CaseHistory/files/Story%20and%20Shera
https://ecir.groups.io/g/CaseHistory/album?id=253720


Re: Lavinia mark up requested on sole pictures please

Qhgirl
 

Hi Cindy
Thank you for comments. Chicy has the Cloud EVO wedge pads taped to her feet. She has very thin stretched soles. I am the one who removed the wall Saturday. I  do not think toes are  rolled enough. Trying to find confirmation rasping just point of toes back will achieve the comfort angle discussed in the trim write up. Do not want to take too much. Need to know there is enough there and about how much more toe I can take back. 
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Lavinia mark up requested on sole pictures please

Qhgirl
 

Thank you Maxine. You are the first person to tell me I have not taken too much. I am thinking I need to take a bit more off point of toe, do you agree? I look forward to your video. I think I figured out what Lavenia meant by standing her on shavings to trim. Foot will still have shavings under it. Makes sense. I am going to buy a cutting board to use or use the shavings trick. But I definitely need to know if I can take a bit more off toe and achieve the comfort she needs. 
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Lavinia mark up requested on sole pictures please

Qhgirl
 

Lavenia,
I later awake all last night trying to figure out what I have done wrong on her feet. Should I remove more toe or is there enough there to bevel it at all. One member said I have not achieved anything that will make Chicy more comfortable. Desperate for feedback or I am going to look like a fool when I meet with vet and farrier Thursday am. I know you are busy. Tons of members need your help and reaching out. 
--
Janet and Chicy (in foal)
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Setback: need advice on X-rays

Kirsten Rasmussen
 

Hi Joan,

Ranger has a very sweet face.

The timing of this and his December laminitis are suspicious for early PPID, which can be diagnosed by an exagerated ACTH rise at this time of year.  Early PPID cases will test negative outside of the seasonal rise.  Might be worth ruling out this possible cause by testing ACTH again in late Sept/early Oct.  I would include an insulin test with the ACTH, too, since that will tell you if his pain is from active laminitis, or if it is due to the trim.

Agree with Sherry's advise to keep him off grass, but we really need to see a case history to advise you better.  I can see from his rads that he would be painful running around on his hooves and there are aspects of his trim that need to be addressed.  If you can ask Lavinia for her input, or for markups, you will see what needs to be changed. 

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


Re: Could someone tell me if the blood results could have been affected by sedative

Carrie
 

Thanks Dr. Kellon....
.....There are no hard and fast rules for dosing. If she is stable/not laminitic on 1/2 mg, I'd leave her there. 

Noted, monitoring  & will book in later in October
Thank you very much
Carrie
--
Carrie 
March 2021
UK


Re: Setback: need advice on X-rays

jandchornby@...
 

Hi, he's 17. He tested negative for PPID earlier this year but I don't know any figures.
Thanks
Joan
--
Joan Hornby
UK North West
December 2020
https://ecir.groups.io/g/CaseHistory/album?id=268474 


Re: Could someone tell me if the blood results could have been affected by sedative

Carrie
 

Kirsten thanks for this link  from your previous message :
It depends on the sedative used:

https://ecir.groups.io/g/main/files/SEDATIVE%20EFFECTS.pdf

I cant find the Medesedan on it. But its a good site to have as a resource so thanks.

I'm unsure if it would have an effect. But as there was such a rise with ACTH ,more than half from April to June- I was looking for things that would interfere with results.

I've come to the conclusion based on the two sets of blood results I've had so far :
April 2021-
Glucose 3.3 ml
report states post Karo syrup the glucose peak was not high enough to interpret insulin.
I think this is potentially due to delay in bloods being taken on the day, 30 mins over the max time  (60-90 mins advised by Liphook) post syrup. Plus the delay in Liphook getting the sample - due mostly to a Bank holiday here in UK. Won't make that mistake again . This may also have had an effect on ACTH result. Plus her stress & pain at the time.
My vet thinks not when I queried it at the time, but I just think it should be less of a jump in July if all was correct.

July 2021 -result sample taken 29th June received by Liphook on 1st July
Glucose is within range at 3.3ml (range 2.3-6.8)
Insulin 2.1ml (range less than 32)
Adipodectin 2.1( range- less than 8 is abnormal suggesting EMS)

To me it throws up some queries -the sedative being one, also timing to the lab. It's difficult to ask for no sedative as keeping my donkey still & calm is difficult as she's 13 hh & strong. 
I normally try to have Xray & bloods done together. But I think to try & get a truer reflection on whats going on with figures I think I'm better just having bloods done. Then booking again for Xray.
Dr K. has advised to leave the  half a Prascend tablet as is, if I think no laminitis then get bloods done mid October. So while monitoring, thats my plan.

Have you or anyone else any further thoughts on the difference between samples. I know the first was with Karo syrup so is an induced situation & not comparable in some ways-  but it just keeps making me question things.

Again thank you for your support
Carrie 
--
Carrie 
March 2021
UK


Re: Terrie and Dixie Prascend dose advice needed

Sherry Morse
 

Hi Terri,

That means her Prascend dose is working for her.  Her insulin is still elevated so I would continue to soak her hay until you get test results back and work on addressing her trim issues.




Re: Setback: need advice on X-rays

Sherry Morse
 

Not knowing how old he is I would also be checking for PPID as we're in the seasonal rise (just past the peak in the Northern Hemisphere) and fall laminitis usually is one of the signs of elevated ACTH.  Grass is a definite no for an IR horse with sore feet.  If you can't create a dry lot for him the next best option would be a small area with a completely sealed muzzle for a few hours a day.



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