Date   

Re: New pain management since CBDs are a no go with new PPID diagnosis

TERRI JENNINGS
 


Re: Need assistance with trimming hooves and BCS

Eleanor Kellon, VMD
 

You can send your hay to Dairy One (same as  Equi Analytical) for wet chem ESC + starch. https://dairyone.com/services/forage-laboratory-services/international-sample-submittal/ . You want profile 10 here https://dairyone.com/download/forage-forage-submission-form/?wpdmdl=14351&masterkey=5d41c7b773d79  for a complete analysis including minerals.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Need assistance with trimming hooves and BCS

a.k.a.petpalace2@...
 

Apollo's doing very well despite our vet not being receptive to using metformin.  No heat or elevated pulses but was foot sore and especially stiff in mornings although improved once got moving.  J-herb recommended by Dr. K really helped.  Soaking hay also seems to have helped.  Recently read on this site that only wet chemistry should be used for hay analysis.  Had our hay tested by local certified forage lab last October; results < 10% ESC + starch but when I checked with this lab, I was informed only mineral portion was wet chemistry and everything else was NIR.  They "reassured" me that NIR results were within 2.5% of wet chemistry values, I politely informed them that might be enough to affect a horse with severe IR like Apollo.  They said I could request wet chemistry hay analysis but that it would not include ESC.  According to thelaminitissite.org in UK, there are no labs there or in Europe that do ESC by wet chemistry.  I used info from ECIR website last fall before I joined ecir.groups.io and unfortunately, the "wet chemistry only" hay analysis recommendation was not mentioned there.  Could it be added so no one else makes the same mistake I did?
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo

Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Re: Need assistance with trimming hooves and BCS

Eleanor Kellon, VMD
 

Just a suggestion but if you bevel his walls out of weightbearing you won't need a special pad of any type - just experiment to find the consistency he likes best. Repeat films, at least laterals, would be very valuable at this point.  His heels are underrun and feet may be too long.  This deprives him of the support and cushioning of a robust frog and digital cushion.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Banamine/Gabapentin/Pentoxifylline

Eleanor Kellon, VMD
 

Alicia,

Do you mean on the palmar aspect? That is the soft tissue calcifications I was referring to and the original examining vet noticed in 2016.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Banamine/Gabapentin/Pentoxifylline

Eleanor Kellon, VMD
 

That report brought tears to my eyes. The bullnose right front is chronic but I'm sure if the other hoof changes were present then she would have noted it.  The other changes I noted on RF are chronic too. It's amazing he has been comfortable with a fragmented sesamoid  bone but that's very chronic too and my best guess without being able to see the horse is that it is indeed his feet but I doubt it's laminitis. By all means test insulin and ACTH but my first suspicion is still white line disease and very poor horn/lamellar quality.

He appears to have medial/lateral imbalance but there is so little hoof to work with you really can't correct that. I'm suspicious of a collateral ligament rupture on the RF at the coffin joint because the joint space is not even from side to side.

IMO he needs:
- a protein correct, mineral balanced diet  based on hay and/or pasture analysis
- weightbearing taken off the hoof wall all the way around https://hoofrehab.com/DistalDescent.htm
- put him in casts with pad and dental impression material underneath
- Jiaogulan

Any chance you can get that original examining vet to evaluate him now?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Need assistance with trimming hooves and BCS

a.k.a.petpalace2@...
 

Hi Kristen,

Agree with subclinical laminitis. I suspect Apollo suffered from it for years due to undiagnosed IR.  Early PPID last fall tripped him over the edge and he became acutely laminitic.  His previous owner reported problems with chronic thin soles and intermittent lameness especially during summer.  It's very frustrating that despite yearly vet exam with geriatric blood tests and year round farrier trims every 4 weeks, Apollo still didn't get the care he needed.  Apollo had low thyroid levels for at least 3 years before being diagnoses with IR/PPID.  I first read about subclinical laminitis on website of a farrier in UK.  Further research lead me to ECIR's website which helped get Apollo properly diagnosed.  Unfortunately, treatment is proving very challenging and I'm beginning to feel I'll never get him stabilized.  Vets in my area don't seem to be very knowlegeable about treating IR and it's frustrating to know there is more I could do if vet was willing to try medications to bring down insulin.  Fortunately, soaking his hay and limiting supplemental forage to timothy balanced cubes has helped.  Clinically he looks and seems to feel better than he ever has.  Awaiting some blood test results which I will post soon. 

Have been using Cloud boots with thick foam pads.  Initially used pieces cut from old neoprene saddle pad because was only thing that made him comfortable.  Also used a sinker pad technique recommended by hoof trimmer i.e. trace hoof, then bevel out edge so horse weight bears more on pad under sole than on wall of hoof.  This seemed to help get him more comfortable but when he started moving more, gorilla tape holding them on would rip and they wouldn't stay in place.  Currently using 3/4" 6# sinker pad from happyhoofpad.com which seem to work well.  Will be replacing pads after farrier does trim tomorrow.  Should his Cloud boot treads be beveled?  Our farrier had use rasp fronts to improve breakover.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

Thank you so much for your concern, Dr. Kellon and all. I just posted the 2016 exam report conducted by an independent vet when Charlie first came off the track. I also posted to my case history file the remaining two x-ray views I received from my vet last week. My purpose then and now was to give Charlie a good life as a pasture companion -- no work ever! Until this month, he was able to move around quite comfortably on my 10-acre pasture, together with my other two rescued horses -- one of whom was just euthanized on Tuesday after chronic liver failure. 
--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/album?id=275965 


Re: Banamine/Gabapentin/Pentoxifylline

Alicia Harlov
 

Sorry- by calcification I meant on P1/P2, unlike any "high ringbone" I've personally seen.. I assumed the artifacts in the hoof were dirt, other than the defect on the dorsal aspect of P3. 
I wonder if the calcification at the upper condyles of P2 are painful or were in the past?

--
-Alicia Harlov in South Hamilton, MA 
PHCP hoofcare provider, The Humble Hoof podcast


Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

Kathryn Papp, DVM

1008 Piketown Rd.  Harrisburg, PA 17112

Phone: 802-238-0094 - kpapp@... – Fax: 717-307-3304 

 

Post-Racing/Newly Adopted OTTB Exam Report for Marcy Dalton

 

Charlie’s Quest - 7 yo, Dk Bay, OTTB, Gelding

Date: Arrival 8/5/2016 from PID, Initial In Depth Exam 8/11/2016

General Examination and History:  

Charlie was recently retired from training and competing as a claiming-level thoroughbred racehorse.  His last reported race was July 10, 2016.  He was retired and purchased privately as a companion and possibly for light riding use.

Charlie had not hit the board (1st-4th) racing since September of 2015.  His racing career originated in 2012 when he was a 3 year old.  He alternated between racing in claiming and allowance races on the dirt over the next couple of years and changed trainers/owners 7 times throughout his career.  He ran his best races around two turns and usually closed for most of his wins.   Almost every racing chart reflected that the horse preferred to run very wide across the racetrack and often drifted out.  He was an inconsistent finisher and dropped in ranks over time.  He has only ever had one period of time where he had a significant break from racing, which was from 11/2015 to 6/2016.  He never ran well again after his return.  

Charlie came directly from PID to my rehab and medical boarding facility in Harrisburg, PA on 8/5/2016. He is a large horse and arrived with a BCS (Body Condition Score) of 4/9, a healthy looking coat and appropriate muscling.  He was quite exuberant and slightly pushy to work with.  He had aluminum race plates on up front and was barefoot behind.  His hooves were in decent condition. The gelding exhibited mild reactivity when hoof tested across each of his four feet. Charlie’s heart, lungs and GI system all ausculted normally, both at rest and after exertion.  The heart rate and rhythm were all within normal ranges and he appears to be in good cardiovascular health.  A brief ophthalmic exam revealed no abnormalities.  A brief neurologic exam, as well, did not show any definitive abnormalities.  Some responses that looked possibly neurologic could most likely be attributed to underlying soundness issues.  Dentition appears appropriate and though teeth could use a floating in the near future. 

An upper airway endoscopic evaluation identified asymmetric abduction of arytenoid cartilages and vocal folds with the left vocal fold classified as having a 2b paresis.

Soundness Evaluation:

Charlie’s most obvious limb abnormality is a very enlarged and firm fluid filled distended RF flexor tendon sheath just above his RF fetlock.  His range of motion in the RF fetlock region is limited and deep palpation of the area causes the horse to try and withdraw his leg in discomfort.   Also noted were his relatively long pasterns all around.  No additional heat or sensitivity was detected during palpation of other structures, but static flexion of all fetlocks as well as hocks did result in an attempt to withdraw the limb.  He had an acceptable range of motion in his neck and back.  

The horse initially appears sound at both at the walk and trot in a straight line, but when turning it was obvious that there was some pain on both forelimbs as he tried quickly to unload the weight off of each before returning to straight traveling.  When traveling on a circle in both directions and on different ground surfaces (soft & hard) he was extremely playful and not very adept at lunging appropriately in a controlled circle.  He showed decreased anterior phase of stride in his right hind limb as well as a hip drop (lameness of 2/5), especially when traveling to the left.  It was difficult to discern whether or not the right forelimb lesions were contributing to this behavior.   He also showed a left forelimb lameness 2/5 traveling on the circles in both directions.  An intermittent, though not consistent, right forelimb lameness was noted.  He did exhibit normal upward and downward gait transitions, but would bunny hop and counter or cross canter frequently when traveling in either direction at the canter.   His cardiovascular status post-exercise was within normal range and he recovered to resting status quickly.  No abnormal respiratory noise was noted.  

Active Flexion Testing Results were as follows (scale Neg-+5):

RF – +2             LF – +1

RH – +2             LH – +1.5

Charlie’s previous racing charts were reviewed and his conformation, soundness, as well as expectations for his potential as an athlete or long-term companion, were taken into significant consideration when examining this horse. 

After reviewing the numerous diagnostic images obtained, including digital radiography and ultrasound, my recommendation was to refer to surgeon for further work-up and likely RF annular ligament desmotomy/tendon sheath tenoscopy to help relieve adhesions and/or decreased range of motion and damage in that limb. 

Initial radiographs of the entire horse including feet, fetlocks, knees, hocks, stifles, tibias and dorsal spines were taken and reviewed.  The RF medial sesamoid was basically destroyed with multiple fragments identified and disruption of suspensory branch attachments.  Floating calcifications were seen within the flexor tendon sheath, which was distended with a large amount of effusion as well as fibrous thickening.

Radiographic Imaging Findings:

 

FRONT:

Right Front

RF foot:  navicular appropriate, nearly flat coffin bone, disrupted hoof pastern angle, long toe (bull-nosed appearance), decent sole depth and medial to lateral balance

RF pastern:  large linear proximo-palmar calcification/enthesiophyte associated with palmar P2, mild pastern joint OA and spurring 

RF fetlock:  major demineralization, degeneration and fragmentation of both sesamoids, apical and basilar fragments small and large close and far from parent bones, jagged and irregular palmar fragments intra and extra-articular, remodeled dorso-proximal P1, fetlock OA with decreased joint space and flattened palmar distal condyle, flexed DP view shows condylar sclerosis as well as a lucent line in sagittal ridge, decreased width of distal MC3 neck

RF canon/MC3:  thickened dorsal cortex consistent with previous bucked shins and race related bone remodeling, calcifications and fragmentations coming from sesamoids are visible within distended and thickened digital tendon sheath at this level

RF knee:  3rd carpal bone decreased cortical medullary definition and sclerosis, prominent but clinically irrelevant distal radial epiphysis

Left Front

LF foot:  mild navicular changes and sclerosis, flat coffin bone (almost negative palmar angle), broken hoof pastern angle, long toe, medial to lateral imbalance with medial heel higher and causing pinching in joints along the column, sole depth ok

LF fetlock:  palmar condylar flattening and obvious lucency/bruising with associated surrounding sclerosis, moderate joint OA with spurring and decreased joint space, decreased sesamoid density, flexed DP view shows OCLL/subchondral bone bruising with discrete circular lucency

LF shin/MT3:  thickened dorsal cortex consistent with previous bucked shins and race related remodeling

LF knee:  3rd carpal bone decreased cortico-medullary definition, medial proximal splint old and quiet, small lower knee joint spur and prominent but clinically irrelevant radial distal epiphysis

HIND:

Right Hind

RH fetlock:  Significant dorso-proximal P1 remodeling, moderate OA with spurring and decreased joint space, lateral sesamoid small basilar fragment, plantar condylar flattening with medial OCLL and deep bone bruising evident

RH hock:  pea-sized OCD lesion dorsal talus surrounded by sclerotic ring, decreased lower hock joint spaces  

RH tibia:  plantar cortical remodeling (possible previous or current early stress fracture)

RH stifle:  distal medial femoral condylar flattening, corresponding lipping of the proximo-medial tibial plateau

Left Hind

LH fetlock:  Dorso-proximal P1 remodeling, P1-P2 pastern joint dorsal spur, moderate OA with decreased joint space, medial apical sesamoid is irregular, distal plantar condylar bruising, both sesamoids irregular apical margins

LH hock:  moderately decreased lower hock joint spaces

LH tibia:  island-like medullary lucencies and calcifications proximally of unknown significance, proximal plantar tibia cortical remodeling and thickening (possible callus)

LH stifle:  distal medial femoral condylar flattening, corresponding lipping of the proximo-medial tibial plateau

Other

Withers:  WNL (within normal limits)

Thoracic/lumbar spinous processes:  2-3 overriding spinous processes near the thoraco-lumbar junction with some associated boney erosion and reaction (ie. Mild-moderate kissing spines)

 

Ultrasound Imaging Findings:

RF distal limb:  Thickened digital flexor tendon sheath with multiple adhered and floating calcifications present, sheath lining is also thickened with normal to sometimes fibrinous fluid effusion and fibrin adhesions in the distal MC3 region, significantly thickened annular ligament and decreased transmission of synovial fluid through the sheath proximally and distally to the fetlock, majorly disrupted (barely recognizable) sesamoid bone architecture and concurrent disruption of and damage to suspensory branch attachments both medially and laterally  

 

Bloodwork Results:

CBC: Mostly within normal limits excepting mild dehydration and blood transport artifact

Drug Screen:  Negative for all substances included in Cornell CVM PPE drug screen testing

Lyme Multiplex:  Negative for all OSPs

 

In my professional opinion, and based on the provided surgeon’s report and evaluation, Charlie has quadrilateral lameness, some of which is very severe, progressive, degenerative and likely painful.  Many changes identified are chronic, with no acute lesions noted on exams.  It is my opinion that the reason for this horse’s poor racing performance and continued drop in class was directly related to these limiting lameness factors.  It is hard even to believe that this horse was even completing races and daily training, nonetheless, passing consistent racing veterinary inspections.   While he does appear to be a very stoic and strong patient and quadrilateral or even bilateral lameness can be more difficult to detect, it still seems unreasonable that a horse that is mainly unfit for even moderate riding sport was recently subjected to high speed racing competition. 

It is very unfortunate that Charlie’s Quest is most likely going to be unusable as a companion riding horse or low-level competition partner.  Even with a pampered life as a pasture companion he will continue to have degenerative changes that will worsen over time due to the initial injuries and wear and tear that he has previously incurred.  

I hope that we have helped to guide you for the future care of this horse and given you the needed information to maintain his comfort and welfare for the years to come.  It is amazing and incredibly lucky that a caring adopter has agreed to take on Charlie even with all of his issues and give him the life a horse who has worked hard for his people deserves.  I believe, as a veterinarian, that all animal lives have inherent value whether or not they provide us humans with a particular self-serving use.  Their lives have value for the sake of living peacefully and comfortably even if nothing more.  I applaud your thorough approach to the homing of Charlie’s Quest and wish you both all the best.

Kind Regards,

Kathryn Papp, DVM

--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/album?id=275965 


Re: New pain management since CBDs are a no go with new PPID diagnosis

Eleanor Kellon, VMD
 

Here's the article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552276/
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New pain management since CBDs are a no go with new PPID diagnosis

Eleanor Kellon, VMD
 

The reported dose for a full size horse is 2.5 grams in the evening meal.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Phyto-Quench

 
Edited

Hi Mary,
Thanks for all the great questions.  I’ll take a stab at a few.  We all have different experiences and see things from different vantage points so our answers are not identical in where we place our emphasis.  Also, it’s possible that you haven’t quite defined the question for what you want to know.  That happens to me a lot.

Pergolide lowers insulin by mediating the effects of PPID, specifically the increase in hormones such as ACTH.  These elevated hormone values can result in increased insulin.  The only hormone we are able to measure, related to PPID, is ACTH.  But there are other hormones which are also affected by PPID.  I don’t know which hormone(s) are responsible for increasing insulin because my horse never showed an elevated insulin, even when his ACTH was not particularly well controlled.  So, it’s quite possible that Vandy’s insulin would improve dramatically if her PPID were better managed.

There are occasional horses who never show much of an ACTH increase but have good reason to be PPID.  I have one and there are others on the group.  The point of the TRH stim test is to identify those horses more conclusively.  Whether it picks up all of them, I don’t know but you are fortunate in that it did identify Vandy as one of them.  I did not do the stim test on my little guy because I wasn’t aware of its existence many years ago when he was first tested.

So, what the test is telling you is that it’s primarily hormones other than ACTH that are being elevated in her PPID.  My big guy was on a significant dose of pergolide.  He had maintained an ACTH of about 30 but not entirely symptom free.  Nice low insulin, fortunately.  I switched him to another drug used for PPID and it immediately became obvious that an ACTH reading of 30 had not been telling the whole story.  After a very remarkable veil, he began to blossom.  At age 31!  Even his top line showed improvement in a very short time.  When I tested his ACTH, it was higher than I’d ever seen it, at slightly over 100.

To me, there is no question but that Vandy is PPID and quite likely would benefit from considerably more pergolide.  In my mind that’s a win because treating the PPID with medicine makes management of IR so much easier.  My understanding is that your horse’s breeding, as a Paint, is closely tied to QH?  QHs are less likely to be insulin resistant without the provocation of PPID than other horses so that makes it even more likely that your solution is more pergolide.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Banamine/Gabapentin/Pentoxifylline

Eleanor Kellon, VMD
 

Alicia,

We really need more views. It does look like there is a soft tissue density at the toe on LF and pressure from that could be causing the indentation in the coffin bone.  The "calcifications" I believe are soil, both feet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Phyto-Quench

Eleanor Kellon, VMD
 

Both her insulin and her post TRH ACTH were way over the top.  The uncontrolled PPID is likely driving her insulin. It's not only cortisol/ACTH that causes this in PPID horses.  The other hormones do too.

You are absolutely right that phenylbutazone typically does not do much for laminitis pain and she may very well have arthritis. More comfortable on extension than flexion suggests knee or fetlock but you would need a good lameness exam with nerve blocks to pinpoint pain locations. Even if she does have arthritis  pain, that's no reason to ignore her metabolic issues or you will be adding more foot pain to the mix.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Need assistance with trimming hooves and BCS

a.k.a.petpalace2@...
 

Hi Cass,

Do you have any recommendations regarding brand of rasp and where I could purchase a high quality one?  We bought a "Tough-1 farrier rasp" from Tractor Supply. which seemed fairly decent but wasn't very expensive.  I suppose you get what you pay for so probably will need to upgrade.  Over-all I would say Apollo is fairly easy to trim although better easier with front than back hooves.  Personally, I think a hoof stand would make rasping easier but a good one is expensive.  Farrier's coming to do trim tomorrow.  Interestingly, Apollo doesn't seem to outgrow his Cloud boots between every 4 week trims.  Maybe that's part of his problem, i.e. slow hoof growth. Hopefully, that will improve with more time on a better diet.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Please help with hay analysis

epersh@...
 


Re: Banamine/Gabapentin/Pentoxifylline

Eleanor Kellon, VMD
 

Alysoun,

Please do share.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Need assistance with trimming hooves and BCS

a.k.a.petpalace2@...
 

Thanks for info.  Actually when Apollo was foot sore, I couldn't really tell which was side more sore.  I had issues with previous farrier who had been trimming Apollo for 8 years.  Right hoof toe crack would come and go but he had it more often than he didn't.  Couldn't understand farrier's treatment approach which was to notch out crack every hoof trim.  Said he needed to clean out crack yet denied need for any other treatment.  When Apollo became acutely laminitic, farrier requested x-rays but then seemed to do same trim he had always done i.e. long toes on hoof x-rays.  Actually a blessing when he abruptly quit.  Current farrier seems to have a better idea about how to do balanced trims but I've also had some concerns.  Early on he was using hoof knife to remove some of Apollo's soles, especially on left front, most affected by laminitis.  When I questioned this, he said he had to remove calloused part of sole but this made sole uneven with small divets all over it.  Fortunately it has grown out fairly well.  Apollo scheduled for farrier trim tomorrow.  Will relay info other ECIR members have provided and keep fingers crossed he won't get upset.  He was okay with doing hoof photographs but felt they don't always accurately reflect what's going on with hoof because they're only two dimensional.  Really thinking I should learn to do my own trims so I'm not so dependent upon someone else and would have full control of what kind of trim he gets.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Re: Weighing hay

kristiel
 

Thanks everybody for all the suggestions on weighing hay. As usual, I was making it way to complicated. I found an old Rubbermaid tote that is exactly the size of hay flakes and it holds around 9 lbs of hay! It’s perfect. Thanks again!


--
Kristie, Siena, and Satch in Western Colorado 2022
( https://ecir.groups.io/g/CaseHistory/files/Kristie%20&%20Siena )

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