Date   

Re: HELP! Farrier hit blood vessel in sole

Sherry Morse
 

Hi Karen,

Based on the pictures you posted from early in July there is a lot to be improved in Apollo's trim (the flares and long toes being a good place to start).  You would need to post a picture of the injury for us to see where it is for us to be able to evaluate it but as he has no sole it's probably going to take a while for it to heal.




Pergolide doses and formulations to control ACTH

Nancy C
 
Edited

ECIR believes the best dose of pergolide is that which controls ACTH. For those of you struggling with the Rx portion of PPID control, here are a few links to more info that may help as you formulate a plan for your equine. This is especially important anytime you are preparing for the fall and seasonal rise.

Information on determining the best dose and formulation: https://www.ecirhorse.org/pergolide.php

A thread discussing working with a vet on getting an Rx for pergolide: https://ecir.groups.io/g/main/search?q=%23legalityofpergolide&ct=1

EDITED TO ADD:

How to assess pharmacies

https://ecir.groups.io/g/main/topic/26662758

ECIR Group testing of compound pergolide: Several years ago, the ECIR Group Inc. funded a small group of members who submitted their 30-day old pergolide capsules for testing by this lab https://www.arlok.com/laboratory-services/analytical-testing Stability is each case was found to be 90% or higher. Here's an older message from me https://ecir.groups.io/g/main/message/223447

Average dose? We have raw data collected from over 200 member horses on pergollide doses. We are working on quantifying this data and collecting more in the future. The average dose was 5 mg. My own gelding was on 14 mg in the last years of his life.  https://ecir.groups.io/g/main/wiki/1484

Hope this helps.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Re: Using diaper to pad hoof: how to determine appropriate size

Sherry Morse
 

Hi Karen,

Ideally you want to do diaper covered by vet wrap covered by duct tape.  If you do that it usually will stay on.  This is a good video if you want to have a look: Equine hoof bandage video - YouTube




Re: HELP! Farrier hit blood vessel in sole

a.k.a.petpalace2@...
 

I thought maybe Jiaogulan was part of problem given it can potentiate bleeding thus recommended it be withheld 24 hours before dental work.  Never expected this to happen.  Don't understand why it's so hard for farriers to accept anyone else suggestions.  This farrier lives locally, is well respected and has been trimming and shoeing horses for decades.  I know someone who is an endurance competitor who has him as a farrier so it's not like I picked him off a list on-line. He doesn't have a big ego and is very laid back so doesn't say much about anything.  I've printed off information for him but never gotten any feedback so don't know what he's thinking.  I've tried to respectfully ask about his trimming techniques and relay what ECIR recommends but obviously that didn't help.  In retrospect all that probably should have been a red flag.  I'm devastated this happened and if I'd learned to to trim him myself it wouldn't have.  Guess I just wanted someone else to share some of burden in caring for Apollo.  Is there any way to tell how long it will take for his sole to regrow? Will it probably be several weeks or several months?  Definitely bad to have it happen just as seasonal rise is starting as complicates watching for signs of foot soreness. Plan on taking x-rays again when he's more comfortable.  Based on his activity level before this last trim I'd say Apollo was doing very well in terms of both comfort and quality of movement so it looked like a full recovery was possible.  Of course, now there's seasonal rise factor to consider as well as his hoof injury. 
--
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: Solar Penetration

Sherry Morse
 

Hi Nicolle,

The conclusion from the study is that you need to be very cautious when administering the 2 medications together, which doesn't mean at the same time of day but at the same time at all.  You can read a summary from Dr. Kellon here: Giving Omeprazole To Horses Getting Phenylbutazone (groups.io).  Just something to be aware of.




Re: trickle feeders

 

Which feeder is this?  I have a Quick feed, but cubes are too big.

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


Re: Help for my mare Alaska

Bobbie Day
 
Edited

Hello Eli and welcome to the group.
I will be including your new member message below which is full of very important information to help you through this time with Alaska, (very beautiful name BTW). Please take note that there are hyperlinks included that will take you even deeper into the subject. The basis of the ECIR'S protocols is DDT/E which stands for Diagnosis, Diet, Trim and Exercise (but only if the horse is willing and able). I see that Dr.Kellon commented on your post, it's almost impossible for us to give you advise without more information on Alaska. We want to help you through this, but we need a case history. 
you don't say what her age is, her breed etc. 
1- You mention she has sometimes had heat in her feet and sometimes not? And hoof care hasn't helped her? What do you mean by this? We need to see pictures of her feet if at all possible and all x-rays that have been taken. What is her trim like?
2 - Diet, what exactly is her diet? Also mentioned as not helping, but we need to know what measures you have taken, what kind of hay? Has it been tested to be below our 10% recommendations? If not, are you soaking it? Also look at our safe feeds list in your message.
3 - Blood work was "inconclusive", and are confusing to you? Can you contact your vet's office and have those results sent to you? We need to have her numbers to be able to comment. 
4 - How long was she on the Pergolide? Dr. Kellon has commented on this many times, this is just one message but if you put "edema" in the search bar you will see many more. 
     https://ecir.groups.io/g/main/message/275492
5 - Ertugliflozin, can you give us more information as to why your vet prescribed this medication? 
6- Cold weather, we see a lot of cold induced foot pain, you can put her in boots (if she's not already) with a sock for warmth and get some lined shipping boots on her to help her to stay warm.            some horses can't tolerate anything below 40-50 degrees. You can also try Jiaogulan for increased circulation if her trim is in order.
7- We've had a lot of discussions regarding ovaries, but I will bow to Dr.Kellon on that subject, some members also come to mind, hopefully they will chime in as well. 

As promised your welcome message is below, please don't hesitate to reach out if you have problems with your case history, we want to be able to give you the guidance needed to help Alaska, as soon as we have more information, we can get you the help you need. 


Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 





Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: Using diaper to pad hoof: how to determine appropriate size

a.k.a.petpalace2@...
 

Think you're right about size chart.  Would even be helpful for people buying diapers for humans because same weight babies can vary quite a bit in size.  Tried to remember how old/big my daughter was compared to weight on package.  Wonder about cutting current diaper in half and using that piece to cover wound area as elastic in crotch tends to pull it off hoof.  First two nights stayed on but found in shavings this morning.  Soft pads aren't holding up to Apollo's weight so tried firmer foam but he wasn't comfortable so cut new one of  softer foam again.  Unfortunately don't have a lot of it and think healing is going to take awhile.  Small piece of gauze closest to wound is still firmly attached so I didn't disturb it. It didn't come off in stall when diaper came off so that makes me think it's rather deep but obviously don't know for sure. Gauze pad hasn't changed color and only usual hoof odor noted. Apollo had tetanus booster with EWE vaccine so he's covered for that.
--
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: Using diaper to pad hoof: how to determine appropriate size

a.k.a.petpalace2@...
 

Shirley,
Thanks.  We do have local Aldi's store and size 4 working with a 5" foot does help give me some idea.  I had to buy brand name because that's all farm supply store had and I didn't have time to check elsewhere.  Actually diapers, even brand name, are one of cheaper things I've needed to buy for Apollo.  However, I'd like to send bill hoof supplies to treat hoof wound to farrier who caused it!  Sadly, he hasn't even checked to see how Apollo is doing.  Said Apollo would probably be sore for a day or two. Wish that were true but probably going to be weeks for Apollo to get back to were he was before farrier trimmed. So hoof trimming 101 here I come!

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: Too much pergolide or increased too fast?

a.k.a.petpalace2@...
 

Martha,
You all do a wonderful job at helping.  Maybe I read too much on this site.  I usually print off those posts with info I want for future reference but not always.  I remember reading on someone's post that most horse usually need at least 2.5 mg but can't find it now. Maybe that was stuck somewhere in back of my mind too.  I'm very nervous what is going to happen this year with seasonal rise especially now that farrier trimmed too much.  He was doing fantastic before that, could trot and canter a bit on his side of paddock and was walking heel first contact wearing his boots. Yes, I should have learned how to trim him myself but I didn't.  Now I will learn regardless of whatever else is going on in my life because it's obvious it would be better than what I've been paying for.  And I would also save money so it's a win/win proposition.  But I have another horse and I really don't want to have to trim him too.  Don't know what I'm going to say to farrier but he won't be trimming Apollo any time soon.  I won't say never because universe has way of making you eat your words!  I anticipate he will probably quit just like last one. Our vet has been much easier to reason with and more willing to learn from ECIR's vast knowledge and years of experience working in the trenches helping horses with IR and PPID.  This is probably going to sound crazy but sometimes this feels like doing hospice care (been there/done that) because neither IR or PPID can be cured making Apollo an equine time bomb.  Of course, this is also a real life lesson in learning how to live in the now and taking each day at a time knowing the only thing we can truly control is our reaction to what happens.
--
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: Solar Penetration

Nicolle Dupont
 

Yes, hay is getting soaked for 1 hour and she loves salt so that is in separate bucket.  She would eat 1/2 cup of salt if I let her.

Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Mon, Jul 18, 2022 at 2:00 PM Cass in NorCal <cbernstein@...> wrote:
Nicolle, are you feeding wet hay? Are you salting her hay? Both should help with hydration. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


To soak or not to soak new hay

a.k.a.petpalace2@...
 

Bought 20 bales of grass hay last week and had farmer but rest on load on hold for me.  Cored all 20 bales for sample and Equi-analytical test results:  ESC 7.3% + starch 1.2% = 8.5%  Iron 134 ppm  Plan to also sample rest of load to make sure it's ok but at least I can start transitioning Apollo to new hay.  I was soaking previous hay since lab analysis only did minerals by wet chemistry and S/S by NIR which was < 10%.  Did well on that soaked hay but had to I rinse and drain before soaking due to heavy soil contamination.  Looking forward to simpler feeding routine.
--
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: Help for my mare Alaska

Eleanor Kellon, VMD
 

These issues are all very familiar to use. Please get a case history up ASAP.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Too much pergolide or increased too fast?

 

Karen, my thought about increasing the pergolide was to see if you could get his insulin down further.  I probably wasn’t clear on that.  You wouldn’t need to test ACTH or do a TRH stim test but testing his insulin would let you know if more pergolide helped.  I know all that is expensive and it’s not absolutely necessary to test.  I just feel that it would give Apollo more protection going into the rise and potentially even going forward from there.

When I first began my PPID adventure, I had the same questions you do.  I could get guidance but no absolutes.  Just as every horse is an individual, each PPID situation is also unique.  Fortunately, it appears that in most cases you can give more than adequate pergolide without causing harm.  If I were going to to plan on testing twice yearly, I would test just after the rise and again before the next rise, increasing the dose each time as needed.  While you can increase the dose during the rise, it seems that the increases are less effective than they would be at other times.

Don’t worry.  Your’e doing fine and we’re doing our best to give you good advice!
--
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


 
 


Help for my mare Alaska

Eli
 

Hi there, I have just joined this group and hope I am posting in the right spot! I am in desperate need of help with my beautiful mare Alaska.We have struggled with sub clinical lamanitis since we got her 6 years ago.Recent xrays have shown inflammation again and very slight rotation on her right front.She has heat in all feet some day and others none and sometimes just one. We have seen so many vets and can't get to the bottom of how to help her.Diet and hoof care hasn't helped her,you name it we have tried it.Her bloods are very confusing for me to understand but vets tell me they are in conclusive. She was trialled on pergolide just incase it helped but she became so much worse within 3 days and developed ventral edema and was very sick.We have recently tried a new drug called Ertuglifozin with zero improvement.She flares up over winter(we are in South Australia)and is much better in the summer but still not 100%.She also has issues with painfully cycles and her left ovary twisting.Please help! and info or advice would be greatly appreciated.Eli and Alaska
_._,_._,_
--
Eli South Australia 2022


Re: Too much pergolide or increased too fast?

celestinefarm
 

Karen, we all understand about feeling overwhelmed because the vast majority of us have been there. One of the frustrating problems with pergolide dosage is getting the dosage right when you cannot test constantly. And few of us can afford to test after each increase. I can't. I just increased Juniper's dose from 1/2 tab to 1 full tab today as she became a bit footy yesterday. Her ACTH was 33 pg/ml ( range <30) She symptomatically responded to the 1/2 mg. for two weeks, then became footy yesterday. Nothing in her feed, hay, routine, etc. changed but we are in the seasonal rise and I believe I am fighting that. We'll see. I want her in the teens and low 20's, but for now I need to monitor symptoms. You may have to simply increase in slow amounts and monitor symptoms. They all react differently to pergolide and numbers are not the only story for them. Sometimes you have to go by symptoms, which is hard when you are not familiar with what to look for. Taking photos of crests on your cell phone, eye weeping , etc. can help provide dates, etc. so you can see improvements. Make notes of if there is soreness, loss of appetite etc. Plan testing for when you get the most bang for your buck. Meanwhile, discontinue anything that isn't necessary and of benefit.( so often people come here with a wagon load of supplements that either duplicate or aren't of value )  Drop anything you know isn't working and let the group help you trim down to what does. That will help your finances.




Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Re: Too much pergolide or increased too fast?

Lorna Cane
 

Karen it is indeed overwhelming,and I don't see any apologies warranted.

Just know that this group has been around for a very long time ( 2000?) and its members have been ,in some cases,blazing the way for new and better information.There is always more to learn,but we have been boots- on- the- ground participants,as horse owners and care givers.
Most of us know what it's like to be where you are now,not that that is much comfort to you,really. But through our tears we have been able to determine what works and what does not work. Horses vary,of course,so can vary in their responses to various treatments.
One of the hardest things to do is go against 'common practices' and professional advice,when these run counter to what we have learned here,in the field,with thousands of horses.
Now I feel as if *I* should be apologizing for the rant,but am just trying to help give you a leg up.
--
Lorna in Eastern Ontario
2002


Re: Solar Penetration

 

Nicolle, are you feeding wet hay? Are you salting her hay? Both should help with hydration. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Using diaper to pad hoof: how to determine appropriate size

Shirley J.
 

When its wet outside, I put diapers on Olaf's feet inside his cavallo boots to absorb any moisture that leaks in.  They are good for about 1.5 - 3 hrs depending on how wet things are.  Then I bring him in, dry off his feet and put on dry boots.  He's a size 4 diaper with about a 5" foot (the 3's were a bit narrow).  Also, not sure if there's an Aldi grocery store by you, but I found them to have the cheapest diapers.  

--
Shirley J. in Michigan
Joined 2020 (because what else could go wrong?)
https://ecir.groups.io/g/CaseHistory/files/Olaf%20and%20Shirley
https://ecir.groups.io/g/CaseHistory/album?id=254671


Re: Too much pergolide or increased too fast?

a.k.a.petpalace2@...
 

Thanks for additional info.  I understand that PPID is a very complicated disease and there's still so much that's unknown.  And I realize everyone is doing there best with what is known.  I apologize for misinterpreting everyone's recommendations.  Hopefully over time I'll become more comfortable in managing Apollo's IR and PPID but for now I'm finding it overwhelming.
--
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
 

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