Cory (IR) new test results, YEAH!
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paulah@...
Cory's tests results are back from April 15th blood work, using new vet. She came highly recommended and when I told her Cory was IR at age 5, she was very concerned and thought we should really carefully check his ACTH in case it was driving the IR. At least she thought there was a problem! When she came out she wondered if the previous clinic, who pulled blood for me three times prior (Aug 2013, Sep 2013 and Jan 2014), did not handle the samples correctly. I mentioned that degraded samples usually give falsely low numbers, not high numbers. All work except glucose was done at Cornell. She finally texted me the results today and said all numbers were normal, except Leptin, but given his normal insulin levels, this was not significant. Below is a summary of his glucose, insulin and leptin numbers (updated CH also available, see link below). The vet appears to think he is normal. Plugging the numbers, he is G:I = 3 (severely IR), but his IR status is compensated IR, laminitis risk. I have not discussed this any further with her yet but it will be interesting to hear what else she says. I would love for him not to be severely IR, but considering that he was most likely IR as a skinny 2 YO when I bought him, I am happy that we may have achieved compensated IR status! I am so grateful to have the information and advice provided by this group. Otherwise, I might once again take the vet's advice and put this poor boy out to eat grass to his death! Cory's appearance and behavior are consistent with him doing much better than in January when he was getting only 10.3% s/s hay and no grass. Current hay is a record low of 5.1% s/s fed very slowly with our new hay pillows. I don't know if he can tolerate a hay higher than that but at the moment I have no need to ask that question. The individual results thrilled me but the G:I brought be quickly back to earth. It means no mistakes permitted! It looks like we have diagnosis and diet pillars strong but I am still worried about the trim. Trimmer will be here on Friday, so after that I will take a good set of photos for feedback. She seems frustrated with his tendency to break over the outside of his right foot instead of the front. I keep wondering if the laminitic wedge or whatever you call it puts pressure on the front and he is avoiding it. She has started suggesting I need a vet/chiro/accup to work on him because the problem is from his body and not his feet. I have a chiro that does work on Cory once a month and Cory's shoulder was out, but I am still thinking it is his feet. She thinks my current chiro is not getting the job done. Question: How soon do I need x-rays? The last ones were January 8th. The new vet is not on board, thinks his feet are too small as it is, and now seems to think he is not IR anyway, so not much help there. His feet do look better, I think, but the exercise part of the program is limited by my concern for his feet. He walks down the drive for turnout (turned out with a taped muzzle and only for 45 minutes to avoid his pasture mate helping him get the muzzle off) and I hand walk him for 20' about 5 days a week. We have been increasing the hand walking over the last couple of weeks, but he can be a little challenging to hand walk even after turnout. He does occasionally trot and canter during turn out and seems comfortable with no obvious negative consequences as far as I can tell. He has not been on pain medications in months and he is no stoic, so it would seem he is fairly comfortable. He has gotten sore after some of the trims. He eats boots, literally, so that is not a great option for him. I have studied the mark ups but do not understand enough to try to trim him myself at this point. Any feedback or suggestions on how to proceed from here? Thanks to everyone, Dr. Kellon, volunteers, members who share their questions, stories, losses, successes and failures. I have learned so much and you have helped Cory so much! I am inspired and infinitely grateful! Paula (Cory IR and Onyx no ECIR) in Bucks County, PA, USA EC 2014 NCRplus2011 https://groups.yahoo.com/neo/groups/echistory8/files/Paula_Cory/
https://groups.yahoo.com/neo/groups/echistory8/photos/albums/275503778
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Hi Paula
I would want to talk with the vet about the handling of the April labs. The reference range for glucose at Cornell is 71-113 mg/dL. Your glucose is low enough to potentially point to an issue. Mishandling would affect the insulin too. Leptin can be a good indicator of IR and should not be dismissed. You are doing a really good job based on your clinical signs. I'm sorry to potentially rain on your parade. Have been in your position and made some bad mistakes based on labs that were not accurate. Just watn to make you that you investigate further. Nancy C in NH ECIR Moderator 2003 Learn the facts about IR, PPID, equine nutrition, exercise and the foot. www.ECIRhorse.org Check out the FACTS on Facebook https://www.facebook.com/ECIRGroup Support the ECIR Group Inc., the nonprofit arm of the ECIR Group http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc ---In EquineCushings@..., <paulah@...> wrote : Paula (Cory IR and Onyx no ECIR) in Bucks County, PA, USA EC 2014 NCRplus2011 https://groups.yahoo.com/neo/groups/echistory8/files/Paula_Cory/ https://groups.yahoo.com/neo/groups/echistory8/photos/albums/275503778
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paulah@...
---In EquineCushings@..., <threecatfarm@...> wrote : Hi Paula I would want to talk with the vet about the handling of the April labs. The reference range for glucose at Cornell is 71-113 mg/dL. Your glucose is low Nancy C in NH Vet say she had to get new strips for the glucometer and that sometimes gives spurious results (!?!?). I had not told her I was interested in the ratio of glucose and insulin. She said the samples for Cornell were handled according to protocol and indicate that the diet changes have Cory in the normal range. She did not detect pulses when she was out April 15th to do the blood work and vaccinate against rabies and flu/rhino. When I mentioned that Cory gets sore on the stone driveway after a trim, she said he did not have much foot. When trimmer was here on May 2nd, she felt pulses in all four feet, not bounding but there. She said it indicated systemic inflammation. I felt them too that day and for the next couple days. Wasn't sure today... I scraped the grass further back along the paddock fence line. With all this rain, the grass is growing where it doesn't normally. He is turned out with a taped muzzle for 45 minutes while I clean stalls and paddocks, so we walk a couple minutes down the drive, he often runs around a little in the pasture, trot and canter, looks sound and comfortable (and he is no stoic!), and I hand walk him every other day for 30 minutes (haven't been able to fit it in every day). Help with feet, please: I posted hoof photos to get an evaluation of how we are doing with that. I tried to compare these latest ones with the mark ups that Lavinia had kindly done for us. I think we are much closer than three months ago but not sure if we are there. Trimmer says the coffin bones are in proper alignment now. She is frustrated with his tendency to toe in and roll over the side of his hoof instead of the front. She thinks I should use a new chiro/acup/vet instead of my regular chiro as she thinks the problem is further up in his body. She thought I could add some lateral work in-hand to keep us entertained and maybe open up his body after all this time on the paddock with little exercise and no work. Still no tight circles or lungeing. Would someone please give us some feedback on the feet? Thanks so much to everyone for all the information and encouragement. I get discouraged sometimes, but we have made a lot of progress. "When going through hell, keep going." --Winston Churchill Paula (Cory IR and Onyx no ECIR) in Bucks County, PA, USA EC 2014 NCRplus2011 https://groups.yahoo.com/neo/groups/echistory8/files/Paula_Cory/
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PapBallou@...
Help with feet, please: I posted hoof photos to get an evaluation of how we are doing with that. I tried to compare these latest ones with the mark ups that Lavinia had kindly done for us. I think we are much closer than three months ago but not sure if we are there. Trimmer says the coffin bones are in proper alignment now. She is frustrated with his tendency to toe in and roll over the side of his hoof instead of the front. Paula - Lavinia did your last markups. I'm not certain she's readily available so will take a look a better look tomorrow. About the toe -in...Cory has medial-lateral imbalance and remodeling of the coffin bone. It may simply be that that is the way he uses that foot because of the internal changes. Will post more tomorrow when I can look more closely. Linda EC Primary Response West Coast May 2004
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PapBallou@...
Paula -
I think the trim is pretty nice. I added two markups here: The toes can definitely come back so that they 'kiss' the white line. There is a little bit of dead sole that has pushed forward into the small space the toe length has made, making it appear there is no room for more rolling or beveling of the toe. The sole markup - follow the green line which is actually Cory's white line. It disappears under a small 'ledge' of sole which is outlined in blue...a false toe callus. Trim to this line with the toe up on a toe stand, and with the rasp, back the wall. The red dots show how much wall can come off, both in the toe, and the heel/bar area. It also appears that the heels are purposefully being left high above the sole. There is a thought that this encourages sole depth, but only if the horse is in such squishy terrain as to let the heels sink to allow the coffin bone to achieve its more correct orientation with the ground. Those feet look quite dry so this would not be a trim decision I would make. Also on the topic of 'quite dry' - since I live in a wet, cold winter environment and a very, very dry, hot summer environment - the hoof capsule/sole/frog shrink as they lose winter moisture and they don't do it all in the same proportion. I find that the sole/callus shrinks before the walls, often leaving a bit of a gap where the WL is, making it appear to be separated, just as what I see in your photos. I actually hate spring trims around here since this transition foot never quite looks the way I want it to. Then come late May and all is well again when the horn structures are equally dry. The toe- in - the DP x-ray from a few months ago demonstrates a M-L imbalance, as the arrows show from Lavinia's markups. There also appears to be a deficit or remodeling of the outer aspect of the CB. The orange lines highlight this. I also think the x-ray is not quite perpendicular to the CB, so some of this appearance may be more technical than a magnitude of the problem. Purple circle shows small development of sidebone, which would be expected with a horse that is loading his foot/weighting to the outside as he breaksover toe-in. Why he does this, certainly can't say. Chiro, etc may relieve any discomfort that he has in the upper skeleton from walking a little 'out of kilter' but it is what it is. There are so many, many toe-in, toe-out horses, (and people with conformational issues!) and the worst thing anyone can do is try to correct this to appear to be 'normal' on a grown animal. This is his 'normal'. IMO, I would trim those heels to be more at the level of live sole plane so the CB can seek the loading pattern it naturally has. Many feet with such a twist will begin to modify themselves. I don't see a current photo of the RF sole, but in the photo from several months ago, he clearly is not wearing an odd pattern to his wall. His foot works for him, and I suspect that it may only show a wear pattern when he gets too long. So, lots of words that really boil down to "looks pretty darn good!" and would suggest a few little tweeks. Not twerks as I first typed in total error! Darn keyboards! Linda EC Primary Response West Coast May 2004
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Lavinia Fiscaletti
Hi Paula,
Saw Linda's reply to you. One of us will get back to you shortly with more in depth comments. I've been having access issues with Neo :( Lavinia, Dante, George Too and Peanut Jan 05, RI EC Support Team |
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paulah@...
---In EquineCushings@..., <PapBallou@...> wrote : Paula - I think the trim is pretty nice. .... So, lots of words that really boil down to "looks pretty darn good!" and would suggest a few little tweeks. Not twerks as I first typed in total error! Darn keyboards! Linda EC Primary Response West Coast May 2004
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PapBallou@...
Paula -
It's cold, I have a cold, and the computer is acting strange. Will send you a link to the info about live sole plane a bit later, and will explain what it says, here. It can make your eyes glaze over since it's quite detailed...but once you get the gist of it, it makes easy sense. More later - Linda EC Primary Response West Coast May 2004 |
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PapBallou@...
OK -
I use the term live sole plane in the heels quite a bit. It's how I find heel height (for most horses) and is part, I say, part, of the trim method advocated by Mike Savoldi. I can't link the actually document, but if you go to the files of ECHoof and scroll down to Heel Height and Uniform Sole Thickness, you'll find it. If anyone has paid attention to hoof form, you know that there are all kinds of shapes and sizes, and even with a new trim/set of shoes, the foot often just doesn't look right. All you need to do is google shod horse hoof and you'll find a multitude of photos, with few having much resemblance to each other. One of the ongoing problems, especially with feet that are shod, is getting and keeping the balance correct - balanced in three dimension TO THE COFFIN BONE. I know for a fact what it's like to trim granite feet, and if it weren't for the grinder, I clearly would not be trimming as much as I am. What Savoldi has done, as I read his work, is address this situation of NOT finding the correct hoof form before setting the shoe. He bases this method on the fact that the sole is of uniform thickness where it joins with the wall...sole in the heels, toe and quarters at that junction are of the same thickness. Therefore the trim should allow the wall/sole junction to be ON THE SAME PLANE. Heels above the level of the live sole are making the trim/orientation of the coffin bone out of balance. The dissection photos clearly show this. His trim method advocates removing all dead sole so that you get down to live sole across the entire foot. By doing this, you 'reveal' the foot to what it truly is and know how to therefore trim it. Dr Bowker advocates in several of his articles to do this on the first trim in order for the hoof care person to"see" the real foot. IMO, that is generally unnecessary in that there are other, less draconian ways to find the proportions of the foot. But, if you trim the heels to LSP, you can radius the rest of the wall around the foot to join up to be on the same plane. You will have sole, an obvious white line (not hidden anywhere) and a wall that you bevel or roll, or leave flat for a shoe. This also leaves the callused sole untouched, and the bare horse can do with it as his environment and movement allow. Trimming to LSP in the heels means just revealing a very small area of waxy sole in the back of the "V" of the heel/bar triangle. Look at the first photo in this album. While it's a toast dry desert foot that may look different than those of horses in wet or humid climates, you can see that there is just a bit of WL exposed in the heel/bar triangle. The rest of the walls are radiused with the rasp, OK, the grinder, to make the wall, WL and sole on the same plane. No other dead sole has been touched on this foot. Tex wears it this way in the summer. He's almost at the point of needing a touch up trim of the walls. Shod feet don't readily exfoliate dead sole, so there is usually a large build of in the cup of the foot. If the farrier does not remove this, or only addresses what can easily pop out, the foot begins to get bigger - more build up of dead sole, a larger cup (hoof capsule) develops. You have an out of balance foot. Let heels be high, and you change the loading pattern of the foot to put more weight bearing onto the toe sole...which actually has no additional structures to share the load in the same manner as the sole in the heels, which has buttresses, bars, frog. In the lateral x-ray of Cory, it appears that this little stiletto of a heel has slipped off the back of the block he was standing on. I know some folks like their horses "to have a little heel" since they think they support the horse better. I never found heels to be comfortable or supportive at all. All it does is throw off the balance of the coffin bone, except in certain terrains. Linda EC Primary Response West Coast May 2004
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paulah@...
Hi Linda,
Thanks for your patient and detailed explanation. I am struggling to understand the actual details. I understand the concept of aligning the structure but not the execution yet. I would like to discuss with the trimmer but need to study more to understand. Is there additional material and photos available somewhere that would be appropriate? I hope you feel better soon! Thanks again, --Paula ---In EquineCushings@..., <PapBallou@...> wrote : OK - I use the term live sole plane in the heels quite a bit. It's how I find heel height (for most horses) and is part, I say, part, of the trim method advocated by Mike Savoldi. .... In the lateral x-ray of Cory, it appears that this little stiletto of a heel has slipped off the back of the block he was standing on. I know some folks like their horses "to have a little heel" since they think they support the horse better. I never found heels to be comfortable or supportive at all. All it does is throw off the balance of the coffin bone, except in certain terrains. Linda EC Primary Response West Coast May 2004
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