Hi Lorna, Yes, I tried to follow the instructions and I was able to download the file to my computer but it still would not open for me even then.

Thank you so much, Lavinia, I will send you the x-rays. Do you want the previous ones from January as well as her current ones?

I have always worked with Dr Kellon through private consultations and if I remember correctly, I've divided the doses in order to avoid stomach upset. Misty's  ACTH & Insulin have never been brought into normal range since her first labs were done in 2002. She has always had a sensitive system; (prone to mild colic or diarrhea) after she had severe colitis in 1995 from the Bute overdose and she has also been known to have a hypersensitivity to drugs. She is one of Dr Kellon's miracle horses.

Due to her strong will to live, I am willing to continue to treat her as though she is living rather than dying, however, I first must get her pain under control and that is what I need help with first. If I remember correctly, pain can alter the lab results (?)

Kris & Misty

Central Ohio

Oct 2002

Kris,

Send me whatever xrays you have. Both sets are helpful as we can see what changes have occurred from the first to the last. Current hoof pics would be great too.

Lavinia, Dante, George Too and peanut

Jan 05,RI

EC Support Team

Hi Kris,

Getting Misty's ACTH into the normal range should be a priority right now. That uncontrolled PPID could be the driving force behind all the issues she is having. Uncontrolled PPID will cause tendon issues and a host of other problems as well. Jaini has given you a great guide for getting your perglide dose higher to work toward getting that ACTH under control.

Have you considered botox injections for the contracted tendons? Also, a lot of muscle work to facilitate her ability to lower her heels. The demineralization of the coffin bone is likely due to the excessive pressure being placed upon it from the heels being too high.

If she is in a chronic state of pain then it shouldn't really skew ACTH results. Insulin/glucose may be a bit affected but you still need to know where they are so you can make management decisions based on facts rather than guesswork.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team

Hi Kris,

I have created an album with the latest xrays in it in the Photos section of ECHistory8, titled Mist Folz:

https://groups.yahoo.com/neo/groups/echistory8/photos/albums/419209585

Lavinia, Dante, George Too and peanut

Jan 05, RI

EC Support Team

Thank you Lavinia,

I am trying my best to keep things moving forward and I should hopefully have everything I need to start the Pergolide dose change from twice daily to once daily on Monday.

However, I can not find any comments, suggestions, or any further discussion any where regarding her feet after you posted her x-rays. Can you please point me in the right direction?

Thanks so much.

Kris & Misty

Central Ohio

Oct 2002

Hi Kris,

Good that you're getting the pergolide situation addressed. That needs to be your first and primary focus.

Would you be able to get some current hoof pics so we can compare them with the xrays to be able to give you the best advice? You can send them to me if you aren't able to add them to the album with Misty's xrays.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team

Hello everyone,

I just wanted to let you all know that I have posted photos of Misty's feet on EC History 8, which for some reason will not allow me to post the link here.

Please keep in mind that my Vet(s) and Farrier decided to allow her heels to be high due to her injured tendons, yet we have never been able to get them lowered again.

Thank you for any help that might be available here.

Kris & Misty

Central Ohio

Oct 2002

Hi Kris,

The mark-ups the vet has done on the previous xrays are good - they are what is needed currently as well.

Thank you again so very much, Lavinia.

Our Vet(s) & Farrier told me that if we were to trim Misty according to those "ideal" mark ups on the x-rays, that we would totally blow her tendons.

 This is why I have been trying for the past year to find someone who might be able to help us with a better alternative than what we've been doing.

We've known that we need to lower the heels, but we need to know "how" we can better try to achieve that?

Can you please tell me where I can find the information and instructions regarding therapy and massage work to stimulate and stretch the muscles? Also, is there any expert advice or guidance available here on the group about the Botox? I will ask my best Vet about the Botox but my guess is that if he knew much or anything about it for this purpose, he knows me well enough that he would have suggested it.

I tried to tag Dr Kellon once since my original post but I have not yet received a reply from her nor from any other Vets or Farriers here who may be able to help us further.

Kris & Misty

Central Ohio

Oct 2002

Hi Kris,

What exactly has been diagnosed as the problem with Misty's tendons? Have you ever had ultrasounds done to examine/diagnose the issues? If not, that needs to be on the "to do list" to see exactly what you are dealing with. Getting her heels slowly but steadily to the correct length won't "blow her tendons" as you are just aligning her feet to their correct physiological position - where they are genetically designed to be. High heels do not remove tension from tendons as the muscles they anchor just shorten to take up the slack.

Any person who is certified in equine massage therapy or equine muscle therapy should be able to set up a rehab program to work on this. It will entail working on getting the appropriate muscles to release and then using stretching exercises to maintain that release and build upon it. You will need to coordinate the PT with the work of the farrier so that s/he can build on the muscle work to achieve the needed hoof capsule changes.

Try searching for Equine Rehab facilities or large veterinary hospitals as they may have referrals available to qualified people.

You'll need to research the Botox option as that is really outside the scope of this list. There are some members who have used it - maybe one will respond if they see this thread.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team

Kris,

Another suggestion: Have the heels lowered to the point where Misty appears to not be able to stand down on them then have nerve blocks done to see happens. That will provide a huge amount of information.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team

My posts aren't showing up again. It's happened two days in a row. In years past, they would typically show up very quickly. Is there anything that I can do differently? Are the posts here now being "approved" before they actually post, perhaps making it so that there is a 2nd process involved which may be contributing to the interference?

Thank you both, Nancy and Lavinia, for your replies.
If you would please tag Dr Kellon for me, I would very much appreciate it as well. She was trying to help us with this but I did not recieve any email(s) from her regarding HOW to lower Misty's heels, when she was not able to put them down, so perhaps she can inform me here?

Here is the Ultrasound Report at the onset of Misty's tendon issue. I have absolutely exhausted myself since, trying to get information on exactly what to do and HOW to do it after this plan {below} failed. We continued to try to lower her heels without success. A Tenotomy is not an option for us

------------------------------------------------------------------- 

MISTY-FOLZ - Ultra Sound Report 05/10/2011

Misty has been doing better now that her feet are under control. Kirk has been doing an excellent job maintaining her
balance, etc. Misty did not grow any foot in the RF during the last trimming cycle. During her entire founder history, her
radiographs have always been "worse" on the LF foot. She has, however, always been more sore on the RF foot. Misty
has been more comfortable after the last few trims but she has been bearing weight abnormally on the RF foot.

Misty walks on the toe of the RF foot and does not drop full weight onto the fetlock nor lower her heel to the ground. Kris
mentioned that Misty will put full weight on the RF foot when she is on very soft ground (mud). Kirk and Kris had to stand
Misty in the mud the last time her feet were trimmed in order to pick up and trim the LF foot. Misty has not been making
hay piles to stand on in her stall. Misty's feet have been stable but she continues to have pain from some source,
especially in the RF limb.

Misty was mildly sensitive to flexion of the right knee. She has scar tissue present in the right check ligament and mild
inflammation around the RF deep digital flexor tendon about 4" distal to the knee. No sensitivity on palpation of the
proximal (upper) deep digital flexor tendon (DDFT), superficial digital flexor tendon (SDFT) or Suspensory ligament. Misty
exhibited increased sensitivity on flexion of the RF lower limb (fetlock, pastern, hoof). Misty also exhibited pain on
palpation of the plantar (back) aspect of her RF pastern. The RF pastern was also warm on palpation. Both hoof capsules
cool on palpation. Digital pulses within normal limits (quiet).

Discussed that the pain appears to be coming from the pastern region. Horses with injuries to the flexor tendons or
suspensory ligaments often exhibit the type of lameness Misty is displaying.

Misty is also exhibiting signs of a limb length disparity. These signs were not apparent previously due to her stance, gait,
and appearance of her feet. Now the RF foot is wider and more flattened in appearance. The LF foot is more upright.
When Misty stands square, the tops of her shoulder blades are not in alignment. She has varying distances between the
tops of her shoulder blades and her withers. Her RF limb is the tall limb (shoulder blade closer to the withers) and thus
bears more weight and has a flattened appearance to the foot. The LF limb is the shorter limb and thus bears more
weight. This altered weight bearing contributes to the more upright appearance of the LF foot. The limb length disparity
may be contributing to the continued stresses on the RF limb. Misty's acquired stance of placing the right front foot
forward also allows her to correct for some of the disparity. With the RF foot placed forward, her limbs are more equal in
length and she is able to relieve some of the tension of the flexor tendons in that limb.

An abaxial sesamoid (at the level of the sesamoids/fetlock) block was performed to desensitize Misty's lower limb. Due to
Misty's medical history, a small amount of antibiotic was added to the carbocaine.

Misty exhibited a 100% improvement in her way of going following the nerve block. She was willing to place full weight on
the RF limb and drop the heel. After the RF foot and pastern were blocked, Misty was actually a little more sore in the LF
limb.

Due to Misty's recent radiographs, we opted to start with an ultrasound examination of the pastern region.
Sesamoids and distal suspensory WNL (within normal limits). Misty exhibited scar tissue and fiber disruption in the DDFT
at the level of the pastern. She also exhibited a core lesion in the DDFT.

Plan:

1. We need to decrease pressure on Misty's DDFT and correct for her limb length disparity. 

2. Use double wedge cuff on the RF foot to decrease stress on the DDFT.
 
3. For the time being, use the single wedge cuff on the LF foot to help lift that limb. We will switch Misty to stacked thick
leather pads to provide a lift for the LF limb without the wedge effect.
 
4. Plan to keep Misty in the high wedge for about 3 weeks (unless she becomes more uncomfortable). After she has had
the double wedge on, we will place her in the single wedge to begin stretching the tendons and allowing more loading.

5. Misty has mild contracture of the flexor tendons around the knee due to her acquired stance and way of going.
 
6. Since Misty's feet have been stable, placing wedges is an option. We will still need to monitor her for discomfort and
change our treatment plan accordingly.

7. We briefly discussed glue on applications if needed to help decrease labor intensiveness of taping on cuffs and/or pads.
 
8. Misty will likely not require a lift pad on the LF foot indefinitely. Since the forelimbs are attached via muscles, her body
will compensate and help re-align the forelimbs. We can also leave the LF foot just a little longer to help compensate as
well.

Please call with any questions or concerns.

END OF REPORT

Kris & Misty
Central Ohio
Oct 2002

Nancy,

Would you please clarify the second half of this for me so that I'm sure that I'm understanding it correctly?

>>I have seen this work done with other horses who have long dealt with high heels. Also seen lots of animals on this group who did not acheive this with very bad results. <<

Thank you.

And Lavinia,

My farrier came today and he showed me how to rasp her heels in between his 4 week visits. He also gave me contact info for a certified therapist who is not too far from us. If she is willing to instruct me on what to do and how to do it, in between her visits, I am willing to do everything that I can.

I asked my Vet about PT and another Ultrasound prior to our last x-ray/trim appointment on July 22nd but he did not pursue that route after he saw the x-rays. I'm sure that I can get a new Ultrasound, perhaps from a different clinic where they say that they specialize in reading them, but I sure could use some detailed info and guidance from you or someone who's qualified here on this group regarding what to do with the info as it relates to lowering her heels and the therapy that she'll be getting. I'll need to know that we're all doing things right and working together as best as we can to try to accomplish this goal of getting her heels lowered without bowing her tendons.

Pergolide dose change from twice a day to once a day is nearly complete. New hay samples will be sent off for analysis on Tuesday, and I will get her labs done in 3 weeks as you suggested, BUT, is there a reason why I can't do the blood work sooner than 3 weeks since we have not changed the actual dose?

Thank you all again so much!

Kris & Misty

Central Ohio

Oct 2002