banamine for laminitic pain


LJ Friedman
 

Jesse is getting 500mg of banamine  around 8 am and another 500,mg at 4-5 pm/.   10 clicks each time..  the tube is 30ml 50mg/l and one tube is good for three days for the avg horse.

Dr. Kellon aterted me more than once. that this is an overdose.. I told my vet I was told this was an overdose and he opened some app and said it was ok.

Today. I took the time to analyze the numbers and 10 clicks per 24 hours is the max dose..  500mg for 1000 lb horse

Also, today. I emailed my vet just reminding him that we are giving 10 clicks ( 500 mg) in the am  and 10 clicks ( 500 mg) in the early eve.    His reply.  "  yes, that is the maximum I give for a horse this size."

I told my trainer to change to 10 clicks  ONCE a day. until I figure this out

Before I fire this vet.. ( poor x rays were taken as well.) is there ANYTHING  correct about his  doseages?   ie Jesse walking so poorly..? acute ;laminitis?

hoping dr kellon can reply .. ( though she has already commented.. I'd appreciate another comment before i take action) thanks

--
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


Nancy C
 

I'm not Dr Kellon, but I worry you are not hearing us lj.

Based on personal experience both with abscess and with laminitis -- which, IME, can be occurring at the same time -- no to any use of banamine.

He could develop laminitis not only from metabolic insult like uncontrolled PPID, but also from compensating for his RF due to bad trim, abscess or both. He could develop additional abscesses in one or both feet from any of these issues.

Getting him comfortable is key and NSAIDs are not the way.

Did we ever see pictures of the last trim?

Continue to look for abscess in the RF.  Keep him correctly trimmed. Every two weeks.

--

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
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LJ Friedman
 

thanks for the reply. We've had crazy rain causing a delay in pix.  Bec x rays showed no abscess, I continue to  be comfortable with giving the proper dose??? of banamine for the limited comfort it gives.  and dr kellon has said it does give a bit of comfort. pix as soon as I can.. I'm not forcing him to walk as you suggest. so perhaps tomorrow. things will improve for pix..  thanks again;;  

oo

--
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


LJ Friedman
 

I have boots/pads on order.. slow bec of the holidays
--
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


Lorna Cane
 

>>>I continue to  be comfortable with giving the proper dose??? of banamine for the limited comfort it gives.  and dr kellon has said it does give a bit of comfort


In Dr. Kellon's words yesterday:

"It makes no sense to use Banamine IMO.

It's also not innocuous on other fronts. It clearly states on the label not to use it for more than 5 days. Side effects include oral and gastric ulcers, kidney damage and in some cases liver disease. Like all NSAIDs it binds to damaged tissues and is not completely eliminated for 72 hours. Duration of effect is 24 to 36 hours. Giving it twice a day is an OVERDOSE which increases all the negative effects."



--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Eleanor Kellon, VMD
 

On Mon, Dec 26, 2016 at 06:06 pm, LJ Friedman wrote:
I told my trainer to change to 10 clicks  ONCE a day. until I figure this out

Good. That's the correct maximum dose.  However, even this dose should not be used for more than 5 days. The manufacturer does this to avoid lawsuits if complications arise during a dosage regimen they recommended.

It won't kill him but you could be doing organ damage. 

This study shows what happens if you use the twice a day dosing schedule for 12 days:

https://www.ncbi.nlm.nih.gov/pubmed/20927172

Specifically:

".....Also, in donkeys treated with NSAID, hyperaemia, erosion and ulceration of the gastrointestinal tract, and congestion of the liver, kidney and spleen, were observed. Microscopically, hepatic and renal lesions comprised biliary hyperplasia and interstitial nephritis, respectively."

The Ulcergard can help (no guarantees) protect the stomach but not the rest of the gastrointestinal tract and not the liver and kidney.

Is it ever correct to deliberately overdose like that?  Not IMO.  Higher dosing does not provide more pain relief. It only increases side effects.
--
Eleanor in PA

www.drkellon.com  2 for 1 Course Sale

EC Owner 2001


Eleanor Kellon, VMD
 

On Mon, Dec 26, 2016 at 06:46 pm, LJ Friedman wrote:
Bec x rays showed no abscess,

 Most abscesses/collections can not be seen on  X-rays.  They are only visible if infected with an organism that produces gas or there is a connection to the outside that allows air to enter the area.  Most collections in laminitis are not infected and therefore invisible.
--
Eleanor in PA

www.drkellon.com  2 for 1 Course Sale

EC Owner 2001


LJ Friedman
 

Seems I was so stressed  when Jesse first went lame:

Vet told me" lets do 2 days of hi dose banamine and if he doesn't improve. then put him down."

So, that's why we were giving so much banamine.

Honestly. I must have been in  state of shock, bec i have no ,memory of this conversation. but my trainer said I was there and present.

Today. I started the metformin at Dr. Kellons siuggdose of 30mg/kg bid...  ( 13.5 - 1000 mg tabs twice a day is the rx ) \and soft ride boots should arrive in a few days



https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


Lorna Cane
 

Hi LJ,


Is your trimmer set up for next week ? That would be 2 weeks from his last visit?


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




LJ Friedman
 

yes  he will be trimmed next week...  there might be another decent traimer coming to the barn this thurs.  would a few rasps be helpful?  it , mite upset the current trimmer.. who is good..  I would have had jesse trimmed this week if  my regular trimmer was going to be here..
--
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


Lorna Cane
 

On Tue, Dec 27, 2016 at 07:46 pm, LJ Friedman wrote:
yes  he will be trimmed next week...  there might be another decent traimer coming to the barn this thurs.  would a few rasps be helpful?  it , mite upset the current trimmer.. who is good..  I would have had jesse trimmed this week if  my regular trimmer was going to be here..

 I'm not the one to answer that,LJ. But I think we're waiting to see pix of last trim,are we not?

If it were me,wrt  involving another trimmer,when you are happy with the one who is working on Jesse now (again, we're waiting for pix), I would leave well enough alone.
--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Lavinia Fiscaletti
 

Hi LJ,

Would be really helpful to see pix of his feet after the last trim and before he gets trimmed again to make any useful comments.


--

Lavinia, Dante, George Too

Jan 05, RI

EC Support Team


LJ Friedman
 


-- will keep same trimmer.,. will get pix today before he gets trimmed again
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


LeeAnne Bloye <ecir.archives@...>
 

On Tue, Dec 27, 2016 at 05:35 pm, LJ Friedman wrote:

Vet told me" lets do 2 days of hi dose banamine and if he doesn't improve. then put him down."

So, that's why we were giving so much banamine.

Honestly. I must have been in  state of shock, bec i have no ,memory of this conversation. but my trainer said I was there and present.

Today. I started the metformin at Dr. Kellons siuggdose of 30mg/kg bid...  ( 13.5 - 1000 mg tabs twice a day is the rx ) \and soft ride boots should arrive in a few days

Hi Lj,

I know I sound like a broken record BUT if you update your case history it will help everyone, especially you to know where you've been, where you are now so you can make a plan to effectively help Jesse.  All the details of what meds, feed

I know you have had blood work done since last July but the volunteers need to see it and compare to past blood work, diet etc.  To compare things the information needs to be in one document not spread over many different message threads. Please take a few minutes - I've done most of the work for you - and add all the details you've been posting about to Jesse's case history that I recently uploaded to his folder.


As far as I can see you've been advised many times to stop the banamine and told why by Dr. Kellon. Not sure you have done this yet but here is one more try.


From Dr. Kellon:

NSAIDs like Banamine worsen impaired circulation and block vasodilating effects:
https://www.ncbi.nlm.nih.gov/pubmed/25492024

She also said that it does very little to lessen laminitis pain. 

If it helps the following was taken from Pain Relief Alternatives to Bute and Banamine.pdf  and I think may help Jesse's situation.  

Chronic Laminitis Pain: If pain continues past the 3 to 5 day mark, the underlying cause has not been adequately controlled or you have significant structural damage that will take more time to resolve – or both. At this point, you should repeat X-rays (or get them if you haven't yet), to make sure the trim is correct, keep working on the cause and correcting it.
Your options for pain are:
• Do nothing. This is a very, very difficult course for most owners to take but some degree of pain is actually your ally when the feet are unstable. It lets the horse know he has to protect his feet. Simply standing on weakened laminae may cause damage. If the horse is eating and drinking well, passing manure and urine, not down so much that pressure sores are developing, let the horse decide, based on pain level, how much time should be spent up on those damaged feet. As a plus, many people have found that pain actually improved after stopping NSAIDs.
If ongoing pain is too severe to do nothing, at least switch to something besides NSAIDS. For moderately severe to severe pain, Uckele's PhtyoQuench is a standout and also helps improve blood flow. If feet are still hot and pulsing, combine with Microlactin.
• Once inflammation has quieted down, Jiaogulan is excellent for circulatory support. See files for details on use.
• For enhanced circulatory effect (e.g. In horses bothered by cold), combine AAKG with Jiaogulan. See files for details. Very affordable. Some owners have had good results with nitroglycerin paste applied to the digital arteries too.
• For horses that have had longstanding problems with IR and foot pain, or foot pain that does not respond despite establishing IR control, try acetyl-L-carnitine for neuropathic pain. http://www.bulknutrition.com/ p1186_Acetyl-L-Carnitine_Powder_1Fast400.html. Please contact me directly for dosing drkellon “at” gmail.com

Time is ticking on LJ and as you have said, Jesse sufferers.  Removing the laminitis trigger can't be done without clear and up to date case history.  As you said, you are in a state of shock at the idea you might need to put Jesse down.  PLEASE, let us help you help him.  Get Jesse's case history updated. I sent you an email (aol account) on Dec 27th but haven't heard from you.  Do you need help with this?  

 
--

- ​LeeAnne, Newmarket, Ontario - Email me (If link does't work use ECIR.Archives at gmail dot com)

ECIR Archivist March,2004

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LJ Friedman
 

thanks for the reply.. I'm working on the ch as I write this.

I sent what you wrote to my trainer.. since i have pq  and j herb.. it makes sense to give it a try.  ( slowly off the banamine of course)

ch in progress

fyi   lymes negative.. will include in ch

insulin retested  at cornell  .. levels same. 




--
LJ Friedman San Diego Nov 2014

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


LJ Friedman
 
Edited

Jesse is walking better... still dead lame.. but an improvement..   easycare cloud boots will   \ be put on tomorrow..

this email from my trainer when I suggested we try pq and j herb... I have tried triple dose pq twice a day for prev lameness and ti didnt work well , Jesse is my horse, of course,, not sure i am in complete disagreement..  :

I still don't think we should stop the banamine. We can talk to [the vet] about alternatives, but he needs to be on some kind of pain medication. Otherwise I think it is cruel to let him suffer so much. You can tell the group I said that. He is 26 years old with advanced Cushing's and laminitis from a cause we cannot identify. We need to keep him comfortable in some way, and I would choose potential damage to his gastric lining and liver (the latter which we can monitor through blood testing) to not giving him any relief from the pain. If he were a human, I would be saying he should be on morphine.

Everyone agrees that we need to find the cause. Does the group understand that there may not be a trigger we can control to get his insulin down and stop the laminitis? I would ask them what they would do in such a situation with a 26 year old with no front teeth who shakes from pain when he is standing on hard ground and forced to walk even a few steps.

Feel free to copy and paste directly. I would even be happy to comment/talk to them directly if you give me the link to your group conversation.

I feel that everyone is latching onto anything they can because everyone wants there to be something that can be done to help Jesse, to help him improve, otherwise we feel powerless and helpless as an animal is suffering. The reality is still that the odds are stacked against him, and even if he gets through this, it is extremely likely he will go through it again. Changing his banamine isn't going to doom him or save his life at this point.

FYI.I se nt out a sample of tim pellets for analysis and tc nat bal cubes are sched to arrive on tues.

--
LJ Friedman San Diego Nov 2014

ch link blank but i did upload a ch.  mod helping me on how to get a pdf fileinto a link  thanlks again 

https://ecir.groups.io/g/CaseHistory/files/LJ%20and%20Jesse


Nancy C
 

I wish I had more time for this response lj, but she's wrong on the banamine, especially if this is a subsolar abscess. She is certainly wrong about the human/morphine analogy. I have a mother in hospice so I understand about morphine. 

It's not just about his gi system, although that is a huge concern. Not sure how many more times we need to say, NSAIDs block healing.

As Dr Kellon has said over and over: Hope is not gone until you choose to abandon it.

I may be misreading but it appears she is asking you to move on, perhaps without adequate information of what is possible. It takes a team to get through this kind of rehab, lead by a confident owner. It is too bad your trainer is not familiar with the work of this group. An investment of time and a mind open to possibilities to see the work the group does, but you could start with the film.

https://vimeo.com/195362730

If he shakes on hard ground or when moving, don't ask him to do that.  This pain could easily be from abscess that can resolve through proper trim and numotizine. Even if he is penetrating that can still be resolved.  I have been there, done that and nearly put my horse down 15 years ago because I was getting advice like this.

Jesse is your horse however, lj, and we are not there with you. It is ultimately your decision how to proceed.

In the end this long distance back and forth  between the parties is probably not helpful, but you have my permission to share this with whomever.

I hope you can find what you need to move forward for Jesse's sake.
--
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
ecirhorse.org



Lorna Cane
 

On Sat, Dec 31, 2016 at 04:57 am, Nancy C wrote:

As Dr Kellon has said over and over: Hope is not gone until you choose to abandon it.

I may be misreading but it appears she is asking you to move on, perhaps without adequate information of what is possible.

 That's what I'm reading,too.

I wish it weren't so, for Jesse's sake.


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Lorna Cane
 

On Fri, Dec 30, 2016 at 08:09 pm, LJ Friedman wrote:
I would ask them what they would do in such a situation with a 26 year old with no front teeth 

 A 26-year-old horse, with no teeth is not that unusual in this group. There are/have been many horses here of that age and even 8-10 years older.And some (mine was one) in late 30' early 40's. People who haven't been around these horses have no idea, and can be spooked  when they do encounter one.

We have been trying to explain what we would do . Repeatedly.


>>who shakes from pain when he is standing on hard ground and forced to walk even a few steps.


Please do NOT stand him on hard ground  and force him to walk.


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Lorna Cane
 

On Sat, Dec 31, 2016 at 05:32 am, Lorna Cane wrote:
and can be spooked  when they do encounter one.

 Don't misunderstand the above.

Most of us *are* spooked  by this when we encounter it,especially with our own horses. We do not approach it casually. A lot of tears are shed.

But we live in well-founded hope.

We surround ourselves, and especially  our horses, with positivity, as we move forward using the protocols we know - from our work here -  to be appropriate and successful.

Sometimes the Dragon wins.

But not nearly as often as people unfamiliar with these horses would have us believe.

Having said that, horses are very good at letting us know when they're ready to let go, and we are there for them then.


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002