Jesse was examined today with a blood draw for cornell  for insulin and cbc stat labs:

Doc took off the LH wraps  that we were wrapping for abscess bec of ouchiness and lifting resting of the LH. 

Vet pared the hoof a bit and saw clear signs of laminitis on LH( 2 pics uploaded ch photos section  "  Jesse LH  2 photos taken"

Questions:

   Vet  is still suggesting 10-15 min daily walk based on how Jesse walked today.

  thoughts on this?

    Trainer suggested i ask here if we should get any boots for the rears?  If  yes, type?  

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

lj friedman san diego nov 2014

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

Oops - meant to include link to photos.

https://ecir.groups.io/g/CaseHistory/album?id=2621  
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

thanks for the reply.

I knew from my reading..never to walk a laminitic horse\

farrier sched for thursday

will order boots for the back feet today
--
LJ Friedman San Diego Npv 2014

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

Hi LJ,

Agree with Jaini regarding the walking - NOT NOW. The trim is nowhere near where it needs to be so that is playing a part in slowing Jesse's recovery.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Jesse's photos are located here:

https://ecir.groups.io/g/CaseHistory/album?id=2117&p=Name,,,50,2,0,0 

The link to his photos can always be found in his case history and I've also added it to Jesse's Case History document's description
--

Hi LJ,

I've added a mark-up to Jesse's album here:

https://ecir.groups.io/g/CaseHistory/album?id=2117&p=Created,,,20,2,0,0

Shows what needs to be done with the toe on the RF - back it up in the horizontal plane WITHOUT taking any height away in front half of the foot. The result leaves you with a "snub-nosed" look rather than a thinning of the entire dorsal wall. 
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

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

I looked over the picture of suggested corrections to Jesse's RF. The farrier suggested we could do something like this (to me it almost looks like resectioning the toe) and said that he has used this method with a lot of success when he was primarily working on laminitic horses, but was hesitant to do this in Jesse's case. I am also concerned about doing something so drastic when Jesse seems to be doing so well now. What would be the benefit of this if he seems like he is already well on the way to recovery? He seems to be walking comfortably on all four feet and is so much brighter now!

--

Julie W from Southern California December 2016

Hi LJ,

Same thing - need to bring the toe back. I can't see the heels due to the sand covering them (know you've had some health challenges that make getting better pix difficult) but looks like they're under run as well. There is too much wall length being left that creates an illusion of concavity. True concavity is created by the gorse being suspended up higher within the hoof capsule, not by leaving the walls longer or by carving concavity into already too-thin soles.

The trim needs to be tightened up all around, on all four feet. If the farrier is saying that you can't take the toes back in the horizontal plane any further because they are already at the "white line", that is incorrect. The white line has been stretched forward along with the toes into an unhealthy position so need to go thru it while NOT rasping/scraping/cutting anything off the bottom.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Hi Julie,

Resectioning involves cutting into live tissue, a veterinary procedure. Backing the toe so that it does not extend beyond the point where the new angle of growth coming in under the coronary band would hit the ground only removes dead, non-functioning material. That excess horizontal toe length impedes the breakover of the bony column with each stride. It creates tearing pressures (and pain) on the already compromised laminar bonds, weakening them again every time the foot takes a stride.

If you have long fingernails and bend one backwards every time you try to pick up an object it's painful because it tears the attachment of the nail away from the nail bed. This is the same type of thing, except those connections are supporting the weight of a horse, not just the pressure of your hand. A correctly aligned hoof capsule that conforms tightly to the position of the bony column is the safest, fastest way to relieve pain and maintain the strength of the laminar bonds.

When you have a moment, have a read here for a more in-depth explanation:

http://www.ecirhorse.org/index.php/laminitis

http://www.ecirhorse.org/index.php/laminitis/realigning-trim

Download the Trim: Essential Missing Ingredient, from the 2015 NO! Laminitis Conference here (free):

http://www.ecirhorse.org/index.php/conference-proceedings-recordings/2015-no-laminitis-conference-proceedings/2015-no-laminitis-outline-downloads

HTH.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

Just to toss in my two cents worth: I totally agree with what Lavinia is saying. My experience with my horses was that I pussy-footed around, wringing my hands and not wanting to get the toe back. The result of this was that for a year I battled those stretched, thin soles and under-run heels, and the horses were just not as comfortable as they could have been. When I finally rasped the toe back, perpendicular to the ground, from the top, Merlin in particular walked off with a bigger stride. You could almost the thought-bubble over his head: "Finally!"  

It is not an aggressive trim; it is merely putting the foot in the best position for a healthy capsule to grow.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy

jesse continues to do well.. happy eating well   and appears to be walking w/o discomfort,( to my eye, of course) 

 Trim delayed bec of the weather.   Insulin results in. ( will input to ch)

Cornell  1/09/17     164.17        range 10-40

A few questions to Dr Kellon:

 with  a modest drop in insulin levels.( from 197)  should the metformin be continued?  till when? thoughts on that level of drop? 

Per vets rx. I'm still giving 1gm aspirin a day;; ok to continue as dose is so low it wont make a difference? or stop?

pentoxyfiline almost running out..   no need to refill, as you said its .probably not doing much? 

Is it Agreed that with the continued hi insulin, that probable cause of the laminitis was most likely insufficient pergolide control during the rise?  or we can never be certain?

He has easycare cloud  boots on all 4 legs..  getting massaged and sore no more to hocks and back end muscle area.

any treatment change needed based on the above? 

Vet suggested walking Jesse,which we arent doing.  Is there a usual amount of time that passes from the acute laminits, to appearance of looking good,  when we reconsider rehab walking? 4  weeks? 8 weeks?  more?  how do we know?  send video of jesse walking   here  so you can have a look before we consider that?  thanks

--
LJ Friedman San Diego Npv 2014

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

NO on continuing aspirin - it is an NSAID. I don't believe it was clear that it was still being administered. 

Should not have been administered at the same time as banamine/Previcox was being given as it is dangerous to give multiple NSAIDs concurrently at any time. Also carries all the same risks for gastrointestinal upset as other NSAIDs.

Once Jesse appears to be pain free AND the trim has been fully corrected, then he can start on being hand walked in straight lines, wide turns. No riding until feet have grown out at least half of the current damage. Turnout to move freely on his own is fine as long as he isn't on any NSAIDs that would be masking pain and allowing him to overdo movement because he has no idea he is hurting himself.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

thanks for the reply.

With Jesse now having 4 easycare cloud boots on, when do these boots come off? would we consider taking hinds off before the fronts?

are they kept on during walks and turnouts?-- 

LJ Friedman San Diego Npv 2014

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

They should stay on as long as they make a difference in his comfort level. Until the trim is correct, I would recommend leaving them on as much as is possible.

If there is no change when you remove them, then leave them off. Any time he appears the least bit uncomfortable they should go back on. Only way to know which ones he needs on and when is to experiment and listen to what Jesse tells you.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team

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

 Trim delayed bec of the weather. 

That's not a good idea. There must be somewhere dry he can be trimmed.  It is absolutely critical to get the trim correct to keep him moving forward.  The Jiaogulan is going to increase the rate of hoof growth.

Insulin results in. ( will input to ch)

Cornell  1/09/17     164.17        range 10-40

A few questions to Dr Kellon:

 with  a modest drop in insulin levels.( from 197)  should the metformin be continued?  till when? thoughts on that level of drop? 

There are no studies reporting on its effects with insulins as high as Jesse.  I agree that's not much of a drop.  However, I'd keep on board for about a month and check insulin again before stopping.  There are also studies that show metformin  can protect the vessel linings so it may have been helping directly on that level.

Has Jiaogulan dose been adjusted to deeper pink gums and tongue?

Is it Agreed that with the continued hi insulin, that probable cause of the laminitis was most likely insufficient pergolide control during the rise?  or we can never be certain?

ACTH has been steadily dropping since October.  I'm sure it was a factor but you'll never know what the sugar and starch in his diet was all those previous months.

 
--
Eleanor in PA

www.drkellon.com  2 for 1 Course Sale

EC Owner 2001

thanks for the reply.

Trainer says gums are pinker. ( will post a pic of how gums/tongue looks today for a comparison. And I have increased amount of j herb   ) 

Trim is scheduled  for  this Tuesday.  Weather delay was based on farrier and  his schedule delays  ,( he doesnt live nearby and  bec Jesse is improving, it made sense to wait for him vs trying a new farrier without our farrier's experience with laminitis)   Trainer says she will be present at tuesday's trim and will show all the markups and directions that Lavinia gave us,.

Vet is on board with your required  trim and farrier wanted some confirmation from him, before he trimmed 

 
--
LJ Friedman San Diego Npv 2014

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