Need Help with IR/Cushings Pony


Sherry Hite
 

I am not new to this group and have been reading all of the posts on a daily basis since joining.  The information has been invaluable in helping me in my efforts to manage my 14yo Arab cross pony since I joined in 2015.  However, after over a year of not being able to get her insulin under control, I need to ask for direct assistance.  Diagnosis:  Her test results are on her case history.  She will have blood drawn for her spring testing on May 2nd.  The results will be added to her CH as soon as I get them.  Diet: I have taken Dr. Kellon's NRC Plus Course and feel that I have done a good job of balancing her feed and keeping her diet tight but I will be contacting someone on the mineral balancing list to verify that I am not missing something that is contributing to her high insulin.  She only has access to a dry lot and is not getting any pasture time.  Exercise:  This is the one area where I have fallen short.  I have been reluctant to start her on an exercise program until my vet assessed a clicking in her left hock.  She also has seemed to be somewhat lethargic for an arab and I was reluctant to push her too hard.  I wasn't sure if the lethargy was related to her hock or her elevated insulin.  Trim:  This is where I need Lavinia's help.  I recently had my vet do xrays of her hocks to try to determine what is causing the clicking.  I was told by the vet the xrays were negative.  However, she suggested that I put her on a series of Adequan injections to see if it helped.  Her first injection was that day.  I also asked the vet to do hoof xrays so that I would know whether the internal structures were okay or not.  The vet only agreed to do the fronts as she claimed they are the standard.  (My vet is set in her ways and can be very difficult to work with.  She becomes arrogant if she is questioned or suggestions are made.).  The xrays showed rotation and thin soles. She strongly suggested that I have shoes and pads put on her or else just let her be a pasture ornament for the rest of her life. (She is against barefoot horses and has nothing good to say about trimmers).  She also stated that Pepper may never be sound again.  As you can imagine, I was devastated.  I consulted with my trimmer who told me that she felt the xrays were not good quality and the poor technique may have made things look worse than they are.  She assured me that they definitely did not show damage to the extent the vet had led me to believe.  My trimmer also consulted with another well respected trimmer with more years of experience.  Their consensus is that the rotation is fixable and that casting may help with building more sole.  Since Pepper is not as energetic as she would expect an arab to be, the more experienced trimmer suggested long slow easy rides for exercise instead of any trotting for now.  Information from this group has always been not to ride at all until the hoof grows out so I hesitate to do much until I hear from Lavinia.  My trimmer came out two days after the xrays were taken, took pre trim pictures, did her normal 6 week trim, and took post trim pictures. I have created a photo album and loaded the xrays as well as the hoof pictures into it.  The pre trim pictures were taken so a comparison could be made with the xrays.  I am hoping that Lavinia can add us to her list and give suggestions on how we should move forward.  My trimmer also monitors this group so she may also have questions or comments.  In the meantime, Pepper is in boots during the day when she is out on the hard ground and barefoot when she is confined at night. 

I also need some help from Leeann.  I have tried numerous times to copy and paste the link to my photo album in my signature and it just refuses to "stick".  The album is under "Sherry and Pepper".  Any help would be greatly appreciated.

Thank you everyone and sorry for the book.  I will wait anxiously for suggestions.
--
Sherry & Pepper, August 2015, No. Calif

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper


Lorna Cane
 

Can you copy/paste this,Sherry ? It should work


https://ecir.groups.io/g/CaseHistory/album?id=5798


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Sherry Hite
 

It will turn blue but doesn't get the underlining that links usually do.  When I go back to check it is gone.
--
Sherry & Pepper, August 2015, No. Calif

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper


Maggie
 

Are you scrolling all the way down to the bottom and clicking on "save"?


Maggie, Chancey and Spiral in VA
March 2011
EC moderator/Primary Response.


Sherry Hite
 

Oops!  Spaced, hit return, and saved but it still doesn't look right.
--
Sherry & Pepper, August 2015, No. Calif

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

https://ecir.groups.io/g/CaseHistory/album?id=5798 





Lorna Cane
 

It's fine.


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




Lavinia Fiscaletti
 

Hi Sherry,

https://ecir.groups.io/g/CaseHistory/album?id=5798

I totally agree with your trimmer about the poor technique in taking the xrays - it appears as if each view was taken when the foot was off the ground, which makes interpreting them more difficult and less precise. Also agree that there is nothing here that is of the "dire consequences, doom-and-gloom prognosis" that the vet gave. It's all extremely fixable, much of it fairly quickly. There is NO bony column rotation visible (HPA is correctly aligned) and only very slight capsular rotation (dishing of the dorsal wall), which is a trim problem (toes too long horizontally) coupled with some sinking. It is likely that the coffin bone is closer to ground parallel, with a broken back HPA, when the feet are weight bearing.

Agree the soles are a bit thin and it appears as if there may be some sinking (not clear with the compromised technique). The amount of overall hoof capsule height in the pre-trim pictures, coupled with the thin soles shown on the xrays, also points in that direction. There is substantial side bone on both feet but that doesn't normally create soundness issues in most horses.

Sore feet may be the cause of, or at least contributing to, Pepper not being enthusiastic to work. They would also contribute to hock issues. Unless she is actively laminitic, I would say get the trim tight and use properly fitted, well-padded boots (on all four feet if necessary) to start regular but easy exercise as long as she is sound.

Trim needs to back the toes - LF from the top, RF a steep bevel may be enough. Wall flares needs to be addressed by bringing them into alignment with the well-connected growth above. Heels are tending to run under but need to be very careful in addressing them as the xrays show that there is no excess height available to bring them back quickly without tipping the CB negative plane in the process. Keeping the toes backed so the breakover is correctly aligned will be huge here. Well padded boots, which provide pressure-and-release to stimulate the frog/digital cushion/sole, are one good way encourage the more robust growth. Casts are another possibility but they cannot replace getting the trim correct.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team


Sherry Hite
 

Thank you so much Lavinia for getting back to me so quickly.  I have already spoken with my trimmer and she will be out next week so we can implement your suggestions.  We are both so very happy!!!  Thank you, thank you!!!
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Lavinia Fiscaletti
 

You're welcome, Sherry.

For the upcoming trim, just work on the toes and flares, from the top. Suggest leaving the heels completely alone as they were lowered during the most recent trim.

 How does she land - heel first, flat or toe-first? Is she sound or?
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team


Sherry Hite
 

Generally she lands heel first but when she is tender she will land flat.  She appears to be comfortable at a walk with her boots on.   She is quite expressive with her tail if she is uncomfortable so when I rode her at a walk  for 30 minutes the other night in my pasture, I watched / listened for tail swishes....she didn't swish her tail at all.   A trot on a lead clearly shows her reluctance to exert herself.  She puts little effort into the trot and is short strided with her hinds unless I push her into a more active trot.  If I run along side her in a straight line, she extends herself more and her hinds almost land into her front tracks.  I haven't asked her lope on line for a while so I can't give you an idea of her comfort level.  Is this information useful?

Thanks again for her help!!


--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Lavinia Fiscaletti
 

Hi Sherry,

Yes, this helps. Glad to hear she isn't doing toe-first landings as that would be a really negative thing.

It sounds like she is definitely painful when asked to do more than walk and will only trot when pushed to do so. I wouldn't recommend doing anything faster than walk work currently but to do it on a daily basis if possible. Get the trim tightened up, keep her in the padded boots most of the time and reassess in 4 weeks.

The way to find out if it's the feet causing the hesitation would be to do nerve blocks on the feet then see if she will trot out willingly. If there is still hesitation, the problem is centered elsewhere. I know this could be problematic to accomplish given the vet's general outlook.
--
Lavinia, Dante and George Too

Jan 05, RI

EC Support Team


Sherry Hite
 

Thank you Lavinia.  Your input is greatly appreciated and I will follow your suggestions.  The trim will be done next week and I will keep her in boots & pads during the day when she is out and roaming.  At night she is confined to a small paddock and a well bedded stall so I will take them off so her feet can air a bit.  If we don't see an improvement in her willingness to trot out in 4 weeks, I will find a vet willing to do the blocks for me.  We do have another popular vet in the area who is more open minded and may be willing to work with me on the blocks if needed.  My current vet is less than 2 miles from my house and has a very nice facility including surgical capability.  She is a knowledgeable vet but interacting with her can be difficult at times. I hesitate to burn that bridge just in case I have a desperate emergency that requires a facility like hers.  The nearest comparable facility is 1.5 - 2 hours away. Her senior tech has also been a very good advocate for me in getting my testing and prescriptions taken care of without any hassle. 

I will report back in 4 weeks and let you know where we are.  In the meantime I have reached out to have someone look at my mineral balancing and blood will be drawn next Tuesday to check her hormones.  If nothing shows up there, I plan to reach out to Dr. Kellon for her opinion on were to look next.  Hopefully in the next 4 weeks I will have figured out what is triggering the insulin and she will be her old self happily kicking up her heels.   Thank you again for your help!
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Sherry Hite
 

Lavinia,

My trimmer was able to come out last week and do the additional trimming you suggested.  I have posted the post trim pictures (2016-04-26).  There wasn't any noticeable increased soreness after the trim either barefoot or in her boots. Hooray!  I have kept her in boots during the day and have been riding her for at least 30 minutes almost every day in my pastures.  I let her set the pace and she seems to be slightly more energetic the last two days.  I think the corrected trim helped but I also suspect the Adequan may be helping  (she gets her 4th injection tomorrow).  Please let me know if there is more we need to do on her trim.  Blood was drawn Tuesday, May 2, for ACTH, insulin, leptin, glucose, and progesterone.  Should have the results next week.  I haven't had a response on my request for help in making sure her hay is balanced correctly via the NRC Grads so I will go back to asking Nancy to help me.  I will greatly appreciate any comments you may have.  Thanks for your help with this little girl... she is pretty special to me. 
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Lavinia Fiscaletti
 

Hi Sherry,

Those were some good changes. LF toe needs to com back a touch more, RF more. RF has the hoof capsule twisting toward the inside from push of the lateral heel being run further forward than the medial one. I'll do mark-ups to explain.

Gald she's feeling better.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Sherry Hite
 

Thank you!  Will contact trimmer after you have a chance to do the mark ups.
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Sherry Hite
 

Lavinia,  I know you are extremely busy and have a list of people you are helping but my trimmer is coming next week so I thought it might be a good idea to send you a gentle reminder about the mark ups for Pepper.  Obviously I won't need them until next week but I didn't want to be bugging you at the last minute.  Thanks!
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Lavinia Fiscaletti
 

Thanks, Sherry. What is the exact date, please?
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Sherry Hite
 

She will be here the morning of 5/27.  It will be nice if she can review them a day or two before she comes.  Pepper has been doing well in her boots.  We have been riding almost every day and she is more willing to trot for a short distance.  Thanks Lavinia for your help.
--
Sherry & Pepper, August 2015, No. Calif

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .






Lavinia Fiscaletti
 

Thanks, Sherry. I'll have those for you so the trimmer can see them before the appointment.
--
Lavinia and George Too

Dante, Nappi and George over the Bridge

Jan 05, RI

EC Support Team


Sherry Hite
 

Lavinia, Since it has been a few weeks since the last photos were taken, would it be helpful if I uploaded a more current set this evening?  If your answer is "yes", do you just need lateral, dorsal, and sole?  Do you want the hinds too or are they doing okay?
--
Sherry & Pepper, August 2015, No. Calif

 

Case History:  https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .