Early Cushing's??


LM
 

I apologize I have not gotten the case history filled out yet. There are some very extenuating circumstances.  So I am wondering if any of the moderators or Dr. Kellon can give a little feedback while we care for this horse, find a knowledgeable vet and get the case history done.

First week of August
Non-fasting, hay only

Insulin 15.85
Glucose 75
Leptin 10
ACTH 34.5
Regular CBC normal
Compensated IR
High Insulin Responder
G/I Ratio 4.7

Horse is showing signs of laminitis in all four feet but front worse. Developed crusty neck, and very pendulous stomach developed about the same time-6-8 wks before blood work
Excellent balanced hoof care, was wearing Clouds now 24/7, hand walked 20-30 mins a day 6-7 days a week, always in a dry paddock. Was eating from slow feeder at time of and prior to testing.

Since blood work, he also gets BP, flax, Vit. E. Mg, Se, and Iodized Salt.as suggested on website. Slowly being weaned on to soaked hay as he will refuse to eat for up to 24 hrs. Pain is getting worse, more lethargy.

A well-studied and past moderator on here kindly consulted and suggested I ask the vet for "a trial" of pergolide because he has this long history of dealing with milder laminitis and past owner said he had foundered once. She said horses with this long-standing history sometimes just can't tolerate the ACTH at the higher level let alone it rising into the fall months. I think that makes a lot of sense. He did also have the tell-tale rings of founder and was lame when I first got him. We were able to get him under control previously and comfortable feet. Now we are in completely different circumstances

The one vet I initially got on board has abandoned case as he thinks there is no evidence of iron overload having anything to do with IR. His suggestion was Oral dextrose test, Ace, Bute, Levothyroxine and continued hoof care and soaking of hay ( He keeps forgetting this horse has in past attempts refused all soaked hay. )

We are waiting for our hay to arrive this weekend, then a hay analysis and more vet. and mineral balancing to come along with the case history but could I get some feedback if other horses have turned out to need pergolide to manage so far non-responsive laminitis, along with the test results I wrote above. 

I have asked another vet to come on board but I don't want to be barking up the wrong tree or pretty soon no reasonable vets will work with me.

Thanks so much!

 


--
LM
March 2013
Ohio/Colorado


Eleanor Kellon, VMD
 

This is where a case history is beyond valuable - not to mention hoof photos.

How old is the horse?
Breed?
How long have you had him?
Diet before blood work?
Was he able to be exercised?
Any changes in diet or exercise before he got uncomfortable again?
Any grass?
Any lapses in trimming?
What are the "signs of laminitis"?
Radiographs?
How long before blood was spun?
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


LM
 

I know. I really get it. 
14yro QH gelding. Came into my care 6yrs ago with the past history of founder and changes in hoof evident. He was exercised daily for at least 20 mins 5/wk and on daily turnout on large dry pad with two other horses, He and the other gelding stayed pretty active throughout day. He was previously able to tolerate 20-30mins of turnout on grass. Never tried more than that. Was always slow fed free-choice grass hay. He was adopted out twice and both times came back to us for lack of care one time showing signs of laminitis again. They had put him full-time on grass pasture. 

No radiographs ever done due to cost.
Moved to Colorado in March 2017. On mix grass hay not sure of type of grass. Six to eight weeks after being in CO is when the above history starts:
"Horse is showing signs of laminitis in all four feet but front worse. Developed crusty neck, and very pendulous stomach developed about the same time-6-8 wks before blood work

Excellent balanced hoof care, was wearing Clouds now 24/7, hand walked 20-30 mins a day 6-7 days a week, always in a dry paddock. Was eating from slow feeder at time of and prior to testing.........."

Signs of laminitis include bilateral lameness first front, then hind. Lame at a trot, toe first landing. Resistant to walking on any hard surfaces or rough surfaces. Soles are a little softer than would like to see and tender with a hoof tester. Stands in atypical stretched out position. Similar to a horse that has colic. But he has always taken that position when suspected laminitis flare, especially if in soft ground where he can dig his toes in and get sole support. (Does not do this with front feet when Clouds and wedge cushions are on or soft DIM is used.) Also lays down a lot and has mild but pulse (1 out of 3) bilaterally in front is the only place I can detect.
The ACTH sample was gently inverted several times per Cornells instructions, chilled and then vet said "spun within 45mins"

I will just emphasize he only receives 1.5% of bodyweight in grass hay fed through a slow feeder ( which he can eat quite quickly) and he will ONLY eat one supply of hay that is soaked for no more than 15mins. Otherwise he completely refuses to eat for 24hrs at which point we switch back to unsealed slow fed hay for risk of colic.

Hoping to get at least front hoof pics today and shooting for case history to be done this weekend.

Thank you very much


LM-Shiney's Little Pistol
March 2013
Ohio/Colorado


LM
 

I don't get frustrated too easily and I want to pull my hair out! I gave up on the yahoo group years ago because I had so much trouble using it. Now I am trying so hard again for a different horse. Maggie kindly sent Case History form to me via e-mail. Apache doesn't work on MacBook Air 2013 updated. I finally finished filling out form. I have read all the guidelines many times over and cannot get case history uploaded in it's more complete form. Can someone please help me. Time is ticking away for this gelding due to many factors beyond horse health. We either get him improving or he is euthanized.

Dr. Kellon is it possible you can reply with my response while someone else helps me figure out how to get history properly uploaded?

Thanks all for your help and dedication!
--
LM
March 2013
Ohio/Colorado


Maggie
 

Hi Lauren,


Sorry you're feeling so frustrated.  I looked but didn't see a CH folder for you, so I made one.  Here's a link to it:  https://ecir.groups.io/g/CaseHistory/files/LM%20and%20Shineys%20Little%20Pistol 


Once you open that link, click on "upload file" and look in your computer files for the CH that you filled out, and open it.  Once you see it in the "upload file" box, click on "add".  


If you are still unsuccessful, email me or LeeAnne and one of us will get your CH uploaded for you.


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


Eleanor Kellon, VMD
 

I was hoping to see at least those photos first.

There are many causes of foot pain besides endocrinopathic laminitis and in a QH with lameness dating back to a young age they need to be kept on the list, if not put at the top. The ACTH isn't impressive for his age and the time of year.  Insulin is in a grey zone as well. Before believing that glucose number it might be good to try to borrow a glucometer if you have any diabetic friends and retest it. Radiographs would also be extremely beneficial, especially if he really does have an excellent balanced trim.

The low ESC/starch diet won't hurt him but I would hold off on selenium in your area without a blood level. (Any hair loss from mane or tail?) Even when the evidence is weak it's still reasonable to do a trial of pergolide when the horse is lame but this history isn't pointing to that being likely to solve the problem.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Claudia Goodman
 

Hi Lauren,

I'm so sorry you are experiencing so much frustration and worry.

As I cannot view your case history, I do not know what supplements you may be giving your horse other than the ones you listed above, so I am responding with that in mind. Regarding your description of the poor condition of your horse's hooves, particularly in the absence of elevated ACTH and insulin/glucose test values, one avenue I believe is very worth pursuing is to begin supplementation specifically for hoof health. If his poor hoof quality is due to mineral imbalance, California Trace or California Trace Plus is likely to supply him with that support along with other nutritional components that hooves need to repair. This may be very helpful at least until you have hay analysis and balancing competed. I see this as a way to jumpstart recovery if his issues are at least partially caused by nutritional deficits. (With a horse already in a severe situation, I'd recommend the California Trace Plus.) 

Many in this group, myself included, have used this product for years with excellent results. However, even with this approach, it will still take a little while for help the hooves to improve.  
Link to their website -- http://www.californiatrace.com
--

Claudia & Silhouette  02/2014

California Central Coast 

Silhouette Case History


LM
 

Thanks Claudia for understanding. We are on such a tight budget so we have to pick one or the other hay analysis and mineral balancing or CTM. I do like the plus, have had decent results for that on other horses. As I mention above it's not the quality of hoof (other than frog issues which doesn't appear in these pics) it's the soreness. :/

Thank you for the helpful input.
--
LM
March 2013
Ohio/Colorado


Lorna Cane
 

On Sat, Aug 26, 2017 at 03:09 pm, lauren michele wrote:
As I mention above it's not the quality of hoof (other than frog issues which doesn't appear in these pics) it's the soreness. :/
Do you have a link for the pictures,LM ?
 
--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

 

 


LM
 

Thank you so much Maggie for all your help being tech challenged on the yahoo and group sites. I did just upload the file. I haven't figured out how to add rows or put in past supplements for example but those are small details now. The main thing now is to figure out how to add pics. If I get stuck again, I do still have your e-mail I think but how would I find e-mails to any of you?

--
LM
March 2013
Ohio/Colorado


Maggie
 

Hi Lauren,

Make sure when you want to post pictures that you make a PHOTO album.  The pictures do not go into your CH folder.  Make an album here to upload your pictures in:  https://ecir.groups.io/g/CaseHistory/photos 


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


LM
 

Hi Dr. Kellon,

Thanks to Maggie and LeeAnne, there is a case history and pics now! YEAH!

They for some reason aren't showing up in the signature change to include them but if you search for LM and Shiney's Little Pistol they will show up.

I talked with our really awesome vet that has bravely jumped on board. We both agree that there are probably several things going on at once. IR definitely appears to be part of it. We are going to try a month of pergolide and acepromazine (duration??). I talked him out of bute and we are sitting on fence about the T4. He's game for it but I know it is a temporary fix and would rather address it nutritionally and also be clear on which if the Levo or the pergolide is helping, if it does at all. He had to postpone x-rays till Sept 8th but we are going to do laterals and then a skyline for  any navicular changes?

If you have any additional thoughts now that the basics of the CH and front feet pics are in there that would be greatly appreciated!

Thanks for all your hard work!
--
LM
Shineys Little Pistol
March 2013
Ohio/Colorado


LM
 

Lorna there are pics now though I haven't figured out how to SUCCESSFULLY put link in signature or folder but you can search under LM and they show up thanks to Maggie!
--
LM
Shineys Little Pistol
March 2013
Ohio/Colorado


Maggie
 

Hi LM,


Here's a link to your CH folder:  https://ecir.groups.io/g/CaseHistory/files/LM%20and%20Shineys%20Little%20Pistol 

And your photo album:  https://ecir.groups.io/g/CaseHistory/album?id=9106 

Copy/paste those into your signature and scroll all the way down to the bottom and click "save".  That should make them "stick" in your signature.


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


Lorna Cane
 

LM, go here to see that Acepromazine should not be used with Pergolide:

https://ecir.groups.io/g/main/files/1%20Start%20Here/3.%20Avoid%20These%20Items.pdf


--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002

 

 


Eleanor Kellon, VMD
 

From the pics:

- A bit overweight but no crest, no fatty deposits visible
- Severely crushed and underrun heels
- No LF sole pic
- RF sole pic difficult to evaluate because can't tell if it is packed with powdery material or really is as flat as it looks, but if it is that flat the frog and sole margin are pulled forward and toe likely needs to come back more. Could you redo the sole shots with the feet cleaned and a black marker used to show where the bevel begins on the sole surface?

The radiographs will help further, and if those front feet are flat would add a dorsal-palmar view to evaluate the coffin bone itself. I'd be looking for a source of hind foot pain in these feet from what is shown so far.

There's no indication on the labs for pergolide. Not sure why acepromazine, especially with pergolide (they will counteract). I'm not a fan of drug induced hyperthyroidism as a "treatment". 
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


LM
 

Thanks Lorna. I'm going to print that off.
--
LM
Shineys Little Pistol
March 2013
Ohio/Colorado


LM
 

Oh I hope everyone that's been helping can take a moment to celebrate ;) I finally got onto a different computer (not a macbook!) and it allowed me to put the files in my signature!! And I added a few more pics. 

That is progress and I got Shiney to eat soaked hay so he has actually lost a bit of weight. And doesn't need to lose anymore. However he keeps a nice little area of fat around the front of his barrel behind shoulder it just doesn't show up in pics. You can see in person or feel it and the two tiny little crests that popped up on his neck back some months ago. He seems a tiny bit less sore in his front feet.

So here is where we are now: Fri. the 8th the vet comes to do some x-rays. We are too limited on donations to do as many as we would like. We will do laterals of both front and RH as that is his foot that shows the most amount of reactivity to testers both sole and heel. The RH dorsal wall has a tendency of getting the "bullnose" look too. Then we were planning on doing three skylines for navicular issues.
Any thoughts on the skyline to identify caudal pain when $ is so limited?

Also Dr. Kellon, I feel kind of lost right now, We know he has metabolic issues and past history of founder. Hence the Acepromazine temporarily as a vasodilator since pain has increased and we didn't want to do bute. As I mentioned one of the past moderators had suggested a few weeks ago pre-cushing's and possibly couldn't tolerate a borderline ACTH (34.5). And I think you had said it was reasonable to do the trial of pergolide. Now I understand that the two shouldn't be used together. Vet didn't know this??
Continuing with ER diet as hay analysis and the associated mineral balancing is a ways off due to hay supplier changing. 
LF sole pic is now saved. He does have some concavity to his front feet but not a lot. This has always been a challenge. The artimud and powder obscure landmarks.  About 6-8 wks ago his sole, frog and bars exfoliated. The sole is about ready to exfoliate again. Last time we had a bit more concavity after that. As far as heels go the pics aren't so helpful there either- the one lateral he is in a bit of a divet in the ground. His heels are definitely not what I think of as crushed, the tubules are nice and straight from all angles BUT they do always grow in an underun direction. That said they are almost back to the widest point of the frog and if lowered anymore would be totally even with the sole and probably not in favor of his palmar angle ( assuming it may be fairly low ). I did try to clean them out, mark and get a better pic but with no help and resistance to keeping his foot up they came out blurry. Will try again this week when I have help..
Just for a trial tomorrow I am going to try a few different wedge pads on boots to see if he prefers any of these.
The vet is still real interested in helping and learning more but at this point going with the feedback I have now changed my mind on the pergolide as per last response. Got vet to hold off on the Levo ( Im not a big fan of that either) and now let Shiney go without the Ace vet gave me. I feel other than waiting for the x-rays, soaking hay, hand walking and some supplements I do not have a very clear direction nor one I could explain to the vet. And he's standing around in pain.

I appreciate the feedback Dr. Kellon, Maggie, Claudia and Lorna

 
LM
March 2013
New Springfield, OH/Ft. Collins, CO

ShineysLittle Pistol
https://ecir.groups.io/g/CaseHistory/files/LM%20and%20Shineys%20Little%20Pistol
https://ecir.groups.io/g/CaseHistory/album?id=9106


Lavinia Fiscaletti
 

Hi Lauren,

Thanks for keeping at it :) For some reason your two links are running together and only going to the case history folder. Maybe try putting a space between them:

https://ecir.groups.io/g/CaseHistory/album?id=9106

If this were my horse, I'd have the 4 laterals done, and maybe add DP's of the fronts. I wouldn't bother with skylines as they aren't going to change anything that needs to be done anyway. Even if there are some kind of "navicular changes" they are secondary to the trim issues rather than a primary cause. Have a read here for how to get the most out of having the xrays done:

https://ecir.groups.io/g/main/wiki/Getting-Good-X-rays

DO NOT lower those heel anymore - from the pix and from your description, there is no height there to work with. Although the heels need to be brought back, it can't be done at this point so you need to concentrate on the bringing the break over back first. Also need to control the flared walls. It would be really helpful if you could get a full set of pix of all the feet as described here:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions

I wouldn't help any of the stuff that appears to be exfoliating along - it may be that because he is in boots a lot, the moisture that gets trapped inside is acting to get things to exfoliate earlier than they should.

From what you described regarding the thrush and the depth of the crack in the frog(s), I'd suggest soaking his feet 3 times per week in straight apple cider vinegar, 45 min each foot (can do them simultaneously - just use gallon size freezer bags and duct tape them closed around above the fetlocks). Then daily apply Pete's Goo. Follow this routine until the cracks have healed all the way down. More info here:

http://www.hoofrehab.com/Thrush_treatment.htm

Wedges may help - good idea to try some different combinations and see what he may prefer.
--
Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

ECIR Support Team


LM
 
Edited

Thanks for your response Lavinia! and the sad news the links still aren't working :/
And thanks for understanding the fine line one walks with bringing back the heel and consequently lowering it. As long as he is in the dry climate of CO and I keep artimud all around and in frog as well as white line the thrush is kept at bay but man take it away and add some moisture and it is out of control. I have always assumed this was at least in part due to a suppressed immune system and perhaps less circulation to his foot since he did actually founder a year before he came into our care. Do you see/hear this same thing often? I have but they were horses that were severely rotated for years without care no doubt circulation was compromised.

In OH we would do an Oxine soak with boots that could be sealed at top. It worked really well. Do you guys prefer the ACV for any reason other than it's easy to access?
I'm definitely not encouraging the exfoliation. I had a feeling it might be because of the boots but wasn't sure so thanks for sharing your experience.Unfortunately, I am physically limited right now and I have to rely on a dear farrier friend that donates his time and skills. He travels quite a distance for this horse otherwise I would like to just use some therapeutic uses of urethanes to extend his heels a hair and try a little wedge along with DIM or something similar in the heel area... but I can't right now. :(! I am attempting to add on a removable 1 deg and 3deg wedge to the boot, individually of course, just to see if he stands better and shows a preference for that. Were you thinking wedges because of a broken HPA axis or because of the caudal ( maybe navicular ) pain he shows and I have been describing?

As far as the flare, at each trim we take as much away as possible, leaving only enough wall when you look at it from the sole to get away with boots on. I assume the flare is from weak laminae attachment and the forces he puts on his hind feet mainly due to the way he stands. Other ideas on why flare persists?

I hope you don't mind me asking you so many questions, you need not answer them all I just appreciate the opportunity to talk with some others knowledgeable on the topic and troubleshoot.

I will keep working on more pics too. I did look at all the links. I'm pretty used to a D65Pr-PaDiO being done to look at the navicular bone area. Can you tell me ( so I can also explain to vet ) why that's less helpful than regular DP's? 
Thanks again Lavinia!
LM
March 2013
New Springfield, OH/Ft. Collins, CO

ShineysLittle Pistol
https://ecir.groups.io/g/CaseHistory/files/LM%20and%20Shineys%20Little%20Pistol

https://ecir.groups.io/g/CaseHistory/album?id=9106