New Member - Need Trim/Balance Mark up if possible by 2/25/2020 #understandingtrim


Mel V
 

Hi,

I tried to post once before, but realized I didn't have the links to my Case History and Photos in a signature block.

I am new, Bali has been diagnosed with Cushings with the TRH test, the Insulin test was flagged  as IR, but she did not have a fasting test.  I think I got adequate details in her case history. I'll try to get more details uploaded soon, but the lost initial message and I have to get to bed.  

Hopefully the case file is a decent start.
--
Mel & Bali
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


 

Hello Mel,
You've done a good job getting your case history done and a photo album in place. Thank you! 

I am attaching our New Member Information Post below. All items in "blue" type are clickable links. I recommend that you start at our website (ECIRHorse.org) and read the DDT&E section. Please pay particular attention to the "Diet" section. Getting insulin levels under control is largely about changing your horse's diet and looking at your new case history it appears that your horse may still be out on grass?  Getting the ACTH levels down will also help lower the insulin levels.

In the Laminitis section of the website you will find good info. The "Realigning Trim" can be printed out and given to your trimmer/farrier. Check out the link to a Pete Ramey article at the bottom of that page.

Please use our search functions to search the files and messages. There is a lot of info to be found in both areas by searching. 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


 

Mel,
Please go to the "Subscription" tab, and update your signature to include your general location and join date. Just add join date on one line and general location below your name and above  links to your case history folder and photos folder.  Click on SAVE at the bottom of the subscription page.
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Eleanor Kellon, VMD
 

It appears you had the perfect storm of inappropriate diet and seasonal ACTH rise. Were you actually weighing the amounts of alfalfa/soy/copra? How long was she on that? There's a good chance she has not had her ACTH properly regulated yet since Prascend in standard doses works poorly when started during the seasonal rise. Getting that down into the low 20s should be a priority.

Do you have a hay analysis? How long was she on the other mixture?

The radiographs actually don't look too bad. You have capsular rotation more than any significant bony rotation and little sinking. The horn lamellar zone is a little large but she's a big horse.


Mel V
 

Wow!  Thank you everyone so such prompt support.  You are an amazing group.  I'm going to try to answer all the questions, I thought I'd updated my signature and saved, but I'll manually add it to this post, as I've typed a lot and just noticed it hadn't updated.  You guys make me feel much better on the radiographs not being as dire as I was starting to think.  I was getting myself a bit worked up with self flagellation and guilt over this.  I'll re-read tonight and see if I missed anything.

Hay analysis:  Yes, I have one and I will post the hay analysis (it will be later tonight), it is a bit higher than 10%, the analysis has 6 hays, my farmer has them tested, and my hay is on page 5.  I don't have a PDF tool to break out the single page.  This is 2019 hay, none of the other options are available anymore, but I can tell him I need lower sugar hay for her, and can try to get some 2020 first cutting in.  

She was on winter grass - largely overgrazed in the girl's field, so they definitely were eating the hay, but our winter has been very mild and I'm pretty sure there is some growth happening already, I usually move her off at the beginning of March, and we've been following this annual routine/dance since 2011...I realize now that her first laminitis was earlier than 2014 (I remember where I worked LOL) , she moved to the dry lots Friday, 2/21/2020.  I also have ride journals from 2006 (I'm pretty nerdy), I might have jotted down notes in those books.  I will check those soon as well.  

ACTH level: the vet will be at the farm on March 6 for Spring vaccinations.  I'll ask to have it tested again.  I can also ask him to leave me the correct tubes and I'm good with checking it again and running the blood to the clinic to have it tested again in a couple of months.  

Prascend: She was soundest when I had her off the Prascend for 3 weeks to retest her with the TRH test, like sound enough to do a full dressage work (she's 4th level) with no complaints nor any bute.  She is getting more sore again, now that I have put her back on this week, in fact she has gone from willingly forward to ouchy and not wanting to work - I let her comfort level guide me.  I read that a small number of horses actually develop laminitis ON the Prascend (on the manufacturer's data sheet).  I'll be honest, I am very nervous about Prascend contributing, because Bali is the horse who reacts to everything.  She was sounder when I dropped it to .5mg in December.  A part of me wants to go back to my old baseline of Thryo-L, beet pulp and no grain with some vitamins.  Also, her levels based in the TRH test fall under the Prascend data sheet "equivocal" column.  

The crazy SBM diet, and yes, in hindsight, I was STUPID to take a likely IR horse, who I had been managing pretty well since 2014, with a couple of "my bad" timings when I did not get her moved quick enough, and change 100% of her diet.  She was on that diet for about 4 months.  The first 2 months, I was blaming that infection for the growth/damage, but then it became apparent that something was bad.  I still thought there might be some mechanical lameness from that infection in her LF, and scheduled the vet appointment for a work up and the xrays for my farrier. I kept riding her as she had no heat or significant digital pulse.  I knew they were getting bad.  I did weigh the SBM, and Coolstance Copra.  I also weighed the alfalfa pellets, but when she'd dropped enough weight, I increased those a bit, but never more than a 2 qt scoop, which is about 2.5 lbs.

I should do another post on this diet as I would like to walk through it with people that are NOT sycophants, which seems to be what we have on his Facebook page.  https://theequinepractice.com/feeding-the-horse-as-simple-as-1-2-3/  He did respond to my post that this diet was definitely not working, in an unsatisfactory way (IMO), after my friend who LOVES his diet, bugged him by texting him directly  Again, that is for another post.  

One giant piece of information that I will add about the fall test, when we pulled it, we did not know she had stepped on a nail and was brewing a near-fatal infection.  I dodged a big bullet in that she missed the joint capsules and tendon sheath, but given the location and the fact she wore equipak in her front shoes, and in general I have a well maintained farm (too nice on the grass), we never suspected a nail puncture, until the vet found a dark pocket upon ultrasounding her foot through the frog, the surgeon at the clinic said it looked consistent with a nail puncture, the vet who'd been at my farm doing the ultrasound hesitated to say that, but then my husband reminded me that the horses had pulled a board down, nails up, of course, and Bali had been out in that field, in fact she probably pulled the board down trying to remove her grazing muzzle.  Since it was Labor Day weekend, Morven Park wasn't staffed to do the MRI, nor was Blue Ridge Equine down near Charlottesville, and since we had a likely diagnosis with the u/s and likely cause, I was ok waiting (and let's be honest, saving $2500 for a general anesthesia MRI) , controlling the pain as close as we could with ketamine, then got her to the clinic on Tuesday, when a happy stream of pus was finally found.  The worst part was that I could not start soaking the foot for 24 hours, as we'd tapped her coffin joint, looking for infection.   I wonder how valid that ACTH test was when she had the raging infection.  I have several other lab reports that continued to get worse and worse until we found the infection and treated it, but I don't know that they are useful for THIS case history.  

--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Viginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


 

Mel, 
Use our files to research how horses respond to pergolide (Prascend). Most but not all horses will act lethargic, go off their feed, etc. Tapering them slowly onto pergolide is recommended. Many of us have used APF (an adaptogen) to help our horses adjust to the pergolide. I can tell you that my horse let me know when he needed a pergolide dose increase by his symptoms as he again became apathetic and depressed until a .5 mg increase was added to his dose.

I had to learn that my IR horse simply cannot tolerate grass other than a few nibbles while out trail riding. I kept trying to let him have a small amount of grazing and it just wasn't possible. I suspect most of us owners of newly IR horses go thru this stage. NO GRASS  is what I finally came to terms with. In his case it also means no alfalfa. 

Be sure to seriously tighten up Bali's diet.


--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Eleanor Kellon, VMD
 

Hi Mel,

About your ACTH results...

Both of the  baseline ACTH levels, before TRH, were positive.  TRH stimulation in fall isn't reliable because of a lack of seasonal ranges but it doesn't matter here because the Pre sample was clearly positive. This equine laminitis study showed cortisol (and therefore ACTH) does not correlate with symptom severity https://www.ncbi.nlm.nih.gov/pubmed/15315700 . Bodywide infections with sepsis, fever, etc. can increase ACTH, at least acutely, but localized and chronic infections probably not.

Horses that develop laminitis on Prascend IMO do so because their PPID is not adequately controlled, not because the Prascend caused it.  However, Prascend does have the potential to cause a variety of side effects that make the horse feel, well, crappy! If her next blood test confirms she has PPID I would suggest starting her on APF before adjusting her dose. It is usually successful in blocking side effects.

Her feet very clearly show the effects of the diet change. Unless there was some toxin involved (do you have blood chemistries to post) or some glaring mineral imbalance to explain it, the interaction of diet and insulin resistance was to blame. I'm highly suspicious that her IR tendencies, even back when she was 10, trace to developing PPID.  For one thing, purebred WBs are not prone to develop IR.  It would also be very unusual for an IR horse on an uncontrolled diet to make it to the age of 10 without developing clear indications.

Having PPID isn't exactly welcome news but the silver lining here is that controlling it would also likely do wonders for controlling her insulin and laminitis risk.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Mel V
 

Bonnie,

Thanks for the inputs on the Prascend.  She isn't acting lethargic, just lame/footsore.  She was feeling much better until I came back from her vet visit last week and started her back up on 1 mg.  My vet told me that the Prascend 1/2 tablets are no good the next morning, but I could not substantiate that.  I did see that pergolide, particularly compounded versions, is fairly unstable and loses its effectiveness considerably when tested at 30 days.  

I went ahead and dropped her back to .50 mg, I'll see if that helps her ouchiness.  She is getting bute today and tomorrow, to increase her comfort level for the farrier.  

She's in one of dry lots now, and for the foreseeable future.  I might see if I can figure out a muzzle with a closed hole to let her out, somewhat supervised (she's a houdini).

Thanks again,
--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


Sherry Morse
 

Hi Mel,

To reiterate what Bonnie said, and which is in your welcome message as well - for horses that don't act quite right when started on Prascend we recommend titrating up the dose and using APF to help mitigate any Pergolide veil.  Bute will not help a horse with metabolic laminitis feel better so just keep that in mind - it may help with body soreness, but isn't going to do anything for her feet.  

As Dr. Kellon already said, while some horses may have laminitis while on Prascend, that's much less likely to be due to the medication itself than it is due to not receiving enough of the medication for it to be effective; or they are still not being managed properly if they are also IR in addition to being PPID, which seems to be the case with Bali.  

I suspect that in Bali's case what will help her ouchiness the most is a trim that brings her toes back and gets her hoof capsule more in alignment with where it should be, but Lavinia will be able to help you more with the specifics on that.




Mel V
 

Eleanor,

I don't recognize the APF acronym yet.  I'll go looking for it. 

Bali is rather bright eyed and cheerful this week, just foot sore.  I'm willing to believe that her long toes are contributing.  That's getting addressed tomorrow.  Hopefully my farrier can get her feet balanced tomorrow.  And, Bali tested negative for IR a few years back(probably 2014), which my vet contributed to my controlling her diet.  I did not get lab reports and would need to call the office to see if they have them online still.

How important is it to send an ACTH test off to Cornell? I should check how much that one costs.  Like most, I have to be smart with my vet budget and decide what I should spend my money on.   If my vet needs to run back to the clinic after my farm, I need to make sure he knows so he can adjust his schedule on the 6th. I already stagger her vaccinations.

I do have a few blood chemistries from the Aug 27 - Sep 3, 2019 time frame.  I can upload those into a blood work sub-folder to her Case File?(if I understand the instructions correctly.) 

Off to re-read which folders get which files, then I can put blood work reports there, although they were all pulled when she was non-weight bearing.  A couple of the vets (and not the new graduates) said she was one of the most painful horses they'd ever seen.  She blew through the nerve block in 2 hours.  We truly thought we might have to put her down until the surgeon came up with trying ketamine on an 8 hour schedule, since I did not have a 3 day weekend hospitalization budget.  It worked.

Thanks again,
--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


Lorna Cane
 

On Tue, Feb 25, 2020 at 01:03 PM, Mel V wrote:
I don't recognize the APF acronym yet.  I'll go looking for it. 
Hi Mel,

For a valuable list go to our Files, click on Start Here, and scroll down to fith entry, Commonly Used Abbreviations...

 
--

Lorna  in Eastern  Ontario
2002


 


celestinefarm
 

Mel,
APF stands for the Auburn Labs product, Advanced Protection Formula. It's an adaptogenic herbal supplement that helps to counteract the side effect of initial administration of pergolide, which is lethargy, off feed, etc.  The side effects don't last long, but having a horse go off feed, etc. is never a great idea, especially if you can avoid it. APF is available not only from Auburn Labs , but online in most equine catalogs also. Here is the link
https://www.auburnlabs.com/product/equine-apf-the-original/
Please note that it is relatively expensive . A bottle doesn't seem too costly, but you have to give most horses 10 or more ml  once or twice a day to be effective, so it drains a bottle quickly. An alternative to APF is to give Jiaogulan, which is a vine type of plant from SE Asia that is also a great adaptogen.   Jiaogulan is best given 20 minutes prior to a bucket meal, and the dosage is to effect. Start with one tsp of powdered Jiaogulan and titrate up from there until desired effects are noticed.( usually pink gums, but in the case of pergolide veil, until horse brightens up, begins eating and drinking normally, moves around more, etc.) Many here give Jiaogulan permanently, my stallion get's two tablespoons per day. 

If dosing 20 minutes prior is not feasible, then give in the bucket meal, but plan on giving a higher dose.

It can be purchased online and is far less costly than APF. Members also will switch to it from APF once their horse seems to adapt to pergolide well.  Two sources are Uckele and My Best Horse. 
https://uckele.com/jiaogulan-powder-1lb-bag.html
http://www.mybesthorse.com/productsorderhere.html


--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Eleanor Kellon, VMD
 

The main reason for another test is to see if her dose of pergolide (if she's even on it now??) is adequate.

Has she ever been tested for Lyme disease? How painful was she in 2014?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Mel V
 

Dawn,

Thank you!  Bali isn't off her feed, it is that her level of foot soreness increased immediately upon starting the Prascend again, which could be a coincidence.  She did go off her feed for 12 hours or so when we first started it on Aug 28, 2019.  I had stopped it for 3 weeks before the re-test and workup/lameness  exam/xrays (Feb 17) and started her back on 1mg Feb 19 when the vet called with the results, she'd already had breakfast when we talked. 

She was non reactive to hoof testers and my vet does think I should continue to ride her, so long as she is sound, as we all know exercise is important, and she wants to do things.

I was out of town Feb 19/20/21.  And when I got back on her on the 22nd, she felt NQR. I suppose that the Prascend could be making her feel "meh" and that is why she lost her marching pace.  She loves to ride out and this was a road ride, which she had been feeling decent on, but she definitely did not want to march actively.  She was happy with a slow mosey, so that is what we did. The farrier comes around 9am tomorrow morning.  He also was planning on calling the vet who did the test/xrays.  
--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


Sherry Morse
 

Mel,

While you're wandering around the files and the web pages take a look at the IR calculator: IR Calculator & Leptin


If you plug the numbers in from the your Feb 17th bloodwork for glucose and insulin Bali's G/I ratio show her as being uncompensated IR and her RISQI shows her as a poorly compensated IR.   This is fairly common with our horses where they'll be within a lab 'normal' range but actually are having an issue.  Her fat deposits (enlarged crest, enlarged udder, bulges over eyes) also all point to her being IR no matter what the lab normal range is.  You can read more about how many of these horses will test in the 'normal' range on the Diagnosis page: https://www.ecirhorse.org/DDT+E-diagnosis.php

As far as why we recommend Cornell for testing - they've proven to be the most reliable with regard to testing for all the values we're looking for (ACTH, glucose, insulin and leptin).

And you are correct - you can make a bloodwork folder within your CH folder and add the bloodwork results to that folder as long as they are PDF or Word.  If you have results as a JPG they'll need to be converted to a PDF or put into your photo file.




LJ Friedman
 

i didn’t recognize the nqr acronym.   i had to google. it.   not quite right.   fwiw
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Mel V
 

Eleanor,

Bali is on the Prascend - adding a timeline in bullet format to attempt to improve readability/clarity:
  • Aug 28 - Mid Nov. 2019 - 1 mg
    •  lame, but the giant hole in her foot was cause...I'll add pictures, she had developed a false sole around the infection.
  • Mid Nov 2019 - Feb 1, 2020 
    • .5 mg, improving soundness, light riding, increasing with soundness  I had a dressage instructor/judge (they're good at seeing uneven and irregular steps) watch her go at the end of December, she was looking good, a few off steps in trot, and she warmed up out of those, I was thinking if there might be some sort of scar tissue in the LF around that infection area.  It had been around the DDFT.  I decided to schedule a vet appointment for xrays and anything else needed.
  • Feb 1-17 - stopped Prascend, vet said she needed at least 2 weeks off to retest.
    • Feb 17, retested with TRH test, results in her case file.  Had a lesson during this time with same person Feb 8, and Bali looked/felt really sound, rode 2 or 3 more times that week, she still felt good.
  • Feb 19 - started back on Prascend 1 mg
    • Bali felt NQR to ride on Feb 21/22.  
  • Feb 25 - reduced Prascend to .5 based on titrating advice here
    • I'll see how she feels after we do her feet tomorrow morning.
    • I'll have the vet pull blood for her ACTH levels on March 6 when he is out. 

--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764


Mel V
 

Sherry,

I had just found that earlier today, and it is up on another tab on my browser!  I had been reading one of the older files on converting the lab units to calculate the G/I ratio, but it was late, and I just went to bed. 

I'll ask for the cost differential.  It is usually less expensive when the clinic sends the labs out.  There is a premium on them using the in-house equipment.  

Everyone is in dry lots today, because it is raining.  Luckily I have 3 fatties, so I always have someone to rotate into dry lots with Bali for company, and I have plans to add another dry lot on the other side of my farm, because right now, she gets distressed if I'm rotating the other horses to that side as they are separated. 
--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Photos: https://ecir.groups.io/g/CaseHistory/album?id=241764