Hello Dr. Kellon.

just an update on Riosa.  I woke up today to a horse with laminitis.  Not sure the cause but I did open a new bale of hay this past week from the lot I bought over the winter (was tested) but perhaps it was a hot bale.  Everything else has been the same except she was started on 5mg of estradiol and tomorrow will be a week of that.  I switched her hay over to a new lot of hay I just received that was tested and now we r on the emergency diet minus the soaking.

She has pulses in her feet - left more than right.  She is in her paddock and free to move around but I am feeding her in her hay bags in her lean to where there is deep bedding of shavings.  I gave her some. Ute this am as well but perhaps shouldn’t have.  

Just wondering at all if the estradiol has anything to do with this or just a coincidence.  I suspect a coincidence.  So frustrating as was hoping this year we would have all our ducks in a row for the summer season.  She hasnt had laminitis since June of 2017 which occurred most likely from Dex and undiagnosed IR.

Thanks and any help would be appreciated.


--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Hi Heather,

I  can't think of a mechanism for the estradiol to be involved. It is both insulin sensitizing and blocks endothelin-1. Never say never though so if she doesn't improve in 2 or 3 days just stop it and see what happens.

What is your weather doing?  Any change in her crest or eye pockets?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Dr. Kellon.

Her crest had appeared to go down I thought a few days ago but flared back up again and noticed that yesterday.  She didn’t didn’t have issues with her eye pockets and hasn’t since the first episode in 2017.  Her udder is almost all gone and her flank sensitivity as well.  One foot (left) is hotter than the other and has a more significant pulse in it.  The other I can barely feel the pulse.  Maybe abscess but think I’m wishing.

I am am wondering about switching to straight cubes but struggle with that as we are gone for 10 - 12 hours a day and that makes it difficult to feed just cubes.  For now have just switched her to the straight grass hay.  

I will I’ll keep her on the estradiol for a few more days.  

Thanks for for the help.  
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Heather has your local temperatures been low or possibly the temp suddenly dropped? Dr Kellon had asked about your weather in her post also but I guessed you had overlooked that.

Do you have your hay test results uploaded here somewhere?

Have you had Riosa tested for Insulin/glucose/ACTH levels? I didn't see any test results in her case history.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Hello. 

yes sorry I forgot to mention the weather.  It has been xty warm now for about a week or so and then temps got a bit cooler overnight last night.  Went from plus 4C yesterday down to minus 15C so yes a bit of a drop but nothing like we have experienced will brutal cold and then temperature upswings over night.  

Yes the hay was tested but not uploaded on the site. I suspect the bale I opened was not off the same field as the rest.  Should have known better. Kick myself in the but as now we are back to 8-12 mths off again.  So discouraging as spend all that money on testing, finding hay, mineral balancing, separate pens as feed separately, weighing feed, using hay bags and on and on.  Then in the matter of a few days “wham” here we are again.

I gave her 1.5 grams of bute this am.  Then came back out and booted her.  She has since kicked the boots off and now has decided she wants them off as she won’t stand for me to put them back on.  Will try again later tonight for overnight maybe.  She is wandering around her paddock eating manure at the moment.  Lovely. 

I have tested now the new hay she is on but no mineral blend to go with it yet so just giving flax and vitamin E until I get a blend done. Ordered some magnesium as well.

I have had her insulin and glucose tested about 2 years ago I think.  She tested to be uncompensated IR at the time despite tight diet and mineral balancing and being exercised.  I did test in the fall for PPID with the free test available from BI but she tested negative to that test.  She never seems to really get her insulin under control no matter what I do.  

I am very rural so testing costs a fortune so I limit what I test for due to costs to get the vet out.  I had thought I added her results to her history but maybe the new form didn’t load up.  Will have to check on that.

thanks again for the help.  I wonder if I should just stop the bute as well for tomorrow as I can’t feel pulses anymore and she is moving around pretty good and no more shifting front feet as she was this am.  

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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You may be dead on about abscess. That would certainly make sense.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

I am really hoping it is.  Her crest is rock hard right now and wondering if I should try to take her for a walk or something to get it to go down. Maybe I should just feed hay cubes to be on the safe side of things.  So frustrating. 

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Heather, about costing a fortune to get the vet out: Here in northern Ontario there are subsidies available that allow a group of rural livestock owners to pick a vet to service them at reduced cost. I belong to an association that has a membership fee ( about $65 annually) which means the travel cost will be much less for the vet's trip - two and a half hours each way. Up here we measure distance in hours ;-)
Maybe Manitoba has a similar program? With a name like "Veterinary Service Association"?
--

Thanks for the info Bonnie.  I don’t think we have anything in our area like that.  I do however use a friend of mine who is a vet tech to draw blood for me which helps a lot but she isn’t always easy to get to come out either. 

At this point I guess all the tests would tell me is that her IR is not controlled which I already suspect due to the crest neck and now sudden lameness. I checked her eyes when I went back out and yep they are puffy. She wasn’t like that yesterday so must have been some hot feed. It’s the pits.  We had such a great ride yesterday too and just bought a new saddle :(  oh well hope I can get her under control again. Going to go research slow feeders for hay cubes.

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Hi Heather,

Nose Its are great for ODTBC .

--

Lorna  in Eastern  Ontario
2002

 

Thanks Lorna.  Yes I have one but perhaps need to get a few more.  She loves her Nose It but is getting pretty good at getting the cubes out of it too!  Lol! 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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I'm not sure what size you have, Heather. I got mine years ago,when they were new on the market, and they hold about 7 pounds of the cubes.

--

Lorna  in Eastern  Ontario
2002

 

So Rio was better this am as not as foot sore but also in boots too.  No pulses and her puffy eyes have gone down a bit. Crest was still hard.  I gave her another 5mg of estradiol as well as her omeprazole this am.  I wonder if a conflict of giving both at the same time?  Does the omeprazole block the estradiol?  Just thought of this now.

I came home and she is still walking well with boots on but decided to take them off for overnight to dry her feet out as now snowing here a lot and it is on top of frozen icy areas so slippery.  Her crest seems to have grown since I left this am.  No pulses or shifting weight but I am pretty stressed about this crest issue.  Eyes to me are puffier as well.  I decided to switch her back to a lower s and a hay that is also lower in protein to see if that helps.

I am wondering what I can do to reduce her insulin gas I’m sure it is high due to the crest and eyes. Should I give some metformin?  Should I stop estradiol or give it at a diff time than the omeprazole?  I am wondering if that is the issue of why it hasn’t reduced the crest?  Help please as I just don’t want to push her over the edge more.

Thanks in advance! 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Hello,

Dr. Kellon I was hoping you could perhaps review the last post and suggest to me what should be done for Rio?  Should I continue with the estradiol but perhaps separate when I give it from the omeprazole? Should I try some metformin to try to get her insulin down as her crest just seems to be increasing?  Thoughts please.  Thanks so much!!!
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Are you seeing any flank sensitivity or udder enlargement? Is behavior back to normal?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Dr. Kellon.

Her udder is smaller and just a bit of swelling in front of it but not as bad as before and her flank sensitivities have gone down.  I am terrified about her crest though as it is massive.  I am thinking maybe to rule out any hay issues maybe I switch to cubes or mor cubes and see if that helps.  I wonder if I should take her for a walk and get her some exercise if she is willing and I put boots on her for that.  I just worry about her crest and her puffy eyes.  I will go see her this am and see what she is like and report back.  On my way out now. 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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This am crest is still enlarged and maybe slightly softer. It still huge. No flank sensitivity but she does not like me touching her udder despite it being small and not much fill in front of it.  She is moody with my gelding as well.  Walking around without boots and doesn’t appear to have issues moving.  Still a bit of puffiness in her eyes.  Fat deposits on her loins rump and shoulders as well but those seem to be about the same size as before. This Tuesday will be two weeks on estradiol but as I mentioned before I was giving her it at the same time as omeprazole and perhaps that affected efficacy.  Not sure. Should I continue with estradiol?  Should I exercise her?  Should I give metformin?  Thoughts?  

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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OK. I agree something needs to be done - just trying to make the most reasonable choice!

I wouldn't walk her if she's sore but keep her out where she can move and keep boots on her if they make her more comfortable. No bute etc as long as she is eating and drinking well.

If her cubes are ODTBC, fine to give as much as you like. Soak all hay.

The only thing that makes me hesitate about stopping estradiol is that it's the time of year for issues to appear related to early cycling. I don't want to make that worse but metformin may actually be of some help too.

Could try stopping the estradiol and starting metformin 30 mg/kg, twice a day.

If she develops flank pain or udder enlargement can consider restarting the estradiol.
                  
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hello Dr. Kellon,

I am sending my hay samples away again for a retest to see what is going on. I have switched back to older hay that was tested before but think I will put her in The ODTB cubes in the meantime.  I can’t soak hay as we are still freezing her and no way to do so at home :( so cubes it will have to be.

She is walking around ok without boots on and we just got a layer of fluffy snow which helps. I decided to stay the course with estradiol and see what happens as I agree with you that this is the time of year I start seeing cycle related issues.  Will see what she is like when I get home tonight. 

thanks again for all the help!!!


--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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Hello,

update on Rio.  Her crest is still about the same but maybe slightly softer and not as big.  She seems to be moving ok and I have taken the boots off most days due to snow.  Today I did notice that her eyes are goopy and red which is new. Her udder is still small with little to no fill in front of it however when I went to investigate it tonight she was not happy with me touching it.  Flanks seem to be ok as well.

I am wondering if perhaps some of what is driving her insulin up is uncontrolled PPID.  She was tested in the fall and was negative.  I have her on 3/4 Ont Dehy Balance Cubes and the rest tested hay from the summer which she did well on before.  The weather has been mild and no big temp fluctuations so I would think that since Monday things should be turning around but instead I am seeing odd things like goopy eyes, redness and still some puffiness.  The other thing about Rio is despite me working her on a regular basis (ridden, in hand and lunging big squares) and  ensuring she is using her body correctly her topline is the pits and at times she is ribby but still has fat deposits.

Just curious on your thoughts on this Dr. Kellon.  She will be turning 9 in April and started having issues in spring/summer of 2017. That is when I first noticed the crest development, watery eyes, extreme bug allergies.  Laminitis occurred after she was given Dex to help with the allergies but I suspect she was on the verge anyways due to the symptoms.


Your comments would be appreciated and anyone else have a younger horse with uncontrolled insulin which benefited from prascend?

Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


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