Our pony Flirt in trouble again!!
It has been awhile! Our pony Flirt has been been dealing with sore feet and laminitis for years. I think I finally am getting it under control and then it all blows up with another bout that brings on extreme lameness and soreness. He is IR and metabolic syndrome
The past winter was really tough but he seemed much improved going into April. Then we discovered “gas pockets” in all four feet. Three have healed pretty good, but one has left a huge hole in his left front sole. The farrier thinks it may even extend to under the frog. It is very painful. I soak it in epson salt and flush, clean and wrap everyday. I have posted some 8 pictures in Flirt’s album.
Two showed up on the first page and the other 6 on the last page.
I need some advise as to what I can do. Can this hoof be brought back to health? His current diet is the emergency diet, ( Timothy balanced cubes, stable1 pellets, Vit E, flax, and salt and grass hay.). In addition he takes half an ounce of remission and a couple of grams of L-Car ( which has lowered his insulin number under 100 for the first time in years) each day. I never have had a specific number other than greater than 200 for his insulin. His appetite is good , drinks plenty of water, and is not over weight. Accept for those feet, he remains a very good looking pony with great temperament despite the pain.
I try not to use it very often, but he responds very well to bute. What does this mean? J-herb has never seemed to help. Probably contributed to discomfort during laminitis times.
Many on this site helped save Flirts life two years ago, and now I am seeking your help once again.
Thank you to all for what you do .
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
Can we prevent the coffin bone from sinking through? That is my greatest worry right now.
All help and advice appreciated.
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
Sorry to hear Flirt is having difficulties again.
Thanks for adding those photos. Looks like he may have had a huge sub-solar abscess in that LF. That's a pus pocket that forms between the new sole and the older, exfoliating sole. Once an abscess drains, it should bring a lot of relief, although this one will take some time to grow out fully. It could also be an infection of the coffin bone itself - osteomyelitis. That would be more problematic.
Highly recommend getting some radiographs done to see exactly where this tract is located extends to.
Could also use a full set of hoof pix as one thing is definite - the toe on that LF is definitely too long so the trim needs some tweaking. Here's the lonk to what is needed:
https://ecir.groups.io/g/main/wiki/1472
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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR
Do you have the units of measure or the lab reference ranges for that ACTH from the fall? Without them, there's no way to know whether that was a really good number or a really bad one. Can you get a copy of the actual results from your vet?
Is his hay tested? If not, it needs to be soaked. Or, just feed him all Timothy Balanced Cubes in place of the hay.
If you can get a handle on the insulin and his ACTH is good, it should be possible to stabilize him and keep him from sinking further.
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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR
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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
TROUBLE!!! While waiting for vet, things have become much worse in the last few days. Vet was to be here now but had another emergency. Will be here tomorrow. Meanwhile, Flirt has taken a sudden turn for the worse. In addition to pain in the LF sole due to hole, he now is unable to bear weight in the FR. This came on suddenly. Is it possible to injure that RF because of LF pain and favoritism?
Flirt appears very warm and breathing heavily. He is down most of the time. Additionally might we be dealing with an infection? For the first time looks sick.
Lots of stuff going on. I know trim not good now with long toes. When farrier here 2 weeks ago he did not want to add more stress and was going to wait for X-rays to guide him. So, still waiting with X-rays that will be done tomorrow.
Then vet said today that if X-rays show coffin bone extending down and out that we should prepare for the worse. Do you agree that all hope is lost if that is discovered?? So concerned for Flirt.
This has all happed so fast. Earlier in the week he seemed to be progressing and moving better. Are his meds having an affect? Remission ( half ounce) and L-Car ( 2-3 grams) are taken daily with his Stable1 and balanced Timothy cubes. Half a tablet of prescend is taken each day.
Recap: ACTH test in normal range last fall as stated by vet. Insulin at 107 ( very high ) in March, though much less than a year ago. Cortisol was less than 2.
Searching for additional help, advice, and hope. I want to be as informed as possible when the vet finally arrives tomorrow. Can you help us save Flirt again?
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
The advice you will get here is solid. Follow the emergency diet to the "T". Once he's back on his feet, keep his diet tight. There are no easy answers and you'll have sleepless night trying to figure it out. If after all that, Flirt still stuggles then get in touch with Dr Kellon for the protocol on Metformin or Invokana.
Please let us know how you and Flirt are doing after the vet.
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Nancy K and Smoke
November 2018, Lakeville MA
Smoke Case History https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Smoke
Smoke Photo Album https://ecir.groups.io/g/CaseHistory/album?id=94122
So sorry Flirt is having trouble again.
Did you see Lavinia's replies to your messages in late May?
If you go below the bottom of this page you'll see View All 8 Messages in this Topic.
Click there and all your recent messages and replies will appear.
Please send x-rays when you have them.
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Lorna in Eastern Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php
For Flirt's sake, I'm going to be brutally honest here. I've said many times that "Halfway measures get halfway results". Unfortunately, in this scenario halfway is not at all helpful. The process is DDT.
D - Diagnosis. You seem to have laboratory results but they're not in his file so we can't help you with that. Will assume he at least has EMS.
D - Diet (and medications). This is the cornerstone of controlling insulin/EMS. Without a correct diet as the base, nothing can help. Correct diet means everything is analyzed for safety (sugar and starch), vitamins and minerals correctly balanced. Supplements are not drugs. They don't cure this. What they do is allow the body to function optimally and remove roadblocks to that optimal function. If diet is in place and the animal still needs help, there are medication that can help control insulin. Giving Prascend to an animal that does not have PPID won't help anything.
T - Trim. Correct trim puts the hoof capsule (basically the horse's "shoe") in the correct position to support the internal structures and avoid harmful forces on the weakened laminae and other structures. I don't blame the farrier one bit for wanting radiographs before trimming these feet although the toes could have been safely backed up without them. This scenario isn't familiar to many farriers so the "First, do no harm" principle is understandable. What's not understandable is letting the toes get that far out of control.
Flirt's size is in his favor. If you can get all these factors under control and he doesn't have osteomyelitis he has a good chance.
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Eleanor in PA
www.drkellon.com
EC Owner 2001
-- We know it’s sometimes difficult to post laboratory results to our file. Why don’t you post them here so we can have a looksee
LJ Friedman Nov 2014 Vista, Northern San Diego, CA
Jesse and majestic ‘s Case History
Jesse's Photos
Thinking about the cause of those abscesses and how they may have appeared, I remember Flirt “escaping” last week when feeling Ok. He ran out of the barn when our other horses were put out and would not allow us to catch him ( we have lots of pasture and space). He was out all day and at times gets “herded “ by the others. All his movement may have caused bruising leading to the abscesses. Does that make sense? I am certain that fresh grass that day also compounded the problem.
Our vet checked the hole in the left sole and there was still signs of an infection. He gave Flirt antibiotics to treat that.
Blood was drawn to check his ACTH and insulin numbers.
It will be a few days before those numbers are known.
X-rays were taken and I will post when I receive them. The good news was that that the coffin bone had not gone through the sole. I will not attempt to explain what the vet said, but will allow the photos to be interpreted by the experts here. There appears to be lots of room for farrier to realign. A problem with angle of growth apparent.
In response to diet, I am in need of hay now. I have started to search diligently for low sugar and starch hay. I will not get any hay that does not test low. Does anyone know where approved hay can be gotten in Minnesota. If so, I am all ears. Meanwhile, Flirt does consume a lot of the Timothy Balanced Cubes during this time of shortage.
We definitely have hope once again. I think a crucial time will be how his next few trims will go and if his problems are addressed correctly. I will post the X-rays as soon as I receive them. Please feel free to comment on them. In fact, I look forward to that.
Thank you everyone for your concern and guidance.
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
Flirt must be feeling somewhat more comfortable. Good news.
Dr. Kellon has given you a good plan,going forward. It would be wonderful for Flirt if you can get that nailed down, minute detail by minute detail. You've heard this here many times before, but just in case, the devil is in the details !
I'm sure you've printed out a copy of her post from yesterday.
Thinking of you,and hoping the very best for Flirt.
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Lorna in Eastern Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php
I have posted in Flirt’s photo album the X-rays taken on Saturday. I will add some other visuals tomorrow.
The farrier will get these tonight.
As stated before, I look forward to your observations and any suggestions that I may share.
Insulin and ACTH numbers will be available soon.
I am well aware that we have improvements to make and hope it is not too late to restore comfort for Flirt.
Thank you in advance for your insight.
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
Thanks for getting the radiographs put up.
Trim definitely needs some major adjustments. Even tho there is significant sinking evident in both feet, there is a large amount of excess foot everywhere, so plenty of room to make the needed changes. Flirt being a little guy is working in his favor and it should be possible to get him comfortable once the trim is corrected (and maintained that way) and his PPID/IR are managed tightly.
RF is showing definite demineralization of the leading edge of the coffin bone. Some bony column rotation along with capsular rotation. Toe is way too long, heels too high.
LF has more bony column rotation along with the capsular rotation. Toe too long, heels too high.You can see the shadow of that large hole in the sole reaching almost all the way to the coffin bone itself. Should definitely be careful to keep that clean and packed with an antiseptic dressing, then wrap the foot to keep dirt out of it.
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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR
Thank you Lavinia for your quick response and observations. You had given Flirt and I hope.
However, right now I am Bummed.” Our farrier shared the photos with some of his colleagues, a vet who does a lot of work with rescue horses and his past farrier instructor from school. All were very pessimistic. They saw infection at the end of the coffin bone which they felt was the source of incredible pain, and a crooked stance that could not be changed. Can the infection be reversed? Is that what others see? They both thought Flirt should be put down. They are looking at the same X-rays with a very different conclusion than some here. Why so different?
I have just come in from soaking his feet in water with epson salt. He had been walking around his dry lot. He did have a gram of bhute this morning, but there was a sparkle in his eye with good demeanor. Lots of shifting and lifting his feet when moving slowly. After soaking, we flushed out the hole, cleaned it, treated hole with iodine, then covered with a sterile pad, before wrapping hoof with vet wrap and duct tape. Was the iodine good to use, or should I use something different?
Right now I am looking for ideas and encouragement. My farrier indicated hesitation to continue. Though probably would for us, but ,.,.,.,? I think he feels like the other two. Do any people come to mind in Minnesota?
Demineralization was mentioned. How do I address that?
What exactly does that mean?
Can that”crooked, angular, stance be corrected?
We are not ready to give up, but do need guidance. In our battle, is there any way to reduce his pain? He does respond well to bhute, but how often and long can that continue? Does it impede healing? What can be a alternative? Do we have a chance???
Lots going on. THANK YOU in advance for your support and help.
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
I have been following your Squirts (luv that) journey and I would just like to say the decision to move on has to be yours, yours and squirts.
I know he’s on shaky ground and it’s so hard to watch them, I think we’ve all been there.
My local vet also said I should put my girl down, although she wasn’t quite as bad as your boy she has awful arthritis which really exasperates her condition. Some days she hurt so bad she wouldn’t move and my vet told me I should show my love for her by letting her go.
And I absolutely agree that is the ultimate sacrifice we can do for them but I just knew in my heart she wasn’t ready.
So I followed every single bit of information I could get here. I thank God everyday for the mods, Dr.K, Lavinia because I did not have hope before. I literally drove my vets office crazy with all my insistence. But I got the ultimate compliment when my vet actually told me she may be calling on my for help if she comes across this again. My girl is doing well!
But what was suggested to me by a member which was invaluable was to start a diary or timetable. Write in it everyday, good or bad, what you did, what worked and what didn’t.
I found that to be invaluable.
I wish you the best of luck you obviously love this little guy, I’ll be thinking of you both.
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Bobbie and Desi
NRC March 2020
Utah, Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi
https://ecir.groups.io/g/CaseHistory/album?id=78821
Thank you for your words of encouragement. I am hopeful that all the experiences on this site will help us find a way to bring comfort to Flirt.
So glad your girl is doing well!
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Roger
January 2018 Atwater, Minnesota
Flirts Case History
Flirt's Photos
I looked at your case history and saw the x-rays, if at all possible consider "maggot debridement therapy" if the bone is infected. Take the advice of Dr. Kellon and the advice given to heart. I have been there done that it works. It gave my IR/Cushing horse so many more years. You got to get that coffine bone clean, the maggot therapy will work. Look at the links, Daisy haven farm has very good video on the process.
https://www.monarchlabs.com/mdt
https://www.daisyhavenfarm.com/blog/got-maggots-maggot-debridement-therapy-daisy-haven-farm-style
-- Wishing you the best
Jeannie
2010 Oregon
NRC +, CIR0813, NAT0413
Case History https://ecir.groups.io/g/CaseHistory/files/Jeannie%20and%20Zena
Photo https://ecir.groups.io/g/CaseHistory/album?id=57253&p=pcreated,,,20,2,0,0
Demineralization is a thinning of the bone - think osteoporosis. In this case, we're talking about the coffin bone. It can be due to excessive pressure on the bone, which forces it to remodel to accommodate the pressure; it can be due to infection - osteomyelitis.
If there is infection, the infection needs to be treated to stop ongoing damage. Regional Limb perfusion would be the best method to accomplish that.
If it's due to unrelenting pressure, the trim needs to be corrected to remove the inappropriate pressure. In a full size horse, any damage to the coffin bone is magnified because size matters - the smaller you are, the better off when it comes to damage within the hoof. Either way, we've seen many horses with considerably more damage get turned around and lead happy, pain-free lives.
Not sure what they are referring to when they reference "crooked stance"?
- If they mean the LF leg, where the bony column is definitely not aligned properly, that appears to be a congenital deformity that he's had all his life. It definitely has nothing to do with laminitis.
- If they mean the RF leg, when the RF DP view was taken, Flirt wasn't standing squarely on his leg - he was leaning to the inside and the hoof wasn't even standing fully on the block.
- If they are referring to the bony column rotation present on both feet, that's a trim issue that can be corrected but you will also need to make sure that the underlying cause has been removed or it will continue to happen. To keep him sound and happy, you'll need to make certain that the trim remains correct and that the underlying cause(s) remain tightly controlled.
To reduce his pain, you need to remove the cause. From the experience we have here with thousands of laminitic, foundered horses over the last 20+ years, it doesn't appear as if this case is a lost cause at this time.
If there is no drainage from that hole once it has been cleaned out, I would suggest soaking a wad of cotton with betadine, then stuffing the hole with the cotton to prevent anything from getting up into it. Securely wrap the foot to keep it clean and dry. A diaper wrapped over the foot, then covered with vet wrap and some duct tape makes a good, secure bootie.
Bute is counter-productive after a few days. If you still need NSAIDs after that time it means you haven't found and eliminated the underlying cause so need to do more homework to figure out what part of the equation is missing.
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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR