It is time for an update on Flirt. First I have down loaded some pictures, blood analysts and hay test results.  This is posted in my photo album.  I will post more hoof pictures after the next trim.
It has been about a month, and two trims by our new farrier.  During that time Flirt has received 4500 mg of metformin twice a day as well as 2500 mg of acetaminophen each morning and evening.  The farrier has made major changes in his trim and removed a lot of excess foot.  He returns on Thursday the 13th.
The results have been:
1.  A slightly lower insulin reading from 92 to 86.  I am not sure how significant this is.  I was hoping for a greater drop, but at least it is going down and my vet was pleased.  What do others think of this drop?  Do I continue with metformin?  Is it still safe?
2.  Flirt has not had any NSAIDS in over a month.  He seems much more comfortable, except for the left sole that had the deep hole in it from “gas pockets.”  Yet he is still moving much better than a month ago.  I think it is no longer infected.  The farrier thinks his hoofs have improved a lot and is very optimistic that they will continue to get better.
3-  I take Flirt for a short walk twice a day.  He seems to be moving well.  I can only hope it continues.
One concern that I have is can I continue to give Flirt acetaminophen safely?  I have read that it was relatively safe for 30 days, but not sure of its affects beyond that.  We are now at that point.  What do others think?  I do not believe I have yet removed the trigger for his pain. ( high insulin)

I had a second testing of my hay that was thought to be questionable.  Those results are in the photo album.  I need that hay to be good for our other two horses.  I can always find some other hay for Flirt, but have over 200 bales of this.  I need to make it more nutritious.  What is your interpretation of this tested hay?  Any suggestions?  May need a hay balancer.

The stated changes have all seemed to help Flirt.  It has been a struggle, but we are definitely moving in the right direction.  We will continue to work towards Flirts recovery.

I thank everyone in the group for their encouragement, advice, and support.  There are some “awesome “ members here.

Roger & Flirt
January 2018  Atwater, Minnesota
Flirts Case History
Flirt's Photos

www.drkellon.com 
EC Owner 2001

Thank you Dr. Kellon.  
Can you explain why you think metformin may not be working to reduce insulin levels, and why it might still be beneficial for pain control?  

Flirt has been on L-Car since early January when his insulin was greater than 200.  Do you think the L-Car is working more effectively than the metformin did?

I intend to experiment with his dosing of Tylenol.  There is no question that his comfort level has improved.  I am beginning to think that the improved trim has made a HUGE difference in comfort for him and may be the biggest factor for his improvement.  I will post new hoof pictures later this week after his trim on Thursday.

I thought the ratio of calcium and phosphorus was out of whack in the hay test results and made for bad hay.  Now high iron is noted.  Need to do more research.  Suggestions are invited.  

Would you agree that sugar and starch are within the acceptable range?  

Thank you again

Roger & Flirt
January 2018  Atwater, Minnesota
Flirts Case History
Flirt's Photos

www.drkellon.com 
EC Owner 2001

I just posted 10 new photos of Flirt’s feet.  He just had his third trim with our new farrier.  This last one was a little over due because our farrier was injured when “run over” by a startled horse.  Those who have been following Flirts battle, please take a look and comment.  So many of you have been helpful.

UPDATE:
Flirt has not had any NSAIDS for more than two months.
He is more comfortable than he has been in a very long time.  We go for daily walks and he does well.  We are slowly weening him off Tylenol, but continue to give metformin even if insulin reduction has been minimal.  I agree with Dr. K that it is probably helping manage pain.

Our new farrier continues to be optimistic that we are making good progress.  Old hoof and tissue are crumbling and being removed while new growth beginning to replace.  (Hope I described that correctly).  The hole in the right sole has gotten shallower, but deep hole in left sole remains and foot is still tender, but pain much improved.  The new approach and alignment trim is making a huge difference.  With less pain I hope the insulin level continues to drop.

I intend to add “a little bit” of alfalfa to offset the low calcium to phosphorus ratio in the questionable hay recently purchased. Is this wise or not?  He remains in a paddock with hay and Timothy Natural Balance Cubes without any pasture.

Also, might remission now be used to help lower high iron content in that same hay? or to stimulate new and healthy foot growth? I know copper and zinc are key to balancing that very high iron.  

We have made good progress this summer.  Thank you for your comments and support.






--
Roger
January 2018  Atwater, Minnesota
Flirts Case History
Flirt's Photos

We go for daily walks and he does well.  We are slowly weening him off Tylenol, but continue to give metformin even if insulin reduction has been minimal.  I agree with Dr. K that it is probably helping manage pain.

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Jesse and majestic ‘s Case History 
Jesse's Photos

www.drkellon.com 
EC Owner 2001

www.drkellon.com 
EC Owner 2001

www.drkellon.com 
EC Owner 2001

Clover, SC

Grits and Dually: IR; Bella: PPID, IR; and Eeyore (deceased, but not PPID related)

Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually

Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314

Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978

Hello Everyone,
It has been awhile since I have reported on Flirt.  He has cycled up and down like a yo-yo.  Last summer he responded well to a new farrier and was more comfortable and moving well. His insulin had responded to metformin and numbers were decreasing.

Then December came and trouble reappeared.  His insulin shot back to over 200, cold weather brought back abscesses and discomfort.  Winter was tough on Flirt.  With Dr. Kellon’s help we switched Flirt to Invokana.  His insulin numbers dropped and he was more comfortable again despite those deep abscess holes.  Hoofs were taking shape slowly and farrier very encouraged. By Spring he was improved and fairly comfortable.  Though never pain free.  His feet have always been tender on a hard surface.
Late this summer he became sore once again.  Today we had new X-rays taken and another blood draw.  Tests results will be available in a few days, but X-rays were viewed.
I have posted in my photo album 14 pictures which included today’s X-rays and previous blood results.
My vet was very discouraged by the rotation and sinking in Flirt’s front feet.  I am so disappointed by his pessimism going forward.  He was talking end of life.   Is it that bad that we can not make Flirt comfortable again?  He is moving around with good appetite and lots of water.  In fact he spends a couple of hours out of his dry lot each evening in the pasture with a muzzle on.  With him on Invokana I did not think a little evening grass would be bad.  Movement was the trade off, but now seeing these X-rays I am uncertain.
Can a farrier experienced with founder help Flirt.  Our farrier for, personal reasons, will not be able to service Flirt any more.  I need help.  Can anyone refer me to a farrier in west central Minnesota that could help Flirt?
Flirt is so special with a bright spirit within his eyes. Neither he, nor I am ready to give in. 
Thank you in advance for any help or thoughts.
--
Roger and Flirt
January 2018  Atwater, Minnesota
Flirts Case History
Flirt's Photos

www.drkellon.com 
EC Owner 2001