Update on Flirt
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Roger Benson
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.
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It's safe to continue the metformin. It's not doing anything for his insulin but may well be helping with pain. I'd continue it.
There have been no formal safety studies on acetaminophen. I worry more with ponies because they are at high risk of fatty liver with EMS and that increases the risk of liver damage from the drug https://pubmed.ncbi.nlm.nih.gov/31307592/ . It's probably not doing much anyway. Try stopping the evening dose first and if he still seems the same, stop the morning dose too. That LF toe looks much better. The worst thing about that hay is the high iron but it can be balanced. -- Eleanor in PA www.drkellon.com
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Roger Benson
Thank you Dr. Kellon. 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? Would you agree that sugar and starch are within the acceptable range? Thank you again
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Sherry Morse
Hi Roger, There's almost no doubt that the improved trim is going a long way to make Flirt feel better. If you consider that some of his insulin production may be related to pain, as his trim is improved and he is in less pain from that there may be more on an insulin drop in the future. I would think, as we recommend with NSAIDs that you may want to slowly
decrease Flirt's Tylenol dose so you don't see a rebound effect but aim
for having him off of it completely within 2 weeks or so. As far as the hay balancing, you can find a list of approved balancers in the files: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing and scroll down to the file named Hay Balancing.pdf.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891
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The change in her insulin wasn't significant so it's not helping with that but human research has shown metformin can help with neuropathic pain. We had another horse on this list that was the same way - no help with insulin results but pain improved and every time she tried to take him off the pain would return.
https://pubmed.ncbi.nlm.nih.gov/29959433/ https://pubmed.ncbi.nlm.nih.gov/31238066/ There are many other articles. Eleanor in PA www.drkellon.com
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Roger Benson
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. 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.
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On Fri, Aug 28, 2020 at 03:49 PM, Roger Benson wrote:
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.Hi Roger, I admire your perseverance, ....and Squirt's......since things were looking so very bleak in the past. Well done, both. If he were here , I wouldn't be walking him until he is pain free. I would just let him walk as he wishes to. Maybe I've misunderstood. He is really handsome ! -- Lorna in Eastern Ontario
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You’ write that flirt has not been on nsaids for two months. assume bute/banamine. We know that Tylenol is an NSAID. What is the purpose of Tylenol? Why are using it-- etc LJ Friedman Nov 2014 Vista, Northern San Diego, CA Jesse and majestic ‘s Case History
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Hi Roger,
Very glad to hear Flirt is making progress. Alfalfa is not a good idea. You can use beet pulp instead - about 1 3/4 lb of beet pulp (dry weight) for every 10 pounds of hay. Remission won't help with balancing high iron and won't stimulate hoof growth. Do you have a trace mineral analysis on your hay? I didn't see iron, etc. on the analysis you posted. -- Eleanor in PA www.drkellon.com
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I found the hay analysis in your photos. If that is what you are feeding now, calcium is OK.
For every 11 lbs of hay you feed, give 1.5 doses (1.5 scoops) of Equi-Base grass https://uckele.com/equi-base-grass-pellets-15lbs.html plus 1/3 scoop of Poly Zinc https://uckele.com/poly-zinc-pellets.html . Use coupon code ECIR for a 5% discount. -- Eleanor in PA www.drkellon.com
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Sorry, one more thing. You should shake the hay well before feeding, dunk it quickly in a bucket of water if you can.
-- Eleanor in PA www.drkellon.com
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Kim Leitch
LJ,
Tylenol (Acetaminophen) is not an NSAID. it is a pain reliever, but not anti-inflamitory. -- Kim 10-2014 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
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Hi Roger, it is so good to hear of Flirt's progress!
His feet look much better but given how sore he looks standing still, like Lorna advised I would not be handwalking just yet. He looks like he would be still hobbling around slowly. Allowing him to move at will is probably better for nonow, unless he is noticeably more comfortable with boots/pads on and you use them for handwalking. Also, given his continued high insulin and looking at your new hay analysis, I STRONGLY recommend soaking it for 1 hr in cold water, then rinsing it off before feeding for the best outcome for Flirt That will help remove some of that excess iron (it is very high for an IR horse) that Dr Kellon wants you to shake or rinse off before feeding, and it will reduce the ESC even further and can only help Flirt feel better. I too have a hay that is around 7% ESC+starch and the difference in my horse when I soak it is notable. -- Kirsten and Shaku (IR) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album
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Roger Benson
Hello Everyone,
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Roger, is there any reason you can’t work on Flirt’s feet yourself, with guidance from Lavinia? We had someone in Fargo, ND looking for trimmer help and I don’t know if she found the right person. Looking at the map, it appears you are not that far from Minneapolis. Could you contact the vet school there to see if they might have suggestions for trimmers?
I’m wondering what you thought might be special about the evening hours for grazing? Mornings would be safer if anytime is. You can fully block the muzzle. As he became sore again in late summer, I hope you requested that his ACTH levels be tested. I looked at your case history and it’s been about three years since it’s been updated and really doesn’t contain much useful information at all. You may not know exactly how old he is but your vet ought to be able to wager a guess. Has he never had any previous blood testing done? -- Martha in Vermont
ECIR Group Primary Response July 2012
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)
Martha and Logo
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Roger,
We can't see the December films in as much detail but from what I can see there's not much difference. The trim, however, is much worse. Flirt does have extensive bone loss but in his favor for reasonable comfort is his size. He needs that bevel brought WAY back from where it is. I doubt he moves around enough on pasture to outweigh the sugar. Invokana is not a miracle cure and the diet for each horse needs to be individualized. It also won't compensate for ACTH being uncontrolled. -- Eleanor in PA www.drkellon.com
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Roger Benson
Thank you Martha for your feedback. I have posted Flirt’s recent blood tests in his photo album. In May, his ACTH was 32. Yes, his blood drawn yesterday will include ACTH, INSULIN, GLUCOSE, and TGL.
I do have a call in to some Minneapolis area equine clinics asking for farrier referrals but so far no results. Did you see the recent X-rays in the photo album? What is your impression? THANK YOU for reaching out. -- Roger and Flirt January 2018 Atwater, Minnesota Flirts Case History Flirt's Photos
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Bobbie Day
Roger
thanks for the update, I have asked several times here if anyone had heard from you regarding his progress. Happy to hear he’s still with you but sorry he’s struggling again. Hang in there and pick up that rasp you can do it ! -- Bobbie and Desi (over the rainbow bridge 7/21) Utah, Nov 2019 NRC Plus 2020 , NAT , C&IR March 2021 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi https://ecir.groups.io/g/CaseHistory/album?id=78821
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Roger Benson
Thank you for your observation Dr. Kellon. Test results should be available soon. Meanwhile I will continue to look for a farrier that can help. My regular farrier’s last visit is next Saturday.
Our vet recommended giving Tramadol for pain. He is currently on Hemp Joint Supplement. Can they be given together. Searching for comfort right now. How much sole do you think Flirt has? Is he in danger of penetration? I will post test results when available. -- Roger and Flirt January 2018 Atwater, Minnesota Flirts Case History Flirt's Photos
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Roger Benson
Thanks Bobbie. If it comes to that, I will try. Guidance would be needed. Hoping for some experienced help tho. -- Roger and Flirt January 2018 Atwater, Minnesota Flirts Case History Flirt's Photos
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