Update on Flirt


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.
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


Eleanor Kellon, VMD
 

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 
EC Owner 2001


Roger Benson
 

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


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.




Eleanor Kellon, VMD
 

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 
EC Owner 2001


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.

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


Lorna Cane
 

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
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


LJ Friedman
 


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 
Jesse's Photos

 


Eleanor Kellon, VMD
 

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 
EC Owner 2001


Eleanor Kellon, VMD
 

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 
EC Owner 2001


Eleanor Kellon, VMD
 

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 
EC Owner 2001


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
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




Kirsten Rasmussen
 

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 Case History  
Shaku's Photo Album   


Roger Benson
 

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


 

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


 
 


Eleanor Kellon, VMD
 

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 
EC Owner 2001


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


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


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


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