Still Seeking Answers about where we're at


Anna Dolly
 

good morning, y'all,
I *think* I have done what I am supposed to with Babe's Case History file. Hyperlinks in the case history form didn't work for me, so I searched for the how tos and please forgive me if I missed dotting an i or crossing a t.

We started a half dose of pergolide 2 days ago and are to recheck in 30 days. I am still questioning whether Babe has even a mild case of Cushings or not, and whether the season, combined with the pain of two really nice abscesses in the last month could have driven up his cortisol levels? 

The second of the abscesses has started to drain and I just now realized I forgot to include the pain meds in my case history- he had been on bute, now they have him on Equioxx.

Babe has seen two different vets from the same clinic, and a third is calling the shots. I really like one of the vets who came out- however, she is new, young and defers to the third vet due to seniority. The third vet is who I have typically seen for Babe's care in the past few years and nearly always leaves me with questions I can't get her to answer clearly. I am in a remote area and do not have another clinic within range to consult with, so I am left to flesh out answers on my own, much of the time. 

I am by no means saying they are wrong. I am simply saying I cannot seem to get straight answers to my questions, and there is a history of this with my housepets and this clinic, as well. I do not need every scientific study out there, but I do want to see the picture I'm dealing with clearly enough to make sound decisions.
They've refused to check for Lyme and that baffles me. We live in the mountains in the woods. Actually, the young vet agreed to, and then the third one said, "no".

I had hoped I'd found another equine vet out of VA, but she is just a little too far away to include me in her circle. She did, however, visit with me for a few minutes, which I appreciate. She indicated that she didn't think Babe's ACTH was out of line for this time of year, but that we're generally on the right track. She recommended checking TRH in January, so I will request that when the time comes.

So here I am, hoping that y'all can help educate me. I have not read up on it, but I gather that pergolide is designed to reduce cortisol levels?
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History


Eleanor Kellon, VMD
 

First, did you fast your horse before the tests? Your insulin is normal and ACTH normal for the time of year but they can both be lowered by fasting. Did they do radiographs?  Pergolide is to reduce ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Anna Dolly
 

Yes ma'am, thank you
I know they drew blood prior to fasting and also fasting. If I understand correctly, they submitted both samples for the test, but I may be mistaken. I know that the fasting, at least, was specifically for the test.
They took radiographs of his fronts two weeks ago, I do not have those in my hand yet, I have requested several times and been told "I'll try to get those to you soon" each time. I requested again this morning, with the same response.
They told me he has 'very mild rotation' in his RF, but did not tell me more than that.

--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History


Sherry Morse
 

Hi Anna,

Taking blood "prior to fasting" as well as after would imply that you had bloodwork done 2 different times - once with Baby having access to food for at least 4 hours prior to testing and the other without access to food for several hours.  Is this correct?

If so, we really need the non-fasting test results as fasting will lower insulin and ACTH levels as noted in Dr. Kellon's email.




Eleanor Kellon, VMD
 

Anna,

If you have fasting levels   I'd like to see them too since normals for fasting were published recently.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Anna Dolly
 

Thank you Dr. Kellon and Sherry,
I messaged the vet who asked me to have Babe fast and came and took the blood sample. She said that yes, this test was done fasting. They ran several tests on him (for infection and such) so apparently I was confused about what was for what. 

--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History


Sherry Morse
 

Hi Anna,

So the current fasting results are something Dr. Kellon can look at with relation to the report she referenced about fasting normals.  For the way we usually look at results though, those aren't very helpful since fasting will lower levels.




Anna Dolly
 

Thanks, Sherry,
IDK if it would be helpful for me to upload the images of the page they sent me or not, but that's all I have. 
I do understand why they think Cushings, this bout of abscesses was the worst he's ever had and they said he also had laminitis.
I just don't know enough to do more than contribute what they've told me or handed me.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History


Sherry Morse
 

Hi Anna,

I'm of the 'it can't hurt to ask' opinion.  If it's images sent as a JPG and not a PDF you'll have to create an album here: https://ecir.groups.io/g/CaseHistory/photos (name it Anna and Babe) and then load the images and you can add the link to your signature and also send us a note and let us know it's there.

If you need help with any of that just let us know where you're stuck.




Eleanor Kellon, VMD
 

The study on fasting found a cutoff of 5.2 uIU/mL fasting accurately diagnosed insulin resistance in 87.3% of horses so he's actually in a grey zone but most likely is IR. Fasting significantly lowers ACTH with fed horses having ACTH an average  of 2.7 times higher than fasted in this study https://pubmed.ncbi.nlm.nih.gov/24906932/ .  That would put him solidly in the PPID positive  zone.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Anna Dolly
 

thank you once again, Sherry & Dr. Kellon
I have added his test result pages in a photo album linked here in my signature, if that is of any help at all.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album


Anna Dolly
 

I just received Babe's radiographs, we only did his fronts. I have added them to my photo album.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album


Sherry Morse
 

Hi Anna,

Looking at his x-rays he appears to have room for improvement in his trim as he has quite a bit of toe and his bone alignment is not correct.  That alone could be causing him some foot pain.  If you could add pictures of his feet/legs (guidelines on that are here: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help) and then post a message with a title like 'seeking feedback on current trim' we can probably help you address some of those issues.




Anna Dolly
 

I will do that, Sherry,
he was about due for a trim when the first abscess developed. I was instructed by vet not to trim til we knew what was going on. It is possible that part of the issue is also we have had very soft, wet footing for some time and the hoof has curved under near the heel end of it on each foot. I’ll get photos and show you what I mean. His farrier has been out a couple of times since this all began, but I had not yet scheduled another trim, he wasn’t going to be able to stand on each front long enough to do it, on top of the vet’s saying not yet.
i will be sending radiographs to farrier tomorrow and talking to him about getting us on schedule for a trim.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album


Sherry Morse
 

Hi Anna,

Generally speaking for a horse that's had laminitis or is having abscessing issues more frequent trims to help bring the feet into better alignment are the preferred route rather than going for longer periods of time and losing control of positive changes.  We have several members who have all sorts of tricks for getting feet done when the horse is too painful to take all the weight on the opposite foot.  For starters you can think about having the foot to be trimmed on a block so there's space to work on the foot without the horse needing to hold it up.




Lavinia Fiscaletti
 

Hi Anna,

Although the radiographs aren't the best in terms of the technique used to take them, a few things do stand out. Was Babe standing on each foot when the views were shot or was his foot out ahead of him on the block?

The rads show some pretty typical TB feet: long toes, less-than-ideal sole depth, very underrun heels, ground-parallel coffin bones. These are all trim issues that can be fixed. Abscesses will generally make a horse profoundly lame - many times, even worse than if it were laminitic. As soon as the abscess drains, the horse immediately becomes sounder.

Unfortunately, NSAIDs will interfere with abscesses maturing so they draw out the amount of time the horse ends up suffering with them  As much as we hate to watch, it's better not to give them and allow the abscess to drain as long as the horse continues to eat/drink normally. Soaking and poulticing the affected foot/feet is a better strategy.  If he is laminitic, the NSAIDs won't help either as laminitis from PPID is not an inflammatory process so they have no effect on it.

A set of hoof photos would be very helpful. The soft, wet footing did not cause the heels to run under - that is a trim issue.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Anna Dolly
 

Thank you, Lavinia,
I did not know NSAIDS could prolong abscess issues- and he's been on them for a few weeks now.
The farrier had me soaking and poulticing and then the vet said to stop it because if it was laminitis the hot water would make it worse. So I stopped. That was with the first abscess, which took forever to run it's course (three weeks). By then he had started developing a second one.

They said what they saw in these radiographs (I don't have the front view ones yet, and I've asked again for them) was laminitis.
As for the view- he was standing on a 2x4, but I was watching the screen to see if they had the entire hoof in the picture for them, not watching if he had his whole weight on the hoof. I would be surprised, as sore as he was, if he had much weight on the elevated hoof.

His heels- the hoof material is there, it is curved under because it was soft- is that what you mean by run under? 
I'll be taking photos as soon as I can, and I've got a message in to the farrier, as well. I'll be talking to him about more regular trims.
I appreciate y'all's patience with me and input.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album


Lavinia Fiscaletti
 

Hi Anna,

I'll be able to be more specific once you have a chance to put up a full set of hoof photos and I can see exactly what you're referring to. Then I can get some mark-ups to help guide the trim.

I honestly don't see compelling evidence of laminitis on these rads - just a trim that needs work. What they may be referring to when they say they "saw laminitis" is that the dorsal wall of the RF hoof capsule doesn't quite line up the way it should in relation to the coffin bone's position. Given the overall alignment of the bony column, that's at least partly a long-standing trim issue, quite commonly found in the way TB feet tend to be trimmed. There may be a slight bit of bony column rotation on that RF but with the way the rads were taken that's a question mark at the moment.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Anna Dolly
 

Thank you once again, Lavinia,
I find comfort in your words. I will get photos of his hooves this weekend and get those shared. I can see (and didn't notice before) what you mean about his foot possibly being pointed out front while they took images, rather than squared up beneath him.
--
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album


Eleanor Kellon, VMD
 

Anna,

I do see a slight rotation in the RF and probable mild thickening of the horn lamellar zon- both indications of laminitis. However, even without that I would expect him to be sore with this trim. Abscessation doesn't have to be laminitis related either. Those hoof photos will help further but bottom line is going to be that NOTHING should be removed from the bottom of his feet - not sole, not frog, not hoof wall. Just stand him on blocks of wood and rasp the toes back from above with a file.  Mineral and amino acid nutrition could also be playing a role here.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001