Strawberry new rads :( (Currently in extreme discomfort)


Nicole
 

I have updated Strawberry's case history with more details and the lab results I had at this point (still waiting for results of last Friday). She has really gone downhill this past weekend.
My vet recommended putting the external (screw on) wedges back on her cloud boots, I was wondering what your thoughts are on that. I don't know what else to do at this point, she is in so much pain she can hardly move. I'm not sure how we will be able to get her trimmed on Friday because she can't pick up her feet. I feel so bad for her. 
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Kirsten Rasmussen
 

Thank you for doing that update.  I'm glad she is back on Metformin, hopefully you see an effect soon.  I don't think wedging up her heels is the answer to her pain but I hope Lavinia or Dr Kellon can address that and the trim.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Sherry Morse
 

Hi Nicole,

You've left it a bit late for getting markups, but at the very least Strawberry needs the excessive toe length removed to help stop the external forces pulling on her laminae.  It won't be a miracle cure but it will probably go a long way to helping her feel better.  If you could take a full set of hoof pictures as directed in the Wiki: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help and post a message that says something like "Lavinia markups needed" that would get Lavinia's attention and she would be able to advise you. 

If you'd like those done prior to her farrier appointment I would suggest pushing the appointment out.  You don't need to pick her feet up to address the toes - you can use a block of wood and have her stand on that so she's able to distribute her weight more evenly while the toes are being worked on.  There's no sole to spare so nothing should be coming off the bottom of her foot at this point.

As far as the CH - metformin is dosed at 30mg/kg which would be 9525.45mg 2x a day for Strawberry so she needs 9.5 pills twice a day - not 9.  The timothy balance cubes are fed at a 3:4 ratio for cubes:hay.  By my calculations for Strawberry that would be 10.5lbs per day so she needs an adjustment down on those, particularly if you are still feeding the Teff pellets as well as the timothy balance cubes are a complete diet replacement.  If you're feeding a pound of pellets a day she'll need less of the cubes.



Nicole
 

I didn't realize the Timothy Balance cubes are fed at a lesser rate. I can adjust down, it just seems like such a small amount of food. She gets about 2 cups of the teff pellets AM & PM to mix her supplements in.

Is 1 cup of ground flax per day the appropriate amount? I wasn't sure if I should go by weight or cups. 
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Sherry Morse
 

Hi Nicole,

Flax is fed at a rate of 3oz per day.  You may want to review the diet information on the website: https://www.ecirhorse.org/DDT+E-diet.php



Nicole
 

I just weighed my scoop of flax on my kitchen scale and the 1/2cup scoop is 1.6-1.8oz, so she was getting 3.2-3.6oz per day. (Phew)
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Lavinia Fiscaletti
 

Hi NIcole,

Based on the latest rads, DO NOT put any wedges onto her boots (or in any other way). Her bony column alignment is good, with no bony column rotation.  It's her trim that is deteriorating, with the toes are being allowed to get further and further out ahead of where they belong. The sole depth has decreased, likely because there is sole being taken off during trims. She has sinking but it doesn't appear to have changed much since at least Feb 2021, based on the rads. She has some medio-lateral imbalances (laterally high RF, medially high LF) which again, have been present in all the rads.

Her insulin and glucose results in June had her in the diabetic range, with an insulin over 200uIU/ml and glucose at 177mg/dL. That insulin level is the driving force behind her foot pain, with the increasingly poor mechanics exacerbating the situation. Getting that insulin down is what will stop the ongoing pain.

If you can get me a full set of photos today, I can get you some mark-ups for the trim on Friday. She doesn't need to pick up her feet to get the toes backed up: you can stand each hoof on a 2x4, with the toe hanging over the edge to back up the toe; stand her in deeper footing (like sand or thick bedding), then rasp right thru the sand/shavings to back up the toes. Also can address the M-L imbalance the same way. There's nothing that needs to be done to the bottoms of her feet right now, except to leave them alone.

Use padded boots with level pads in them, NOT a wedge.

Hang in there.

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


Eleanor Kellon, VMD
 
Edited

I agree with everyone that getting her toes back is the major thing that needs to happen with her trim, followed by https://hoofrehab.com/DistalDescent.htm .

Also agree until the insulin comes down she's going to be in pain. Seasonal rise may be part of this but she was out of control in early June and pergolide isn't going to fix it all. Looks like metformin isn't working either. Let me know if you want me to send Invokana information to your vet.  I'll need an e-mail address.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

P.S. See if your local horse supply store has a Devil's Claw product to help with pain. It's not the solution though - only controlling insulin is.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nicole
 

Thanks, I will see about the photos tonight if she isn't too uncomfortable to pick her feet up. I was experimenting with different pad options since she was getting worse I thought maybe the wedged pad that came in the cloud boots might be bothering her, plus it pushes her frogs up so bad that they are disappearing.  I tried a flat thick black pad set my vet gave me and she became more sore. Then Monday I tried a double layer of wool felt saddle pad (about a 1/2" total) and she improved a tiny bit. I thought it might at least help not get so slimy and sweaty. 
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Nicole
 

Lavinia, 
I'm sorry, I wasn't able to get the set of pictures tonight. I will get a good set when she is more comfortable/cooperative, and I can get someone to help me. You gave me some good information already when I asked abouther toe/hoof wall, so will go with that for this time.
Thanks!
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Patti SoCal 2020
 

Hi Nicole,

i use those interlocking foam kids floor tiles and put a felt pad over them.  They give some comfort but also give to the horse’s weight/hoof shape. That’s the good and bad news since you need to cut new inserts every 3-4 days. 
--
Patti
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny 
https://ecir.groups.io/g/album?id=262934  


Lavinia Fiscaletti
 

Hi Nicole,

I've added a couple of mark-ups to Strawberry's album:

https://ecir.groups.io/g/CaseHistory/album?id=267559

As I mentioned before, the biggest thing is to get the toes backed up. This will require backing thru what may look like the "white line" at ground level. Need to leave the rest of the sole alone. Frogs and bars also need to be left alone, at least for this round, as the bony column alignment is fine but the sole depth is not. There is capsular rotation, which is the laminar wedge pushing the hoof capsule away from a tight alignment with the bony column. This needs to be addressed thru the trim. There is also sinking, which is contributing to the compromised sole depth. Once the underlying causes of the laminitis are removed (high insulin), then the lamina will stop being assaulted and can start to heal. Setting the trim up to support that mechanically is another important step. Have a read here for more info:

https://www.hoofrehab.com/Breakover.html

https://www.hoofrehab.com/HeelHeight.html

https://www.hoofrehab.com/HorsesSole.html

https://www.hoofrehab.com/FrogTrim.html

RF lateral composite: On the radiograph side, the pink line shows the bony column alignment and stops at ground level where the breakover should be. There should be no hoof capsule touching the ground beyond this point. There is barely adequate sole depth, so not a millimeter to spare. Green line follows the angle of the new growth coming in under the coronary band toward the ground and indicates where the dorsal wall should be, if it was well attached and there was no laminar wedge. This is a visual marker, not a trim line. Blue line at the toe shows where the toe should end, with the blue X being the excess horizontal length at ground level. Red line indicates that NOTHING should be removed from the bottom of the foot behind the blue line. Yellow line #1 runs thru the coronary band, #2 points to the extensor process. The distance between them indicates the amount of sinking.
On the photo side, the green line is the same as the one on the rad. The blue area corresponds to the blue X on the rad. Red line means nothing off the bottom o the foot. Orange line shows where the heels should line up eventually, once they are no longer underrun.

LF lateral radiograph: Same general discussion as the RF except that here, the sole is thin so really need to preserve every millimeter that exists, This means no removal of anything behind the blue line, even if it appears to be exfoliating or appears lumpy.

Strawberry should be in boots and pads at all times until she is comfortable without. Which pads to use depends on what makes her comfortable. If a pad squishes down and conforms to all the crevices;collateral grooves in her foot, leave that pad and just add another one underneath that one to increase the cushioning benefits. You want the pads to support the contours of the foot to be the most effective.

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


Nicole
 

I posted Strawberry's front post-trim photos to her album. 
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Lavinia Fiscaletti
 

Nice job on the trim, really got the toes backed up perfectly and the alignment looks to be spot-on.

What does Strawberry think?

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


Nicole
 

She is pretty sore yet, she hasn't moved much. I wonder if I should try putting the thick black pads back in again instead of the wool felt that is in there... but I think she is done with us messing with her sore feet for a bit. We adjusted the breakover on her boots back further than I had it too. 

I need to get a new pair of boots for her and was wondering what kind/Brand might be best? I bought a pair of Easyboot Sneakers, but they seemed really tight on her heel bulbs. What about getting her in Easyboot Gloves? Soft rides? Farrier mentioned putting her in a wooden clog that he would build, or a natural balance shoe?? 

Ps. I added a couple hind pics from today as well. 
--
Nicole P
2021, Minnesota 

Case History: Strawberry Case History

Photo album: Strawberry Photo Album


Maxine McArthur
 

Nicole, I found Easyboot Sneakers to be a difficult boot to get on and off. Both Easyboot Clouds and Soft Rides are designed as rehab boots, so are easier to apply to a horse that is having trouble holding their feet up. I’ve only used Clouds, as we don’t have Soft Rides here, but they worked for my mare. Many horses do seem to like the pads in the Clouds. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


 

Nicole,
Wow on getting the trim done! Boots and padding are highly individual. I like the ease of applying Easyboot Clouds but pads were a constant changing problem for my horse.  I suggest getting a few different ones to try, including different thicknesses of flat pads. My horse hated thick pads, probably couldn’t tolerate steady pressure on the frog. It ended up that Carvallo gel pads - thin, flat pads - worked best for her. So keep an open mind. Strawberry will let you know. And what works for 5 days may not work for the next 5 days. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Lavinia Fiscaletti
 

The best boots are the ones that fit her. Best pads are the ones she finds most comfortable. You're going to need to experiment.The Soft Rides or Easycare Clouds have the most forgiving fit. If you use Soft RIdes, you'll need to cut the pads so they are level rather than wedged as they don't squish down and she doesn't need any type of wedging.

Due to the sinking, many of the riding/working boots are likely not going to fit well as she needs a lot more overall hoof capsule height than a healthy foot needs just to have enough to encase the bony column completely. Definitely not in favor of shoes of any type as that's just going to suspend her completely from her already-damaged lamina.

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


Sherry Morse
 

Easyboot Gloves have NO padding and are not designed for rehab so while I love them as an option while riding in rocky areas they are most definitely not something I would consider using on a horse with no sole.