What now....help please


nikkibob1994@...
 

Darby is still incredibly sore. This has been going on for a month. In the morning he can hardly move, after some NSAIDS he is better, ready to be booted up and turned out. I tried going without the NSAIDS for a couple days and he was absolutely miserable. His latest blood results are in his file nothing remarkable except his calcium is a little high and his conjugated bilirubin is low. He has been on metformin (15 tabs twice a day) for about 2 weeks, and prascend (1 tablet) for about a week. His blood glucose is 88, insulin is 32, and ACTH is 28.8.
The vet wants to block him out next week and is saying possibly navicular...but bilateral navicular acute onset??
Please, where do I go from here.
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Nancy C
 

Hi Nikki --

Sounds like you are stopping NSAIDs cold turkey. If so that could be giving him NSAID rebound pain. Could also be dealing with unresolved abscess that will likely not resolve while on NSAIDs. If he were here I'd find another way to keep him comfortable: jiaogulan, phytoquench, muscle therapy.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21.
Veterinary Professional CE certification hours submitted to AAVSB Race 09.08.21


Nancy C
 
Edited

Short PS....

Looking at his photos, he appears to be standing out in front on the fores. I can't see his coronet band, but his heels appear to be ever so slightly under run.  You can see this a little better on the left. If you look at his coronet band without the hair, it should be a straight line, and not curving under at the heels.  A couple of swipes on the heels only, may put his foot back a bit further so that the bones align as they should and mechanisms work more as they should. If here were here I'd try two swipes, take more pictures and evaluate in a day or two.n There is no better learning tool than good pictures. https://ecir.groups.io/g/main/wiki/1472

Working on my own foundered and so-called "naviclular" horses over the years, I have found these tiny tweaks to often, but not always, bring good response.  If he is working on a abscess, that pain will override almost everything else.

As always, I bow to Dr. Kellon and Lavinia for correction.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21.
Veterinary Professional CE certification hours submitted to AAVSB Race 09.08.21


Eleanor Kellon, VMD
 

Have you repeated his Lyme titers recently?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


nikkibob1994@...
 

A lymes test was done through cornell on 9/3/21, everything was negative
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Eleanor Kellon, VMD
 

Well, it isn't an acute insulin issue and isn't a major trim problem either. Other possibilities include vasospasm/poor perfusion worsened by the NSAIDs or neuropathic pain. I would suggest seeing is your vet is willing to switch to Tramadol for pain relief (5 mg/kg orally twice a day) and once off NSAIDs start Jiaogulan. I would also start acetyl-L-carnitine 1 g/100 lbs bodyweight ASAP for neuropathic pain.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


nikkibob1994@...
 

Thank you Dr. Kellon, I will order The Jiaogulan and acetyl L carnitine now. What are your thoughts on adding gabapentin, my vet recommended it a couple weeks ago, but I haven't gone down that road as I thought I was still dealing with laminitis. I can attest to how affective it is no nerve pain......  I have been taking it for spinal stenosis for a few years now. Think its worth adding in to his cocktail? And do I keep going with the Prascend?
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


nikkibob1994@...
 

Thank you Nancy, I am always looking for trimming advice as I am not a trained farrier but have had NO luck having the professional farriers get him or keep him sound.
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Eleanor Kellon, VMD
 

I haven't seen any favorable reports on gabapentin results yet but you could try it. Try it without the ALCar first so you can tell if it's working. I don't know if the Prascend is really needed but this isn't the time of year to stop it. Wait until end November to stop then do  a TRH stimulation 4+ weeks later.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Re: Lyme titer - do you have the actual numbers?




nikkibob1994@...
 

Yes, they are on his CH
OSPA 63
OSPC 22
OSPF 668

--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Lesley Fraser
 

Lyme Borreliosis is just one infection that ticks can carry, and there are many other types of Borrelia plus several other vector-borne infections that can affect horses.  There is no single test that can absolutely exclude Lyme (this applies to humans, too) as a diagnosis, as testing doesn’t yet have this level of capability. This link has some useful information about companion animals and vector-borne infections: http://www.visavissymposiums.org/veterinary/pets/pet-diseases/    It’s a UK site, but the principle still applies.  Ticks can travel many miles on migrating birds, so we never know where the tick that bit us (if we see it) has come from.



--
Lesley and over the bridge Omar,
11-2012,
Cambridge, UK

Omar - Case History


 

Years ago, when Lyme disease was on the horizon but not something we were too concerned about yet in Vermont, we exchanged a very small amount of money for an unrideable upper level Hannoverian dressage horse.  My daughter ran across him at the Connecticut training barn where she worked for the summer.  Somehow the CT people suggested we test him for Lyme.  He was positive.  A course of doxycycline worked wonders.  Every 2 years or so, this would come up again and we would retreat him and then he’d be fine for awhile.  The vet we were using at the time was fine with this.  He then whittled his practice down, leaving us with one of his former employees, who wasn’t as excited about that idea but did eventually come around.  His issue was not laminitis but rather a general ‘stiffening up’.  We no longer have this horse but Vermont has since become tick central with a scary amount of Lyme.
--
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


 
 


nikkibob1994@...
 

I find this very interesting as all of Darby's issues started with a bout of Lymes disease. He initially presented as laminitis but that seemed to progress to being  neurologic....not wanting to walk, crossing his legs in front of himself when he did, he failed the neuro test. When his results came back that it was lymes, we did iv antibiotics for a week they switched to another oral antibiotic for 3 weeks and he came round pretty quick.
Another horse a had years ago also presented as laminitis but none of the standard treatments were working. I spoke to a vet, Dr. Stephen O'Grady, and he suggested using aspirin orally, and nitro glycerine cream on the back of the pastern where the digital pulse could be felt. This was the early 2000's and he said that it was not understood why this was effective but it was....and it worked like a charm, within 48 hours the horse was running around his pasture. 
So I think these are 2 avenues I am going to explore given that its seems pretty clear this is not an insulin issue.
Thank you all for your input, as usual, you never know what we may face but it is assured we are not facing it alone.
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Eleanor Kellon, VMD
 

Aspirin is an anticoagulant, no mystery there. Nitroglycerin works the same way as Jiaogulan, release of nitric oxide. Both of those address the increased endothelin found in insulin-related laminitis.  It wasn't understood then but it is now.

Eleanor in PA

www.drkellon.com 
EC Owner 2001


ediefr@...
 

I highly recommend getting the canine Lyme vaccine for any horse that has chronic Lyme. Did countless rounds of doxy and tetracycline over the years, and then my vet suggested the canine vaccine. Huge difference.

Now my horse gets the vaccine 2x a year, and his Lyme titers, while still slightly high, are lower than they ever were with the many rounds of antibiotics. And he’s comfortable, no soreness or lameness. Perhaps worth a try. Much less expensive and not hard on his digestion. 
EdieFr
Cape Ann, Massachusetts
Joined March 2021


nikkibob1994@...
 

..........perhaps should have added this info earlier...he does have a strong digital pulse for what it's worth
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Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396