Hoof pain


Lisa
 

Good afternoon, 

I finally have a case file and photos added. Please let me know if there is anything I have done wrong and should fix. 

I bought Nira, a 2007 Rocky mare, in June 2020, after losing two MFT mares to laminitis (before I found this group). After finding this group, I got my hay tested (ESC and starch is less than 10% total), well water tested, and had a ECIR member make up a recipe for a custom blend supplement, all in hopes of not going down this road again. Here I am.

Nira has been on pasture in the summers since I brought her home and tested hay in the winter. I rode her at least a couple times a week for at least an hour.

I switched my supplement carrier to soaked beet pulp shreds right away in early February. Prior to that we used a handful of soaked alfalfa/timothy pellets AM and PM. I have discontinued that.

The history leading up to this episode: In November I had to cover for an employee during illness and then she quit, I was working a lot of hours, so the riding stopped (Nira still was able to roam the pasture). In December, I got a concussion and was not able to feed for several weeks. I suspect she got more hay than I would have given her during that time. Then January 27 she cast herself in the snow. It was not more than an hour and she got up on her own after I shoveled aroung her, and when she got tender-footed a couple days later we just thought hard ground and sore back. The vet came out January 31, and did a chiropractic treatment. He thought her back was fine. I had her stalled, and her feet just kept getting more and more sore and she moved less and less. On February 7 we did X-rays - photos in the file. They looked good. We kept her stalled, used bute and got her boots. She continued to be very sore. We started soaking her hay. The vet drew blood and Cornell did the tests - results in file, photo file has the report. Her ACTH was 29 (scale 2-35), insulin was 200 (scale 10-40) and Leptin baseline was 66.79 (scale 1-10).

On February 24 the vet X-rayed again, photos in files, slight rotation on both feet. The farrier took her toes back some. My regular farrier was hurt and couldn't come out, so I had another guy there. I wasn't thrilled with him so I didn't have him do much. Regular farrier is coming on March 11. I put different pads in her boots and wrapped her legs. It seems to have helped some. The vet brought Thyrol-L and Insulin-wise out that day. I wasn't thrilled but we are using them. Yesterday I reduced her AM bute from 2 grams to 1, and she gets 1 gram in the PM. Getting her off the pain meds has been slow, she gets sore again right away. 

I've ordered some different pads to try in her boots, hopefully more cushion. I have Jiaogulan that I ordered in case I can get her off the pain meds. 

Thoughts or suggestions? I feel defeated.

Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Eleanor Kellon, VMD
 

First, no more pasture except for 3 to 4 hours at a time with a sealed muzzle. Dormant grasses they dig down to through the snow are sky high in sugar.

She sounds most like a cold induced hoof pain. Socks over hoof, boots, leg wraps, blanket.  Definitely get her on Jiaogulan. Thyro-L and InsulinWise won't help. Keep your receipt for InsulinWise so you can get your money back. Bute won't help either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Hi Lisa,

Aren’t northern winters the most fun?  Welcome to the ECIR group!  As this is your first post, we’re acknowledging it with an informational welcome from the group.  Below you will find lots of good reading plus links to much more.  If you have questions on any of it, please let us know.

The first thing that struck me, reading through your post, is that IR horses really can’t go out safely on grass unless muzzled, winter or summer.  The hay that you have may need to be soaked.  While 10% is our suggested cut off, not all IR horses can tolerate even that and your hay is quite close to that cut off.  I see that you are soaking it now.  Was the blood draw before you began soaking or several days after that?
Her ACTH is actually elevated.  To be normal it would need to be midway in the reference range or upper teens to low twenties.  Starting her on pergolide could well help but it won’t bring the insulin down anywhere near normal so that will need to be addressed with diet and possibly medication.  Thyro-L is good if she is overweight as it helps to jumpstart weight loss.  If her weight is good, no need to give it to her as it doesn’t help control insulin.  Most people here have not had good results with Insulinwise.  I believe there’s a money back guarantee so, if you also find it doesn’t help, check into that.

Getting her off the bute is important.  I know it is tricky.  Laminitis is not an inflammatory condition so NSAIDs don’t relieve laminitic pain.  If may help with soreness from having been cast.  Instead we recommend Devil’s Claw.  While you need to taper off NSAIDs, that can be done in a few days if she’s on Devil’s Claw while being tapered off bute.  Uckele sells Phytoquench pellets which contain DC.

No need to feel defeated, although for awhile before I found this group I thought my horses were perhaps getting PPID from our water.  Turns out they were just aging along with the rest of us.  We all have accumulated lots of practical experience caring for these metabolic horses and you can benefit from that rather than feeling defeated by past experiences.

So, what follows is our welcome letter.  I’m sure others will post with more thoughts so please keep us posted on your progress and concerns.

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck. 

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating". 

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

--
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


 
 


Bobbie Day
 
Edited

Lisa
I don’t have anything to add except Nira is a very pretty girl!
My little mare was a Rocky Mountain and I have never seen one this color, I thought they were all chocolate in color, I had to take a look, I had no idea! She’s very pretty, you will get great help here as you know. Don’t be too hard on yourself we’ve all been in your shoes and she is in great hands.


--
Bobbie and Maggie
Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi
https://ecir.groups.io/g/CaseHistory/album?id=78821


Lisa
 


Lisa
 

Update on Nira - I have her in Cavallo boots with Easyboot Old Mac gaiters and Easyboot 12 mm mint green pads. She has Weaver shipping wraps on her legs. She is moving better and getting sassy, nickering at me when I come in the barn. I’ve got her off bute, which I hadn’t been able to do before. Farrier and massage therapist are coming out Friday. 

Any additional advice for me on trim based on her last X-rays? I plan to have the farrier trim back her toes some. 

How soon can I start jiaogulan? And how much do I give her? I purchased powder through Herbal.com

Thank you!

--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Kirsten Rasmussen
 

Hi Lisa, 

We have a folder with info on jiaogulan, including how to dose it:
https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Jiaogulan,%20Nitric%20Oxide%20Support,%20AAKG%20and%20Supps

General trim advice: toes need to be backed up on both fronts until the breakover point sits just ahead of where the coffin bone projects to the ground if you were to draw a line along its dorsal/top edge to the ground, and roughly parallel with the dorsal hoof wall.  Don't lower RF heel (it was lowered a bit too much between xrays) or touch sole.  LF heel can come down a smidge (a few rasp swipes, maybe 1-2mm) and don't touch sole either.  Both soles are thin.

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


Kirsten Rasmussen
 

You can start jiaogulan as soon as you like.  Just remember to decrease her trim cycle to 3-4 weeks max.  Otherwise the hoof can get too overgrown between trims.

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


Lisa
 

Hello again,

I need help.

I have updated my case history on Nira. I managed to get her off of all pain meds by March 8. The farrier came out on March 11, he took back her toes on her fronts, some toe off the back hooves, and took off a bit of her LF heel. On the 13th I started Nira on Jiaogulan. I am giving her 3/4 of a teaspoon AM and PM.  

She didn't seem any better after the trim. I tried leaving the boots with pads off yesterday, but after an hour or so she seemed even more reluctant to move, so I put them back on. Today she was chewing on them, so I took them off again. She walked around a bit after that, but then after an hour seemed more reluctant to move again, so I put them back on. 

I am also concerned because she doesn't seem to be drinking much. I wasn't too concerned when she wasn't drinking as much after I started soaking her hay, but since I got her off all pain meds last week she is drinking way less, sometimes nothing at all over night. She is eating well, pooping and still urinating, but not as heavily. The color seems normal and it smells like usual. 

Are any of the supplements a problem? The vet wanted me to start her on Insulin-wise and Thyrol-L (2/24/2022), and if I think back I believe that may have been when she started to not drink as much. Should I stop these? I'm thinking yes. I know Dr. Kellon said they don't help, I just didn't think they would hurt and maybe help her lose some weight, so I was using them since I had them. Now I am scared. Have I caused her harm? Do I need to have the vet come back and do more blood work or something? Is the Jiaogulan interacting (although this has only been three days now)?

I'm at a loss as to what else to do to help her feel better and because of my concussion issues I am struggling to think clearly, formulate a plan and I am struggling with anxiety and worry over everything I do. 

Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Rita Chavez
 

Hi Lisa,

I'm no expert and I know the professionals here will chime in. But I wanted to ask, are you adding salt to her meals? I never used to before, but once I started the emergency diet for Stetson and started giving him loose iodized salt with each meal he really increased his water intake. Still is. 
--
Rita C. and Stetson (2001 Tennessee Walking Horse/Gelding, diagnosed IR)
Aiken, South Carolina USA
June 2021

https://ecir.groups.io/g/CaseHistory/album?id=265166 

https://ecir.groups.io/g/CaseHistory/files/Rita%20C.%20and%20Stetson


Eleanor Kellon, VMD
 

Lisa,

Her toes needed to come back more in both sets of films and she has a thickened horn-lamellar zone which indicates chronic low level damage but there's no real rotation and sole depth is better than most.

Are you wrapping her legs and putting socks under those boots? Cold could be playing a big role.

When they bite at the boots it usually means they are being rubbed by them. Check heels especially.

How much is she drinking? Horses with stomach pain sometimes drink more. It doesn't sound like there is a problem and no danger of interactions or toxicities.

Yes on the vet coming back to repeat insulin and consider TRH stimulation for ACTH.  You could also ask the vet to prescribe metformin, start that at 30 mg/kg twice a day, then wait to do blood work for 3 to 7 days.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Lisa,

Can you please post current hoof pictures following the directions in the Wiki: https://ecir.groups.io/g/main/wiki/1482#Photos-and-Hoof-Evaluation-Help

If she's more comfortable in the boots, leave them on.  If she's biting at them check to see if they're rubbing.

Insulinwise should provide your money back if you send it to them.  If you decide to stop the Thyro-L you will need to wean off of it.

Thryo-L taper: https://ecir.groups.io/g/main/message/265797


How long has she been on weighed hay? 




Lisa
 

Hi everyone, 

Thank you for taking the time to respond. I will try to answer questions and give an update.

Nira has been getting weighed soaked hay since 2/10/22. While this was about 12 days after symptoms started, we at first thought she was sore from being cast. She has lost weight since starting the weighed soaked hay. 

I do add salt to her meals. I have done this since October 2020. She is maybe drinking a gallon of water during the day. She is inside and it hasn't been warm out at all until this week. I drain her hay but it is pretty wet when I feed her, it's been too cold to get it well drained without it freezing.

The most current x-rays I have of her feet are in her photos. These X-rays were taken before the farrier trimmed her toes back. I will try to take some hoof pictures and get them posted. She has been in boots with gaiters and leg wraps since mid-February. I will add socks tonight. Temps have gone up above freezing at night and into the 40's and 50's F during the day now. I'm hoping that will start to help, but the socks might also help if she is getting rubbed. I bought some different boots today to try. They should arrive in a few days.

The vet was here this morning. I was worried about her colicing. He gave her some fluids and did a blood draw to confirm her kidneys are okay and they are. Our plan is to do blood testing again in a couple of weeks (after the temperatures are hopefully a little more consistently warmer at night) and also X-ray her hooves again. Dr. Kellon, I will check into the information on the blood tests you recommended and see what my vet says about metformin. 

Thank you!

Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


 

Hi Lisa,
I find that when I soak my hay, my horses drink much less water than they do otherwise.  Her ACTH is a little higher than where we like to see it maintained (mid teens to low twenties) so you might want to keep an eye on that.  A TRH stim test, where they measure ACTH before and after hormone stimulation, would pick up early PPID.which could lead to elevated insulin, especially during the rise.  If that’s the case, some horses get pergolide only during the rise.
--
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


 
 


Lisa
 

Hello again!

I have added hoof pictures to Nira's photo album, taken yesterday, a week after her trim. Please note the X-rays were all done BEFORE the trim. I did find a rub on her left front bulb, I put some moleskin on it, then added socks under her boots and she seems to have stopped chewing on them now. The other boots I ordered to try should be here early this week. 

I also added the x-rays of her hind hooves to her photos in case anyone has suggestions. Her toes have been trimmed back since these x-rays, but I didn't think to take photos to add. My worry is that she seems to be very unstable on her hinds as well as her fronts (and has been since this started). Is that normal? 

I have eliminated the Insulin-wise, and cut the Thyrol-L down to 3/4 of a scoop AM and PM. Then I added a couple more water buckets to her stall and put 5 teaspoons of apple cider vinegar into the water in one of the buckets. She has started drinking now from that bucket and one of the other buckets that have been there all along. The buckets have always been cleaned regularly and I change the water daily, so who knows why she wasn't drinking!

My husband (best husband in the whole wide world) brought sand up from our sand hill and spread in front of the barn, then set up a 24x24 corral area in front of the door to Nira's stall, so she can go outside now and not be on hard ground or in mud and can turn without having to make small circles. I hope that isn't a mistake, but she really has been cooped up too long. She has wandered a bit and then went back in to lay down when she was tired. She has been really good, not getting crazy and moving too much or too fast. 

I think that is all that is new for her at the moment. I wish she was getting better faster, we seem to have gotten to a certain point and stalled out (this started end of January, started soaking hay 2/10/22, had been feeding her grass hay and balanced minerals all along before that). I really can't think of a single thing to do different to tighten up her diet. In a few weeks we intend to x-ray again do some blood tests to see where she is at. I still need to read up on the blood testing that Dr. Kellon mentioned. It's been a rough week for my head, so things are moving slow. 

Thank you all for your help! This group is wonderful!
 
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Eleanor Kellon, VMD
 

Have you adjusted her Jiaogulan dose to make sure she has obviously more pink tongue and gums?  Have you talked to your vet about metformin to get that insulin down?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lisa
 

Good morning,

In all of the concern about her not drinking and her piles getting dry, I guess I forgot about increasing her Jiaogulan dose. She is at 3/4 of a teaspoon twice a day. I started at 1/2 a teaspoon because she has been pretty sensitive to sedation in the past. I will start increasing that because I don't see a significant increase in the color of her gums and tongue yet.

For some reason, I have it in my head that I need a better baseline blood tests for her insulin and ACTH, taken when she isn't in as much pain as she was to start and it isn't as cold as it was the first time the tests were done. So should I get her going on metformin instead of worrying about that? I'm trying to do what is best for her but I don't need to waste money on unnecessary tests either, I haven't been able to work for over three months now. Clearly I'm having trouble processing all this and keeping all the details straight.

Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Eleanor Kellon, VMD
 

Don't worry about more testing, just start the metformin.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lavinia Fiscaletti
 

Hi Lisa,

Ask your vet to call in a script for the Metformin to Farm Vet:

https://www.farmvet.com/Metformin-HCL-Tablets

This is the best price around at the moment - $45 for 1000 pills of 1000mg.

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


Lisa
 

Hello again everyone,

I have updated Nira's case history and added a few current photos of her. She has lost some more weight, maybe 50-60 pounds total since this started end of January. The farrier was here for another trim last week. She is in Soft-Ride boots. After starting the Metformin (3/22/2022) she did seem to start moving a little better. I upped her Jiaogulan to 1 tsp twice a day that same day. That seems to have increased the pink color in her tongue and gums.

I also just got the blood test results back - checking her insulin after a week on Metformin. It was down to 42.5 uIU/mL (was over 200, scale is 10-40). She was not fasting. I consider that a win? 

We also did the TRH stimulating ACTH test. Pre-TRH level was 15.5 pg/ml (scale 2-30), which I think is great, but the post-TRH was 188.0 pg/ml (scale 2-110). Where does this leave me? Dr. Kellon advice, please?

She will go out in the outdoor sand paddock we made for her and do a few laps and roll, but she still is moving pretty slow. Definitely improved from where we started end of January, but not great. Do I continue on as I am and give her time? I really don't know what else to do at this point, so if I am missing something please let me know. 

Thank you all so much!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134