I'm fairly confident that 6 mg of estradiol has had a beneficial impact on Cayuse's intractable pain. 

She is off all banamine (briefly), she isn't lying in her stall most of the day, her appetite is normal/ravenous, she wanted to be groomed, her crest is visibly changed, and some of the estrus behavior -- squirting, winking -- stopped but only for several days.  Yesterday she resumed that part and spent several hours in the afternoon lying in her stall. Her respirations were slightly elevated at 22-39. We're in the midst of a heat wave (100 degrees yesterday). She doesn't show flank pain that I can detect. She has almost normal pulses, nothing strong or bounding. RF remains sensitive, the hoof with the thinnest sole. I don't see new event lines in her hooves, which are cool to the touch. 

Is heat alone is enough to elevate respirations or are the elevations are a reliable sign of pain? 

If I read old messages correctly, is it possible Cayuse has another follicle that needs to mature? 

Have I missed the window for a repro exam or hormone labs so that my veterinarians can verify to their satisfaction what we suspect? I would like to make this a teaching opportunity so that they can get on board with estradiol as opposed to the Regumate mantra. 

Can you explain to me in simple terms why the progesterone produced by the matured follicle can resolve the pain syndrome caused by the follicle but the progesterone supplied by Regumate is ill-advised? My guess is that Regumate is given daily at a fixed amount, promoting IR, whereas the normal operation of normal estrus has the levels cycling up and down.

Last, do we know or suspect that PCOS-like condition in mares like Cayuse independently promotes laminitis or is it primarily a pain amplification mechanism? Or maybe both?
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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More questions than solid answers here!

Yes, absolutely the heat can elevate respirations especially if she is not sweating normally.

I really don't have a clear enough timeline or enough solid information from ultrasounds to tell you if another follicle might be flaring up.

From tests available today, ask for progesterone, testosterone, estrogen, anti-Mullerian hormone and ultrasound with pictures.

These cystic follicles don't ovulate and mature normally, they just eventually start to develop progesterone producing tissue. I don't know what the levels are compared to a follicle that actually ovulated. When they are hung up in trying to ovulate, inflammation is on overdrive.  When progesterone predominates, insulin sensitivity suffers but the normal progesterone ups and downs with cycles don't usually cause issues. You have to get to the uber levels with pregnancy or Regumate to cause issues. Does that make any sense?

The ovarian issues are caused by the IR, not the other way around. One of the early mares confirmed to have this with presentation, LH, FSH, progesterone was spayed by her owner, who thought that would fix everything. Not. She become laminitic again after the spaying.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Re : HEAT CAN ELEVATE RESPIRATIONS. As an aside due to unexplained elevated respirations I started monitoring heart rate (resting and active) respiration rate, time of day, environmental factors such as smoke etc from Aug. 12 2017 to Oct. 14 2017. So it was a good 2 month trial. I kept a sort of chart of this which was done twice or thrice a day usually 9 am and 6 pm. Of course it was generally cooler in the morning than in the evening. Heart rate was also higher in the evening. After having kept records for a week and seeing consistently high heart rates (45-60 BPM) and under supervision of vet. administered 10 cc of banamine to see if perhaps this was due to pain. and monitored her HR 12 times that day. Results from this were briefly 46 at the beginning to 55 at the last, just about the same as without the drug. By Aug. 23 I was also checking respiration rates which I had more difficulty deciphering but probably averaging 15 per minute again for the 2 month period. There was a correlation between respiration rate, heart rate and air temp and smoke but it was not always consistent. By Oct. 8 2017 the heart rate never went above 46 BPM and respiration had dropped to 6-8-12 so I stopped my little experiment on Oct. 14 2017. Still dont have a clue what this was all about.
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- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382

Thanks, Dr Kellon, especially the clarification that cystic follicles "mature" to produce progesterone but don't ovulate. 

Unfortunately, today we have a repeat of the earlier pattern. Cayuse could barely walk across her bedded stall to her hay this morning. When I checked at 1PM, I found her down in the stall (this time on her right side) with 2 piles of manure in the stall. She was sweating at the flanks and around her belly back by the udder. Same slightly elevated respirations (32 today) that I now think are a reflection of pain. After a dose of banamine and a nap, she was up and hungry, comfortable enough to cooperate as I put on a fresh pair of hoof pads in front. 

I hoped she'd have a full, clear and immediate recovery. A single dose of banamine every other day is an improvement.

I will call my vets Thursday to request the ultrasounds and hormone testing you describe. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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