Hello Lavinia 
could you please review these new pics of mya . The farrier trimmed her on august 5th according to your last markups . She seemed a bit better at first & now is struggling again especially with her left front . She has been doing more of this stretch stance & may be loosing some weight . She prefers to put weight on her right front even though according to X-rays it is worse. I think she may be having an abscess in her left front starting ? Farrier is back out this Monday august 22. 

coujd you give me some guidance as what to do to make her more comfortable with her trim ?

I have to update her file - we are on very little thyroid & only a gram of bute a day . I have added phytoquench- mag ox - vit e - triple crown Timothy cubes - still rinsing /soaking hay - waiting on hay analysis  - metformin bid - 1/2 tab prescend - rsr beet pulp - acetyl argentine- flax 
Thank you lori 
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Lori R in MN - 2022

Owner of 3 Metabolic Horses 

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Hello - I’m sorry about the reply messages - I’m not sure how to delete the message I’m replying to? 

im not a good computer friendly person - difficult for me to understand, unfortunately.

as to the mare I have her on phyto-quench with devils claw already - she doesn’t like eating it unfortunately. So with that I should just stop the bute according to the referenced article I should - but I’m having difficulty in her eating the phyto-quench?? Hints on how to get her to eat that ? 

with epson salt soaks in warm water is that safe ? I don’t want to soften her sole and risk a solar penetration because her sole gets too soft? 

Also I read somewhere in the digests here that I SHOULDNT give the devils claw plus by uckele  as it has yucca and As she is an IR mare that’s not good ? What devils claw product should I give then ? She does eat the uckele devils claw plus when I offered it to her separately before I got the phyto-quench . 

I’ll get some new pics uploaded to her file hopefully by tomorrow- I hope my farrier backed the toe up enough - he doesn’t believe in what I’m doing & would prefer I put her down - even though she stands 75% of the day nickers when she greets me and does eat her soaked hay - she walks stiffly in her cloud boots and has that stance - so he believes she is “done” & should be put down . This just destroys me personally- I feel like I’m fighting a loosing battle & im the only one who thinks we can overcome this . She is on metformin & I need to now get the second blood test to check her glucose & insulin levels - but she is better that she was when he first trimmed her a month ago - so I believe she is getting better . 

--
Lori R in MN - 2022

Owner of 3 Metabolic Horses 

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Hi Lori,
I was looking at your case history and thinking it needs some updating.  And there may be some things we missed initially.  The only way I could catch up is by re-reading all your posts.  The case history is so that we don’t need to do that - if everything is in the case history, we know we won’t overlook something while digging through the posts.  Not that we’re lazy or don’t enjoy reading but our expectations are that we will find what we need to know in the case history.  If you need help with the case history, let me know privately and I will try to work you through it.

If she’s still on Thyro-l, would taper her off.  It’s highly unlikely she has an actual thyroid issue and she does not need to lose weight.

If she’s still on any amount of bute, it should be discontinued over the next few days.  You have tapered her down to 1 mg, I read in your posts, which in my mind is a “standard” dose.  She would be much better served by PhytoQuench and Devil’s Claw.  Once her trim is in order, you can use jiaogulan.  I noticed in the case history that she is on what appears to be an omeprazole derivative.  Is she still on that?  The combination of NSAIDs and omeprazole has fairly recently been shown to be a bad combination, resulting in likely colon damage.  It’s likely heal itself after NSAID removal but that may be part of the stance she shows.  I understand why they are prescribed together but that happens to be faulty thinking.  NSAIDs do nothing to help metabolic laminitis, if they even diminish the pain temporarily, which would be unexpected.  You need to focus on diagnosis, diet and trim at this point because fixing those is what will help the pain.

She is eating soaked, stemmy alfalfa hay.  Alfalfa can make some IR horses foot sore so I would change to a different forage for now.  She doesn’t need poor quality hay.  She needs the best hay possible to heal, with low sugar and starch.  Alfalfa is generally low in sugar and starch but I think you should eliminate it from her diet while you’re sorting things out.  If she were mine, I would switch her to TC timothy balance cubes at least until she starts to gain back some weight and I could locate hay with an ESC+starch of <10% and balance its minerals appropriately.  The beet pulp you feed her should be rinsed, soaked and rinsed again until the rinse water is no longer brown.  It seems that you are adding granulated salt to her diet but there is no mention of our recommended vitamin E and ground flax.  For a refresher, please see the welcome letter I sent you in late June.

Have you done blood testing since starting her on metformin?  If it hasn’t decreased her insulin, I would consider dropping it.  Normally, we don’t start metformin until dietary changes have been made and tested for effectiveness.  It isn’t generally effective over the long term so it’s important that all your management ducks are in a row before putting it in place.  While you’re testing her insulin again, I would suggest testing the ACTH.  You had mentioned that the blood sample was saved quite awhile before submission which is a little unnerving.  The glucose level suggests the test is fine but I would do it again to be sure.  There was some discussion about starting her on pergolide anyway but I don’t know if that happened.
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