If you are using the pads inside the Soft Ride boots that is enough cushion. Letting him out is fine. Some of the soreness is often from poor blood perfusion and movement helps that. If that is the case, you'll see an obvious difference in how he is walking between when you first put him out and after he's been out a while.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Yes, the cubes would be the same as hay - or you could use soaked hay. Don't worry about the temperature effect. It is what it is!
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Oh and also, I'm not sure if I should start a new thread for this question or how that usually works here, but I'm trying to schedule his blood draw ASAP and 1) I read the info about not fasting before the insulin/glucose test and having access to hay the entire time before, do the Triple Crown Timothy Balance cubes count for that? Or does it have to be actual hay? Because I'm still working on finding new hay and testing it. He's still being back and forth about eating the cubes, but I'm trying not giving him any other choice for a couple days. My vet said she tells clients to fast beforehand, but I plan on following the guidelines here. When I requested an insulin and glucose test she referred to it as the endocrine panel for Cornell.

And 2) We have a major cold spell coming in a few days and it's looking like it will last until at least a couple days after Christmas. If I can't get them out here for the draw before the temperature drops, should I wait until after we get some warmer days again? Not sure exactly how long that will be. I'm eager to get it done, but I want to do whatever is best.

--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Don't get me wrong, he's still acting pretty sore and laying down a good amount. But I did decide to let him out for just a quick break from his stall since he wanted to with his boots on. Their main turnout area right now is a small limestone dry lot, so the footing isn't soft. I wonder if topping it off with some fresh screenings would be soft enough or if I need to also reconsider my dry lot plan now. Otherwise all we have right now is mud, I live in the woods so no grass (for once that's actually a positive). Are the soft ride boots enough cushion for hard ground and some rocks?

Hi Brittany,

If he's eager to get out then let him.  As long as footing is soft, the area is too small to run around in, and the other horses can't push him around, he can't eat anything inappropriate, AND he's not on NSAIDS then it's safe to let him move as much as he wants to.  If he's getting crazy running and bucking he will have sore feet after so we advise a small area to prevent the hijinks if he's feeling fresh.  IF you can boot him to help protect his hooves, that helps a lot, but you have to be able to prevent the rubbing.

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

Snickers' Case History
Snickers' Photo Album

Brittnay,
As far as diagnostics.
My horse never had bounding pulses and she had horrible laminitis this last july.
No rotation. Initally she was limping/lame like she had an abcess and thought that is what she had.
But i am thankful the vet who was seeing my friends horse just randomly tried taping Lilly pads under her frogs which improved her walking quite a bit and that's when she said she should be tested for IR/EMS. (The Lilly pads took some pressure off the hoof wall though supporting the frog)
Her insulin was though the roof.
She didn't have pounding pulses then or ever and you could easily pick up all 4 feet and I thought they were quite hot.
Vet kept saying the laminitis wasn't bad.  But it was and got worse and worse til she couldn't walk. I finally got a new vet and found this group and have tried to follow everything they recommend.
The boots and pads are the thing that have made her the most comfortable besides changing her diet of course. 
The new vet wanted shoes with dental impression and pads (she has been barefoot her whole life) i did it just because it was so wet where she was and I couldn't check the boots enough but I took the shoes off after 5 days as she was more and more uncomfortable in them. 
She has been in boots and pads since.
--
Lesley Bludworth 
Phoenix, AZ   7/2022
Sophie TWH mare IR/EMS, PPID?
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749

Sorry, I worded that poorly. I understand what you mean. I meant I was reassured hearing there doesn't seem to be any major rotation, etc.. I guess my question is more how to differentiate between when those things are happening or not. Like for the purpose of knowing if I should allow him out of his stall for example. If that makes sense.

I didn't mean to imply he can't have laminitis, just that there are no dramatic radiographic changes like rotation or thickening of the horn lamellar zone. With an ACTH that high there's a good chance it has also elevated his insulin which can indeed cause laminitis. The bounding pulses are because insulin normally causes blood vessels to be open and counteracts the effects of a chemical called endothelin-1.When exposed to high insulin, the receptors become resistant and it no longer works to counteract constriction caused by endothelin-1 and endothelin-1 levels also increase. The result is that the blood vessels in the hoof are constricted down and the high pulses are because of the backup of blood https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018505/ .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Dr. Kellon, 

That is so reassuring to hear, I feel like I can finally breathe a little.

Not to keep asking so many questions, but I'm curious how the bounding digital pulse factors into this? Like when looking at laminitis vs pain caused by insulin and ATCH. Because the pulses and tapping the front of his feet with a hammer for a pain response were the two main diagnostics that my vet used to say he was laminitic/foundering and needed x-rays.

--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Hi Brittany,
Adding all the suggested salt can be a turn off.  I would suggest putting a much smaller amount in his supplement mix and adding the rest to his forage, whether that’s hay or cubes.  If your hay is soaked, you can sprinkle the salt over the filled hay net.  Otherwise you can dissolve the salt in hot water and add that to the hay.  I have used a squeeze bottle, such as you might find for catsup or mustard, to squirt the salt water over the hay.  You might put his supplements or a little loose hay directly under the net to catch the drippings.  In time, you should be able to add all of it to the supplements.  I’d rather not take that chance so I continue to add it to the hay or cubes.
Horses like salt but they need to adapt to the appropriate amount.
--

From his trying to get out of the stall it sounds like he already feels better - and no reason not to let him out as long as he can't eat grass. His radiographs show more of the long toe, underrun heel issue than laminitis. You should get mark ups and have your farrier back up his toes before starting Jiaogulan - consider getting a rasp yourself and keep those toes backed up between visits. I'm sure that shocks you but MANY here have done it. Also need to get insulin and ACTH checked ASAP because that is what is driving the hoof pain.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Thank you so much for your response Dr. Kellon! I'm glad I checked here before giving him the medication. Would it be best to start him on jiaogulan asap or wait and address the trim and trimming schedule first?

--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Kirsten,

Thank you for the tips! I went ahead and uploaded the x-ray pics I have at the moment and will try and get pictures of his hooves ASAP as well and do that.

I believe the abscess has completely drained at this point from what I can tell, though I don't claim to be an expert. I'm really concerned about if I'll be able to get my farrier to come more often. It's been incredibly difficult to find a farrier at all in my area over the last couple years. We're currently on a 6 week trim schedule and he is about an hour away from us but has a few clients close to me all on the same rotation. I was waiting to get the x-ray results before contacting him about all of this.

I am definitely going to have to try those tricks with the boots. I guess I will play when to retest his levels by ear for the moment and see how things go over the next few days or so.

Thank you so much again!

--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Sherry,

Thank you for the additional info. I have been letting him lay down as much as he wants and trying to not do anything to cause him to get up. 

He's such a crazy picky eater that it's making it really tough. I gave him the Timothy balance cubes today and he has only picked at them. Worried to add salt again and him not even touch it, trying to come up with ways to get him to eat everything. He hates wet food and hay. Trying to find a new source of hay right now. Should I withhold hay completely even if he isn't really eating anything else? I've been afraid of starving him out.
--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Martha,

No problem! The vet said she was prescribing it for circulation. He's pretty content in his stall overall right now, though he was trying to follow me out of the door today wanting to be outside with my mare. My poor Bud. At least they can still see each other the whole time.

I went ahead and filled out everything in the case history document that I could for now and got it uploaded as well as the x-ray pictures that I was sent. The vet did not send any type of description or results along with the pictures though, so I really have no idea what to take from them or what the numbers on the pictures mean. I called the office to ask for more details and they said she's out of the office until Tuesday and she didn't mention that, only that I would get the results last night or today. So I'm pretty anxious and upset about that.

--
Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Acepromazine is not indicated in horses with PPID because it counteracts pergolide. It has no effect on insulin and is one of the few things proven to improve blood flow in the hoof but the effect does not last very long. Jiaogulan is better.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Brittany,

I had a couple thoughts for you.

Here's the info you need to correctly take hoof photos, name them, and upload them into a Photo Album in the Case History sub-group: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help
Lavinia, our resident hoof expert, will do a free set of trim markups for you if post a request once your photos are uploaded and correctly named.

The Bute will slow down abscess mobilization which will only prolong the pain.  Best to encourage abscesses to exit the hoof as quickly as possible with warm Epson soaks, or dry poulticing if the soles are really thin, and by giving jiaogulan (a vasodilator herb) to increase circulation to the hoof and clear out collections.  Generally we don't advise jiaogulan until the trim is in order because it does actually speed up hoof growth and shortens the trim cycle by at least 1 week, but if your trimmer is able to come more often (every 2 weeks to start, which is ideal if you are rehabbing hooves) and you have markups to guide you, you can try adding jiaogulan.  Both my horses are on a low dose of jiaogulan and I find an optimal trim cycle is 3 weeks, but I can push it to 4 if needed.

I use boots extensively and my horse has them on his fronts 24/7.  I always put a sock over his hoof inside the boot, and smooth his hair down under the sock if it gets bunched up when pulling the sock on.  Men's large athletic socks work well, but in winter I use a wool blend to help warm up his hooves.  The socks protect him from rubbing, and the thicker the sock the better that works.  I also use a liberal amount of foot powder in the boot, and the socks prevent the powder from gunking up his soles.  Socks get changed daily because they do get damp (2x a day if they get soaked), and I have a second set of dry boots I can switch him to as needed.

After he's been on pergolide for 3 weeks it's time to retest to see if the dose is enough.  You can wait until January as was suggested, but we are far enough out of the seasonal rise now that testing before Xmas would be fine, too.  Yes, acute laminitis can inflate ACTH and insulin, but usually diet adjustments will reduce the severity of the laminitis within 1-3 days to a point where bloodwork is useful again.

Now that you're here, it will get easier.  There will always be setbacks (abscesses months later being one possibility) but we've all been there and we know what works, so you're on the right track now. 

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

Snickers' Case History
Snickers' Photo Album

Oh, I totally forgot to address the medications!  Sorry about that.  I had isoxsuprine prescribed for one of my ponies once.  It did not appear to make a difference.  It seems that it’s not well absorbed by the horse.  It’s supposed to increase blood flow but there are better options for that.  With increased blood flow, comes increased hoof growth.  If your hooves are headed the wrong direction (not literally, of course) stimulating growth will encourage them to head that way faster.  So let’s get the trim assessed before making that recommendation.  Ace is a sedative and, not being a vet or having experience with using it, I’m not sure why it was recommended, unless he is frantic about being confined.  I’m sure someone else will fill us both in.  So, you made a wise decision there.  Your brain is still functioning well under stress!

My understanding is that QH feet have a tendency to grow “long and low”.  It may be that they are trimmed that way because it’s what’s expected.  I don’t know but Lavinia here is our hoof expert and I’m sure she will give you correct guidance.
--

Hi Martha,

Thank you so much for your response! Your words have already made me feel a little bit better tonight.

I will be sure to get all of the case history and pictures figured out asap. As well as going over the welcome letter in more detail.

His front feet have basically always had a tendency to go into the long toe/underrun shape, but this year is first time we've had issues as far as being sore and lame like this, yes.

His insulin and glucose was not tested at the time that his ACTH was unfortunately. But I will make sure it is next time. The vets recommended holding off on doing any further blood tests during the current laminitis pain as they said they could be falsely inflated. So I guess January it is.

I decided to hold off on those two additional medications for tonight at least. Hopefully I can get some more guidance on that.

Thank you again!
--
Brittany J in Ohio 2022