Hi Dr Kellon,

We started Vinnie on Metformin Wed Jan 18th, and I was curious about metformin's mode of action and if there is any concern using it while Vinnie's tryglicerides are elevated.

We are probably going to do labs soon, but was wondering about this.

He is still sore, and we are trying different things to improve things.  So far he is booted with modifications to the boot to help breakover and load, but he seems to have issues with too much positive sole pressure.  I am trying different pads to see which works best.

Thx Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
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Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

All you want to know about metformin here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552828/ . In other species, it lowers triglycerides. It does not cause glucose loss but does lower glucose production by the liver and may reduce glucose absorption in the gut. It is insulin sensitizing.

Those RF photos show hypertrophied bars, which usually means the coffin bone is sitting low in the hoof capsule and his heels are still underrun. That toe can come back more.  There is an abscess exit site at the coronary band dorsally. Any radiographs? I'm suspecting subsolar collections like he had in 2020.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thanks Dr Kellon

We brought the toe back some more this weekend and have him in boots with a wool pad.

I still haven't received my rads, but yes from what I remember p3 is sitting low in the foot, the LF had less sole depth than RF.


Yes that did seem to be an abcess dorsally on the RF.  We were watching that for sinking too, but it has firmed up and have some growth down.

I would be relieved if this is sub solar abcess to be honest.  I am freaking out a little..


--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
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Can bars become hypertrophied from overtrimming? This may be a dumb question, but this has been an area of major "clean up"  in the past.
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Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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 Not just from cleaning them up, no.  If they are needed, as described with sinking and heels run forward, they will reappear very quickly after a clean up. The other time you will see them being prominent is if the walls are unloaded.

Could you post sole pictures with the sole brushed off well, maybe washed? I can't see the details of the sole-wall junction/white line.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

I will try to get those, but with the trim we just did ( me and my vet) we really unloaded the walls. We applied casting tape around the perimeter of the hoof as that seemed to provide some comfort.  

Our hypothesis is at the moment mechanical/inflammatory laminitis.  Both fronts are sore the RF seems slightly worse perhaps because of subsolar abcess?
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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--
Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History 

I was going to suggest casts for comfort if the white line connections were poor. The drawback there is less pumping action to mobilize abscesses.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

I am having difficulty with boots and sole pressure.  The clouds seem to be the most comfortable but the breakover for him is a big issue. I am working on that with a grinder, but then there is the sole pressure which seems to be problematic too after about 24 hours in any set up.

I haven't yet tried the half moon cut outs, is that usually helpful or does that only work when the p3 has rotated? I am assuming the p3 being so low on the foot is our issue and is there a solution that can help this?  I read the article on distal descent, but it seems like the solution in that article is boots with pads to protect the solar corium?  Is it trial and error?

Currently barefoot in deep shavings seems the best.

TiA,
Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Has your vet gone over his sole with a hoof tester? That might (not always) pick up the sore spots.

I would also try Hawthorne Sole Paks https://tinyurl.com/bdzabstz which have been warmed up in a microwave. An easy way to do this is heat it inside a sandwich bag then cut off one side of the bag and you will have the heated packing with a plastic outer layer between that and whatever pad you have. They usually stay on without boots too but if the feet are very flat you can wrap it in place with Vetwrap. Check every 15 seconds when heating.

I'm surprised Clouds breakover is an issue. They have a pretty strong bevel at the toe already.

Anxious to see those radiographs.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thanks Dr Kellon!! I do have some Hawthorne sole pack so will try that for sure.

I am anxious to get the rads too, I almost feel like we need a new set, but will try to get my hands on the ones from the other day

*edited to add, yes he never seems to hooftest positive and he isn't known to be the most stoic creature.. so that strange phenomenon. :)
Thx Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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Quick update, a pretty significant abcess emerged at the coronary band of the RF.  It is very likely going to need decompression. Image added to folder.  I don't have the xrays yet, but I am guessing we need a new set to see how things have changed.

He started giving trouble eating metformin so started the syringe method,  and I am not sure if related, but now we have some swelling in the lymph nodes under the jaw..so a new variable to look into. 

I decreased to 10,000 mg of metformin in feed which he is eating working back up to the 30mg/kg dose.

Pulled blood fpr some labs, but missed my deadline to send last week, but serum looked wayyyy better on the TG front.

I feel like in spite of the challenges we are making some headway. 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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It might be time to have a discussion about regional limb perfusion.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

I think that may be part of the plan too Dr K. Thank u!
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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Poor Vinnie, (and you Nancy) you guys have had such a journey. Bless you, both for your devotion to each other and hanging in there Nancy.
Thinking good thoughts for him, he's such a trooper. 
--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
ECIR Group Primary Response 
Horsekeeping Moderator

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
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Thanks so much Bobbie ❤
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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Ouch!!  I hope he's feeling better.  I don't know how you do it, Nancy. 

--
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

Thanks Kirsten!! He is starting to feel better. The new worry to add to the list is the swelling under his cheek molars, I am fairly convinced this is some sort if infection.  Will know more after the vet visit today. 

Thankfully between this group, my amazing vet and my husband, my support system helps keep me going.  But yea I am stressed out 🤪🤪
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
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Summer
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https://ecir.groups.io/g/CaseHistory/album?id=249104

Hi, a little update on Vinnie and a question for Dr Kellon.

New labs taken last Thursday 2/9.
Insulin 99.29
Tryglicerides 70
Glucose 117

Meds
10,000 to 12,000 mg metformin 2x per day
13.2 mg pergolide (using an older RX but doubling the dose.  I need to refill my other RX but funds are tight at the moment)

Diet:
~10 lb grass hay total consumed (offering 15) 
5lb alfalfa

8 cups beet pulp rsr
2 cups wheat bran
2cups tc sr gold to get minerals and mix into metformin 
4 cups cavalor fiberforce 
2 cups timothy pellets
2 cups alfalfa pellets

His appetite has been up and down for the last three weeks or so. So he hasn't been consuming all his grain/feeds or his metformin until about 2 days ago, his appetite has improved.  I am free.feeding grass hay to keep him eating and managing the tryglicerides.

He has an abcess that blew out the underside of his mandible that seems to be an abcess of the lymph nodes, so that has been a source if pain I am sure. It is still draining and I am flushing 2 times per day with betadine/water mix.

His feet are much improved but he is still tentative and I assume that the insulin is playing a role here. But he is much better than he was. The RF abcess is almost resolved and we did not resect or do the regional limb profusion.

He has clogs taped on which I have been managing myself until the vet can come to cast them. 

He is thin, about a BCS of 3.5 to 4. Tapes at about ~893lb maybe just a tad under.

My contemplation at this point is the insulin and feet while managing this jawline abcess.

Should I keep him on metformin and remove wheat bran and feed him more like the normal ems diet? 

Should I stop metformin and start invokana or steglatro every other day?

Or??
**edited to add* we.lean towards starting steglatro every other day at 15mg dose.  Noting that when we stopped, it took almost 5 days to clear the dark brown marker for glucose on the urine strips.

Thanks much! 
Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
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Summer
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I have nothing useful to say but I wanted you to know I'm out here rooting for you and Vinnie!  <3

--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0