Attn Lavinia - Hoof markups request please


Joy V
 
Edited

Hi Lavinia,

This may be too short of notice for my request.  I have a new hoof care professional and she is a little last minute (so far) with letting us know when she's coming to our barn.  This will be the 2nd trim with her and she is coming this Thursday. 

Willie has had laminitis that began in February.  I had to clear out grass from his paddock and it took me some time.  He is getting weighed, tested, soaked hay, and diet is tight.  The vet was out on April 27th and he took blood.  Vet was happy with the results and says Willie's PPID/IR is controlled right now and he was super happy with Willie's weight loss.  

I think a lot of Willie's lameness right now is due to his trim (she left his toes very long the first trim when he was actively laminitic still on 03/28/22) and I have been rasping them back since then but don't know if I'm doing it correctly and also the material I'm using for pads doesn't seem to be working for him (waiting for new pads to get delivered).  I don't think he is actually full blown laminitic right now, but I'm just not sure.  I can't afford xrays as the moment unfortunately.

I've been very worried about him for 4 months now and I'm hoping you can help.  If this is too short notice, please let me know and I'll take photos after his trim and upload those instead.  ***NOTE:  Willie's RF is completely fused from the joint at the bottom of the P1 to the tip of the coffin bone fyi.  I do have a 2015 xray of this that I also uploaded.

Thank you in advance!

Joy


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photo Album


Lavinia Fiscaletti
 
Edited

Hi Joy,

Glad to hear that Willie is doing better.

Thanks for adding the 2015 rads - it's helpful to see what the bony column situation is there. Good that you have rasping the toes back as that really needed to happen. Can you please get a photo of his entire body from the side so I can see how he's standing overall?

I can get something out for you in time for the Thur (May 19) trim.

Given that this is the time of the year when ACTH is at its lowest, a result of 26pg/ml is OK but we recommend getting (and keeping) it in the upper teens to low twenties to have really good control. As Willie is a QH, it's likely the ACTH is playing a part in keeping his insulin up higher than it should be. It looks like you are using compounded liquid pergolide. We don't recommend that as it can lose potency from the time you start that bottle to the time you finish it up. Pergolide in capsule from maintains its potency much better.

An insulin of 26uIu on soaked, low ESC+starch hay and no grass is not great, although it is below the threshold for acute laminitis. It's a huge improvement over his having been diabetic at this time last year tho. The emergency diet, which is basically what he's still on, is not meant to be used long term as the likelihood that it's sufficiently mineral balanced is almost nil. He really needs to have the minerals balanced to the hay analysis so that all the excesses and deficiencies can be addressed.

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


Joy V
 

Thank you Lavinia, I'll get a body shot when I go this morning.  

I am hoping to get a big load of good hay this summer and will have that balanced.  I only have about 12 bales left of the hay I'm currently feeding, would it be worthwhile to have it balanced?

I will also talk to my vet about the pergolide and using capsules instead.

Thank you again, so much!!

Joy
--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275142


Lavinia Fiscaletti
 

Hi Joy,

I've added mark-ups to Willie's album:

https://ecir.groups.io/g/CaseHistory/album?id=275142

The toes on all his feet are way too far forward and the heels are seriously underrun - hinds much worse than the fronts. Good that you've been moving them back - just need a lot more of that, esp. at ground level. The idea is to get the breakover back into alignment with where the bony column needs it to be and to get the entire hoof capsule back under the leg. Frogs are atrophied and elongated and the bars look to be flaking off, as they also appear to be overgrown. There is some wall flaring - lateral on both hinds and medial on the LF. Due to the calcification (fusing) of the pastern bones on the RF you don't want to change the palmer angle when trimming as there is no changing the orientation of that bony column. But you can certainly move the breakover into the correct position to help that foot move more efficiently.

It looks like there is a fair amount of overall excess vertical height available to work with, as it doesn't appear that much has changed since the 2015 rads were done. Measure both collateral groove depths in each foot after cleaning them out all the way to the bottom. At their deepest point, you want both to be 1". Up toward the tip of the frog, you want 3/4". Anything more than that indicates excess vertical height that can be removed.

LF dorsal: Green line follows the angle of the hoof all the way to the ground. Blue area is where the flaring needs to be removed on the medial side.

LF lateral: Green line shows where the dorsal wall would be if the toe wasn't so far out ahead of where it needs to be and the heels weren't so underrun. It's NOT a trim line, just a visual. Orange shows where the heels should line up. Blue area is where to back the toe a lot - thru what appears to be the white line at ground level -  and to lower the entire foot from front to back. This will also start to move the heels back under the leg.

LF sole plane: Blue line shows where to lower the entire foot to.

LF sole: Solid blue line at the toe is where to back it up to, with the blue hashed area all the excess horizontal toe length. Blue hashes along the entire perimeter indicate to lower the entire foot. Lime hashes run along the bars, which also need to be lowered. Frogs need to get into ground contact, so no trimming of them unless they are peeling off - then just remove the peeling parts but don't cut more to make it "nice and shiny" - the waxy frog should not be exposed.

RF lateral radiograph: I marked this up to show what should have happened at that time. It clearly shows there is a lot of excess vertical height - and the current foot doesn't appear to be much different. Green line shows where the dorsal wall should be. Pink line follows the bony column alignment to the ground, where the breakover should be - there should be no foot at ground level beyond this point. Orange line is where the heels should be. Blue lines show where the toe should have been taken back and where the entire hoof capsule should have been lowered to. Blue X is the excess toe length and the blue hashes are all the extra vertical length.

RF lateral: Same idea as the rad: Green and orange lines are the same as on the rad and are only visual markers for where those structure should be. Blue area corresponds to the blue X on the rad and the blue area along the bottom of the foot.

RF sole: Again, blue is the excess foot across the entire bottom of the foot. Lime runs along the overgrown bars that can use some cleaning up.

LH dorsal: blue area is the lateral flare that needs to be removed

LH lateral: Same idea as the fronts but the heels are more crushed under.

LH sole: Follow the discussion for the fronts.

RH dorsal: Same as the LH, with the lateral flare. There is also a high spot at about 2 o'clock, where the growth rings consistently bulge upward. That should level off when you lower the entire foot.

RH lateral: Same as the LH.

RH sole: Same general idea as the LH. You can clearly see the high, crumbling bars, heavily flaking sole and even the tip of the frog looks ready to shed off.

Once the trim gets squared away, he should be a lot more comfortable. If he needs padded boots, make sure that there are aggressive bevels/rockers added to the treads at the toes and across the backs of the heels. Something like the Easyboot clouds might be helpful as the pads will squish down and conform to the nooks and crannies along the bottom of each foot.

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


Joy V
 

Thank you Lavinia!!!  So grateful for your help and expertise.  Fingers crossed and saying prayers this trimmer will agree to do what you've suggested.

Question for all responders:  This new trimmer expressed concern about blood in the white line on his FR.  This is something I've seen many times in his fronts with a fresh trim, and it has never seemed to affect his soundness.  I am thinking it's due to the shape of his foot and the mis-alignment going on?  New trimmer said for me not to rasp his fronts back because it causes the heels to be too high and that it results in the blood in the white line.  What, if anything, can I tell her about this issue?  Is it a serious problem?  TIA.

Joy
--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Sherry Morse
 

Hi Joy,

"Blood" in the white line is evidence of old bruising coming out and isn't surprising to see it after a laminitis event or a mechanical trauma (you can refer to this older post from Dr. Kellon on that: Re: Bleeding showing in the white line (groups.io)).  I'll let Lavinia comment on 'heels being too high results in blood in the white line' but the word 'hooey' comes to mind. 




Joy V
 
Edited

Thank you Sherry.  

That's what I thought I was told (prior trimmer) it was from, but I wanted to make sure.  I appreciate your reply!  :)

Joy


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Joy V
 

One more question!

Is a bad trim better than no trim at all (we are at 7 weeks and a couple of days)?   Is she refuses to use the markups should I let her trim him anyway and then try to clean it up/rasp myself?  

Thanks again everyone.

Joy
--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Lavinia Fiscaletti
 

Hi Joy,

Hard to say as it really depends on how the "bad" trim is done. If it doesn't back up the toes and lowers the heels, it would be worse. If it backs the toes somewhat, it's a step in the right direction.

Agree with Shrery on the "hooey". The fused pastern joints just need to be maintained at whatever angle they fused at - you can't make any changes to the palmer angle. That doesn't mean you ignore all the other mechanics for that leg, however, or you will be compounding the problems over time.

Hope the trimmer is open to learning how to effectively deal with these types of issues, as they are extremely common in varying degrees.

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


Joy V
 

Thank you again Lavinia!


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Eleanor Kellon, VMD
 

Yes, let her start the trim then clean it up yourself.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Joy V
 

Thank you Dr. Kellon.  Will do!



--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Joy V
 

Well, she was really nice about agreeing to look at the markups and the written information for each that Lavinia provided, but she read about one paragraph and looked at 3 pictures total.  She brought the toes back much further this time, she took out a bunch of sole which will make him sore for awhile, she rasped the hoof wall when she did the LF (?!) and then started cutting on the frog on his RF and that's when I strenuously objected. 

She seems to be more like a farrier than a bare foot trimmer, if that makes any sense.  This weekend I'll compare the markups to his feet, see how far off the trim still is and try to fix whatever I can.  She said she understood what needed to be done but she clearly did not.

I need to find someone else and then I'll fire this one.  I feel badly for my horse.  But he has on boots and pads on all 4 (foam for now Lavinia, but I've ordered the cloud pads like you recommended) and he has 2 spots in his paddock that are deeply bedded so he can stand in those if he's uncomfortable and I've got game cameras on him, so I can check and see how much he's using bedding piles.

Lavinia, thank you again for your time and expertise.  I'm so disappointed that she could not be bothered to actually look at what you provided.  It's frustrating.

Joy


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos


Eleanor Kellon, VMD
 

Have you looked here https://progressivehoofcare.org/directory/ ?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Joy V
 

Hi Dr. Kellon,

Yes, I've checked there.  No one comes to my area.  But I am thinking I'll email all of them again and ask them to let me know if they hear of anyone.  I will try the Gold Country Trails Council today - they will email every member for me and hopefully I'll get some good leads.

Thank you for the suggestion!

Joy
--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos