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Dr. Kellon: Should Ike be on Metformin?


Julie Thomas
 

Should Ike be on metformin?  If so, how much (he weighs about 1250 lbs)?
Test Results for 6/16/2020:
   Insulin 44 uU/mL (normal 0-42)
   Glucose 87 Mg/dL (normal 70-120)
   ACTH 11 Pg/mL (Nov-Jul > 35 is supportive of PPID)

His case history is current if you need to see his past results for comparison.
Thank you!
--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .


Nancy C
 

Hi Julie

Not Dr Kellon but want to ask if Ike is currently laminitic?  The general recommendation is to use the drug for emergency situations.

Dr K is catching up after three days with out internet, so thanks for letting me suss out the details.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA


Julie Thomas
 

Hi Nancy,
Ike's front feet hurt so bad that he reeeeaaally doesn't want to walk when I take his Cloud boots off.  And if he does walk, it is extremely gingerly.  However, we have been chalking up to his extremely thin soles (7/11/2020 xrays are in his photo file).  I was thinking maybe the metformin could drive his insulin/glucose ratio down.  I didn't realize it's for emergency situations only.

Thank you,
--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .


Sherry Morse
 

Hi Julie,

Considering the lack of sole depth I would leave the boots on as much as possible.  Do you have recent hoof pictures you can share in addition to the x-rays?




Julie Thomas
 

I don't at this moment.  I'll take some tomorrow.
--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .


Eleanor Kellon, VMD
 

The reason we generally recommend for emergency use with acute laminitis is that it often loses effectiveness over time - not always but often. However, some have found it can help with pain even when it's not still lowering insulin, probably because of an effect on neuropathic pain. I do agree he should be kept in boots until he has more sole depth.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Julie Thomas
 

I have posted current pics of Ike's feet as of 8/8/2020 per Sherry's request.  Please let me know if they don't meet the needs & I'll try again.  His last trim was on 7/27/20; his next trim is scheduled for 8/24 - we are on a regularly scheduled 4-week trim cycle.  Any thoughts/guidance to help get Ike's feet feeling better so we can get him out of boots would be greatly appreciated.  Any trim comments?

FYI - at his appointment on 8/24 my farrier is planning to apply hoof armor.  Any thoughts on this approach?  
Thank you all!
--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .


Lavinia Fiscaletti
 

Hi Julie,

Thanks for adding the pix.

Agree that Ike should remain in boots the majority of the time he isn't on a soft, yielding surface as the soles are quite thin. There is some sinking on the rads, so that is part of the the thin sole issue. On the fronts, the toes need to come back a bit more. Heels are somewhat underrun so the back half of the foot isn't providing the needed support. Medio-lateral balance appears OK, no obvious wall flaring. Frogs aren't as robust as they could be, which points to him not landing heel-first regularly. That will also contribute to the thinner soles.

On the hinds, the toes are too far out ahead of him and heels are seriously underrun. Again, he's not getting the support from the back half of the foot as it has been displaced. Frogs are much more robust than on the front feet.

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


Eleanor Kellon, VMD
 

You have made progress since December but it looks like the collateral grooves at the tip of the frog are still very shallow. Have you measured? You could put a ramp on the heels and be a little more aggressive with backing up the toe. Jiaogulan would make the hooves grow faster but you will have to trim more often.

Hoof Armor may make him less sensitive but it doesn't actually fix anything.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Julie Thomas
 

Does the Jiaogulan help the soles (depth) grow faster, or just the rest of the hoof?  I'm fine with trimming more often if we're achieving the goal of increasing hoof depth.
He is also taking Rhodiola Rosea.  Will that help with sole depth?  thank you
--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .


Eleanor Kellon, VMD
 

Unless the hoof has been overly trimmed, the issue isn't the thickness of the sole tissue, it's how close the coffin bone is to the ground - how low it is sitting in the hoof capsule. You can tell the difference on a radiograph by looking at where the extensor process is sitting compared to the coronary band. It should be level or even higher. His is dropped. The solution for this, and it does work, is described here http://hoofrehab.com/DistalDescent.htm . On his 7/11 radiographs there was still too much toe. Need to back that up and leave the rest of the foot alone, except for ramping the heels. Once that is done, he will start to develop concavity which will give him the ground clearance he needs. Sole "depth" = sole tissue thickness + concavity.  By making the feet grow faster, Jiaogulan can speed up the process but only if you don't let the toe get too long again between trims. Measure the toe length and take photos to help you keep track. Learn how to back up the toe yourself.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001