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First acute laminitis episode - Photos added
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Carly
Xrays show no rotation or sinking - or abscess.
I've uploaded xrays to the photo folder. -- Carly Butler Nottinghamshire, UK, 2020 https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest |
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Hi Carly,
Good news. Abscesses don't always show up on rads. I can't find the xrays . Is it just me? -- Lorna in Eastern Ontario 2002 |
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I've not added photos before so probably did something wrong.
Does this link work ? https://ecir.groups.io/g/CaseHistory/album?id=282557 -- Carly Butler Nottinghamshire, UK, 2020 https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest |
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I've made it live for you.Will try it.
If it works it needs to be added to your signature. https://ecir.groups.io/g/CaseHistory/album?id=282557 -- Lorna in Eastern Ontario 2002 |
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That's good,Carly. Thanks.
Just add it to your sig., and Bob's your uncle. -- Lorna in Eastern Ontario 2002 |
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Carly
Thank you. Just testing - looks like it's there in my signature but not a live link?
-- Carly Butler Nottinghamshire, UK, 2020 https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest https://ecir.groups.io/g/CaseHistory/album?id=282557 |
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Yes.
To make it live, go back to signature box and hit Enter immediately after it.Should turn blue. -- Lorna in Eastern Ontario 2002 |
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Sherry Morse
Hi Carly, The most obvious issue is that her toes are extremely long and that alone is probably creating a lot of extra pressure on the sensitive laminae. If your trimmer is willing to work on her while she's down bringing those toes back quite a bit will help with overall comfort and obviously I'll say it again - treat her as if this is winter laminitis and get her legs wrapped and feet in boots.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Good to see the xrays! Carly, her coffin bones are not about to penetration her sole and she has minimal rotation. Yes, her soles are thin and her toes are too long. Those long toes can cause a lot of pain in damaged lamellae, imagine walking on your fingertips with very long nails...the long nails are going to tear and pull away from the nail bed and that adds a lot more pain. I think you should take a full set of hoof photos and request markups to guide your trimmer:
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help Can you please go to your images, click the "Edit" button, and relabel them in this format with the date at the start: YYYY-MM-DD_LF/RF lateral/dorsal radiograph -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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As Lorna said, abscesses don't always show up on radiographs; only if the organisms involved are producing gas. The alignment of the bones is off, especially on the right but it also looks like she was overflexed on the right. I think the most significant finding is that the horn-lamellar zone looks thickened. This is entirely consistent with EMS and the smoldering damage it does to the laminae even if you haven't seen acute laminitis. There are many horses who have never had an acute laminitic episode that develop winter laminitis. Whatever the problem is, bute will only make things worse.
-- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
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Carly
Update - blood results back, insulin was 89.8 (should be 32), glucose 7.1, adiopectin 8.2.
I'll update the case study on my computer later. -- Carly Butler Nottinghamshire, UK, 2020 https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest https://ecir.groups.io/g/CaseHistory/album?id=282557 |
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Hi Carly,
That insulin is too high. If she was on the Emergency Diet when you had her tested, you're going to need to try medication next. If she was not 100% on the ER Diet, then it needs to be implemented. First step is 30 mg/kg Metformin given 2x a day, either in food if she'll eat it all, or in a syringe with a thorough mouth rinse after to avoid oral ulcers. You can add milk of magnesia to the syringe to protect her mouth even more, but still need to rinse her mouth after (a dosing syringe works well for the rinsing). Retest insulin after 3 days on Metformin to see if it has helped. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Carly
She's been on a diet very similar to the emergency diet for years - the exception being grass, and probably too much (soaked) hay - meaning she was likely having closer to 1.8% body weight in forage. I haven't been able to exercise her though.
My vets are not keen on trying metformin. I have ertugliflozin tablets already (sent to me mistakenly by my vet in the summer but I didn't want to use them without blood tests and monitoring and didn't feel confident he'd researched enough about the medication), and we are likely going to start it soon. Dr Kellon has sent the info to the vet. She's got worse again, but this appears to coincide with her being in season. Dr Kellon has suggested in another thread there may be an ovarian issue associated with the IR. I'm going to ask the vet if it can (affordably) be explored. -- Carly Butler Nottinghamshire, UK, 2020 https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest https://ecir.groups.io/g/CaseHistory/album?id=282557 |
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Ok, but for now that level of insulin is high enough to cause acute laminitis and the sooner it's lowered the better the outcome will be. So you need something now to bring it down as the ovarian workup might take a while. Metformin is the safest cheapest option for short term use. Ertugliflozin is an option, too, but here we would never promote a new experimental drug with potential for serious side effects before the proven safe option has been shown not to work in that equine.
-- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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