Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)


 

Based on her body condition, You can definitely feed her more soaked hay. That’s the safest way to feed her more calories. As far as soaking hay in advance, you need to determine that the soaked hay isn’t fermenting. Winter temps should prevent that. Use your nose. Some cold weather members mention feeding frozen hay. My own horse likes frozen beet pulp, so I’m not surprised. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


 

I just returned from checking the photos and definitely agree she could handle more to eat.  At 14.3, I would think 900# would be a generous normal weight for her.  That’s what you’re feeding for at 2%.  Is there any possibility your scale might need re-calibrating?
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Jessica Gunderson
 

Possibly. When I weigh the hay I do so in addition to the empty net weight so really should be 13-14 pounds on the scale. I worry it’s more likely some of the barn staff weighs to ten pounds not accounting for the net weight which means she could be short changed. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
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That makes sense.  I know from experience there’s a tendency to estimate.  Could you bag up her hay in advance for her?  Especially because she really does need more at this point.

I was laid up for awhile with a broken hip and had to hire someone to run my barn.  I wasn’t able to go to the barn but she came to the house to discuss things.  I was amazed at how well things were going and how well she seemed to understand me. I realized that was an illusion when the minis could not be dissuaded from chewing the barn  It seemed that, instead of feeding three meals of a certain size, she was feeding one meal, divided into three portions.  I felt so bad for those minis!
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Jessica Gunderson
 

My vet wants to put Khan on 21 days of Equioxx, and 7 days of Tylenol to help with pain. I know ECIR does not agree with continued use of NSAIDs but Khan is still in pain. How do I push back on my vet or is acceptable to use Tylenol and Equioxx for the short course my vet wants?

If it is high insulin and she is back on soaked hay with no other triggers how long to wait before expecting to see improvement?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Jessica Gunderson
 

Another question is, I do have her on phyto-quench is that okay right now while she is doing poorly?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

If you look at your photo album and the markups that Lavinia did in August you'll see that there's been not a whole lot of change in the trim as yet and this can still be causing Khan to be painful.  Jiagulan will cause hoof growth to accelerate but if the trim isn't optimal that isn't necessarily a good thing.

I would be very leery of using Equioxx (which is just another NSAID) at this point as you don't necessarily want to mask pain and you want to make sure any abscesses are encouraged to drain out and NSAIDs inhibit that process.

If Khan is still on Thyro-L at this point you want to wean her off of it as she doesn't need to lose any more weight now.



Jessica Gunderson
 

Thats disappointing; I thought the recent x-rays looked significantly better as well as her hooves so what are you seeing that makes you feel it is not much improved that I am missing?

she was weaned off of Thyro-L end of August so that has been out of play for awhile. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

To my novice eye, they look better, Jessica, but I’m not sure how much I’m being influenced by having had the apparatus removed from her feet.  I would suggest asking Lavinia for another set of markups.  I know she charges for anything after the first set, but I don’t know how much.  It’s a long process, going from where you began to where you want to be, and providing your trimmer with fresh markups can’t help but facilitate the progress.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Eleanor Kellon, VMD
 

There is some improvement, and the sinking limits what you can do (there is fair ground clearance now but wouldn't want to lose any . However, the toe needs to be backed up more and the entire disconnected hoof wall beleved out of weight bearing so it does not continue to pull on the fragile new connections and jam up growth at the toe like it's doing now. Those "founder rings" don't correlate to severe rotation. They are caused by the growth at the toe being compressed by the bulbous toe. The heels can come down a degree or so but only by filing of the back half of the foot. Follow the distal descent trim
https://hoofrehab.com/DistalDescent.htm
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Don't give Phyto-Quench with NSAIDs, unless you're on a taper, but otherwise it's OK.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lavinia Fiscaletti
 

Hi Jessica,

I'm going to assume the trim was done after the most recent rads - please let me know if that isn't correct.

Based on the rads, there were definite improvements to the trim from the last set of rads - the horizontal toe length had been brought back quite a bit; bony column rotation was corrected so her bony column alignment was good. Sole depth was borderline adequate; heels on the RF were still underrun, LF unchanged. The breakover still needed to be brought back further to place it where the bony column needed it to be. There were some shadows on the LF that could have been abscess pockets, which would have been trimmed into and you can see a spot on the toe area of the LF sole that was probably one of them.

After the trim, more of the laminar wedge has been removed but it doesn't appear as if the breakover was actually brought back further. There is evidence of the sole having been thinned - which wasn't warranted as there was absolutely NO extra sole available to remove. Her frogs and bars were also heavily trimmed, which again wasn't warranted. This over trimming is likely at least part of the reason she is continuing to be sore. If her heels were lowered relative to the height of the front half of the feet, then that would be impacting the palmer angles negatively as well. LF still has a lot of obvious laminar wedge material and disconnected lateral wall flare visible on the sole view.

It would be really helpful to see a full set of hoof shots - all four legs, please. The sole and dorsal shots you have are fine, just need true laterals (camera held lower, at the same height as the hoof capsule) with cannon bones included. Check here for more info:

https://ecir.groups.io/g/main/wiki/1472

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


Kirsten Rasmussen
 

Hi Jessica, 

To answer your question:
If it is high insulin and she is back on soaked hay with no other triggers how long to wait before expecting to see improvement?
You should see reduction in pain within 2 days, and definitely within 1 week.  If that's not happening, then the problem is unlikely to be high insulin, OR the hay soaking isn't removing enough sugar.  I'd continue soaking until you get her last bloodwork back and then make a decision based on how elevated insulin was before you started soaking.  If it WAS  high, then you may also want to check insulin after 1 or 2 weeks of soaked hay to see if it has come down enough, or if you need to consider medication to bring it down further.

I find it easiest to hang a big plastic muck bucket on my digital luggage scale, then zero it out and load the bucket with hay until I have the desired weight.  After that, I transfer it into the hay nets which are fitted over a frame to hold them open and make them easy to load.  Way easier than hanging the net and trying to fill it to the correct weight.  My plastic muck bucket weighs 3.89 lbs so if I forget to zero the scale at least I know exactly how much to subtract.  Wet /damp nets are heavier than dry, obviously, and it can really throw off the weighing.

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


Jessica Gunderson
 

She is really suffering right now and it has been 4 days. Makes me sick and breaks my heart to see her like this.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Lavinia Fiscaletti
 

Is there any heat in her feet? This could be abscessing, which can be worse than laminitis pain.

Did her pain increase after her most recent trim?

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


Kirsten Rasmussen
 

I'm sorry to hear that, Jessica.  Keep soaking her hay until you get her insulin result back and can re-evaluate, just in case.

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


Jessica Gunderson
 

There was heat and pulses in all 4 legs for a few days. She was trimmed on Tuesday by my regular farrier who comes every 2 weeks and became sore on Friday. I had an osteopath/trimmer out on Thursday night to check the trim, which she was overall happy with other than she removed more bar on both fronts. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

Khan had no sole to spare based on current pictures and x-rays so given that additional information it's not actually surprising that she's more sore now than she was.  At this point you need to make sure she's in boots and pads that are helping to keep her as comfortable as possible and do not let anybody touch her soles or frogs when they trim. 




Jessica Gunderson
 

I uploaded Khans interm Cornell results, looks like Cushings to me, not high insulin.  Thoughts?
beta1-vv (groups.io)
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Hi Jessica,
My first thought is that I guess that addresses the question you asked, many posts earlier.  We’re interested in her ACTH because high ACTH can result in high insulin, which can cause laminitis.  Elevated ACTH itself does not cause laminitis.  My horse, Logo, had PPID which was difficult to control but never did he have elevated insulin, nor laminitis.  If Khan’s insulin is not elevated because of your management, then good for you.  It’s important to keep it that way, but giving pergolide will not do the job for you.
My second thought is that your case history needs updating, not only with the new labs but with everything else that has happened in the last three months.  I know I have asked about the omeprazole and bute she was getting and you’ve replied but that should be a signal that your case history needs an update.  I honestly can’t remember your answer.
My third thought would be that it’s time to start a new thread on improving Khan’s comfort through booting and improved trimming.  If you can’t find a trimmer who is willing to follow Lavinia’s advice, you could do it yourself, as many others here have done.  I feel a bit weird suggesting this as I’m not one of them but those who have seem to make good progress.
And my fourth (and final for now) is wondering what your thoughts are.  
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo