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Is Lily's trim ok?

bcvincent@...
 

My mini horse was quite footsore immediately after her trim last Saturday by a new trimmer.  She had had a bout of laminitis in May, but had made a good recovery and was back to driving and being ponied energetically.   Her feet had the shovel shape that laminitic episodes produce, so I tried a new trimmer that was said to be good, but charges a lot less than my last one so I could stand to get her done more frequently.   I thought she was having another laminitis; however,  My riding horse was also quite sore after this trimmer I think from removal of a lot of the rim of wall that was holding his sensitive soles slightly off the ground; he is staying in padded boots for now.   Lily's soles are tender too, she walks pretty normally on grass, but very gingerly on asphalt or gravel.  So, I wonder if things will be all right and it  is worth going through this pain to get a healthier hoof in the future,  or if I should go back to the old expensive trimmer.  I did the solar shots a day or two later and couldn't figure out how to move photos to group each foot together, but all are labelled and dated.
--
Barbara Vincent
Malvern,  PA
2020

photos:  https://ecir.groups.io/g/CaseHistory/album?id=248031


https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

Maxine McArthur
 

Hi Barbara
So that you can get more prompt replies to your question, would you mind adding the photo album URL link to your signature? Then people can click on the link and go straight to your photo album. 


Copy the link (you can see it’s not ‘live’ in your message because it hasn’t turned blue), go to Subscription in the left-hand menu, paste the link into your signature box, add a space (important to make it ‘live’), then scroll down to the bottom and click Save. 

Thanks! 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 

 

Hi Barbara,
I’m wondering if you’ve considered increasing her pergolide dose?  It could be that I’ve overlooked a discussion on this topic but I would expect her elevated ACTH will only cause her more problems as the fall progresses.  Something to discuss that with your vet, perhaps?
--
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


 
 

bcvincent@...
 

I couldn't make this work.  I copied and added the album address to the signature box but it didn't turn blue when I added a space.
--
Barbara Vincent
Malvern,  PA
2020
https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

https://ecir.groups.io/g/CaseHistory/album?id=248031 

Sherry Morse
 

Hi Barbara,

I'm not sure why it wouldn't work but I fixed it for you by going to the link, copying it again and then putting it back in your signature. So the next time you post it should be correct.



bcvincent@...
 

We just did up her dose from 1 mg to 1 1/2 mg in May.   Probably should retest in a month or two.  However,  Her ACTH has been high, never below 68 since she was first tested.
--
Barbara Vincent
Malvern,  PA
2020
https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

https://ecir.groups.io/g/CaseHistory/album?id=248031 

bcvincent@...
 

Lavinia Fiscaletti
 
Edited

Hi Barbara,

It looks like the new trimmer lowered the entire hoof capsule all around as there is a lot less vertical height than in the photos from June 3. Unfortunately, the toes are still too far out ahead of where they need to be and the heels are still underrun. Likely, the same thing was done to your riding horse. As both were sore afterwards, it's likely too much was taken off from the bottom of their feet instead of from just the front to move the toes back. Lowering heels that are alredy too low in order to move them back will also contribute to soreness.

Unfortunately, the long toes and underrun heels were already present in the June 3 pix, so the problems were present from your previous farrier.

Another possibility is that Lily's high ACTH is becoming more of a problem as well, so is contributing to her soreness.

Have you had any radiographs done?

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

Lavinia Fiscaletti
 
Edited

Hi Barbra,

I deleted the older copy of Lily's case history so there is only one in her file now. Please let me know if you need that older copy as I saved it, just in case.

You're right that Lily needs to have her pergolide dose raised. Her June ACTH was 68pg/ml on 1.5mg Prascend, so she is nowhere near being under control. Need to jump on that asap as the seasonal rise is also coming into play now and her ACTH is just continuing to rise. You should speak to your vet about becoming aggressive to get this under control before she founders again as it only becomes harder to do the deeper into seasonal rise that you get. If she was mine, I would be speaking to the vet about titrating her dose to 3mg, then retesting 3 weeks after she reaches that dose to see if it is enough. Many people switch to the compounded pergolide capsules once they get up to more than 1-2mg doses as the cost becomes prohibitive otherwise. That is another option you may want to discuss with your vet.

Making sure she ingests all her pergolide may require just syringing it in - that way, you don't need to find a carrier/treat she will eat.

In the case history you have Lily's BCS as a 6. She really should be at no more than a 5, so could stand to lose some more weight. Given the foot soreness, extra weight and still too high insulin, she really shouldn't be grazing pasture at all. Even with a restrictive muzzle, unless it is totally sealed, you have no way of knowing how much grass she actually consumes plus, there is no way to know how much sugar+starch the grass has at any given time, so it becomes a game of Russian Roulette to allow her access to it. Tolerating grass is not the same thing as not having any issues - she may just be teetering on the edge of outright laminitis at any second.

Her diet needs to be mineral balanced. While CA Trace and Vermont Blend are good, general supplements, unless they actually balance your hay they aren't the best alternative. Would it be possible to feed her mostly Ontario Dehy Timothy Balance cubes (Triple Crown Naturals Timothy Balance cubes), with only a small amount of hay for added chew time? That way, you have the mineral balancing already done, without needing to get more supplements into her.

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

Sherry Morse
 

Hi Barbara,

The fact that Lily's ACTH has never come down means that the dose of medication isn't effective for her.  Given that she tested HIGHER after being on the 1.5mg dose and we're on the cusp of the seasonal rise I agree with Lavinia and I'd be working on titrating her up to a 3mg dose over the next 2 weeks so you hopefully aren't 'chasing the rise' and dealing with continued laminitis issues. 

She also does need to lose a bit of weight so restricting her pasture time (or muzzling her completely) and/or cutting down on hay would probably help her with regard to her insulin and glucose numbers.


bcvincent@...
 

Thanks, Lavinia and Sherry for thoughtful, detailed analyses and sobering comments.  I will consult with Lily's vet about increasing her pergolide dose before the seasonal rise.    Her ACTH has always been high in every test she's had,  starting in 2014,  so I haven't paid much attention for the last 4 years or so when she seemed well,  but perhaps this causes more problems as she gets older.
  I'd like to find a way for her to spend time out of her sandlot and be moving and on pasture with her herdmates for at least a few hours.   I thought her IR was currently being managed successfully with exercise and a restrictive muzzle.  Her insulin  did drop to within normal range in her June test after the very high earlier value in May.    I relate to Katy Watts' sentiment that "fresh green grass is nature's perfect food for horses,"  and appreciate very much all the studies she has done to try to make some grass safely tolerated.  I'm thinking about making Lily a shade paddock; also keeping her in till dawn and letting her out for a few hours then (if I can get up).  I will try to make her do more time in her sandlot.
  A local laminitis expert has put me in touch with a farmer who sells hay that has been tested,  so I can get my next load mineral balanced. 
  I wonder about the value of testing pasture, or if results vary too much week to week to be useful for balancing.  A trimmer mentioned the possibility of high iron in PA forage.  Does a pasture test show this, or Is there a better way to find out if we have this issue? 
 Thanks again for your help.  
  
 
--
Barbara Vincent
Malvern,  PA
2020
https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

https://ecir.groups.io/g/CaseHistory/album?id=248031

Kirsten Rasmussen
 
Edited

Giving up grass is the hardest thing...especially for us owners.  :) 

If she was mine, I would get her ACTH under good control (25 or less) and her weight down to a BSC of 4.5-5 before allowing some grazing (if you feel it's absolutely necessary), even better if that grazing is after a workout.  Also, if she was mine, I would only turn her out with a fully blocked muzzle for up to 6hrs at a time for now.  One of the reasons we recommend adding vitamin E and ground flax seed (and for hay older than 6 month, vitamin A)  to our horse's diets is to replace what is lost when hay cures and ages, but all the minerals that were in the grass remain in the hay.  So I can't say I agree fully with Katy Watt's sentiment, as much as I appreciate the work she has done.  I have done the controlled grazing (overnight turnout only, and only if it's warm enough for the grass to metabolize sugars overnight), and although Shaku survived that his hoof walls continued to grow with laminitic ripples and whiteline separation and abscess, his fat pads never went away, and he needed boots anytime I took him off the soft pasture.  He also always suffered from lethargy, excess weight, and poor fitness, despite getting the same workouts as his buddy, a non-IR warmblood mare with arthritis that was 10 years older than him.

If you look at photos online of mustangs, you can see how healthy and fit they look.  You can also see the quality of 'pasture' they live on in those photos.  If we can re-create that sparse dry grass and the extensive exercise that a Mustang does on a daily basis for a horse in captivity, then I'd say let them out on that pasture 24/7!  But most of us cannot and that's the problem.  Too much nutrients with too little exercise, especially for breeds bred to survive poor pasture and/or extreme winters.  Some breeds and some individual horses of problematic breeds do well on our rich pastures, but we (ECIR members with IR horses) are all here because our particular horses do not. 

A shade paddock in the trees is a great idea, and I don't see why other horses couldn't take a turn in there (or on the sandlot) to keep Lily company.  It sounds lovely!

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

Lavinia Fiscaletti
 
Edited

Unfortunately, the longer the ACTH remains uncontrolled, the harder it can be to get it under control and then have it remain controlled. Over time, this results in more diverse symptoms than just a longer coat.

She can go out with her friends for socialization and exercise, she just needs to remain in a muzzle that is totally sealed while she is out there. She may give you the "stink eye" and/or sulk but you need to shrug it off, tell her it's for her own good and walk away. The majority of horses adapt to wearing a muzzle just fine - it's the owners who are having the most angst. However, a little angst is infinitely better than having someone hit you on your feet with a sledge hammer repeatedly.

Most forage contains excess iron to some degree. You don't need to worry about getting enough iron, only how to balance out the excessive amounts the horse invariably ingests. In an IR animal, this is more problematic than in one with a normal metabolism. Mineral levels are more stable throughout the season in pasture but will vary somewhat.

Testing pasture gives you values at the time the pasture was tested. The ESC+starch change from hour to hour so you never actually know what the values are. Although there are safer times for grazing compared to less safe times, it's always a crap shoot. Fresh grass was what nature intended but nature didn't create the highly "improved" strains of grasses we now have, nor did nature confine horses to small acreages, with little movement while they stuffed themselves. They do not need to search for water, they don't run from predators, their meals are provided daily without fail, so the result is that the horses whose metabolisms are esp. thrifty (great for survival) are being done in by our domestic horse-keeping situations. And nature didn't create minis - people did.

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

bcvincent@...
 

Thanks, Lavinia.    A few more questions.  Could she be out all night in a closed muzzle--9:30 p.m.- 8:00 a.m., with nothing to eat?
 Re pergolide, I'm thinking people on this forum must know the best place to buy it, which Iwould like to know. 
  I also forgot to ask if Lily's slightly low T4 was a factor in this (0.548 ug/dL) was a factor and should be treated.
 
--
Barbara Vincent
Malvern,  PA
2020
https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

https://ecir.groups.io/g/CaseHistory/album?id=248031

Frances C.
 

Yes, right on Lavinia. The wild horses (mustangs) also endured starving in the winters using up any excess fat and came into springtime lean and mean and all the girls were pregnant, We never seem to consider the fact that almost constant pregnancy/lactation plays a huge role in metabolic issues. All the boys too, being stallions  (no wild geldings just in case we forgot) spent a lot of energy just fighting.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382

bcvincent@...
 

Hi Sherry or Lavinia,

   I'm confused about switching from Prascend to compounded capsules.  If you recommend Lily get 3 mg of pergolide, is that 3 Prascend tablets, or less?    Ian at Thriving Pets tells me that 3 Prascends is equivalent to 4 mg of pergolide mesylate.  Could you please tell me what dose you would recommend in both compounded capsules of pergolide mesylate, and in Prascend tablets?

 Thanks,
Barbara
 

--
Barbara Vincent
Malvern,  PA
2020
https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Lily

https://ecir.groups.io/g/CaseHistory/album?id=248031

Trisha DePietro
 

Hi Barbara. Just a suggestion prior to next trim----always walk and trot your mini in hand in straight lines with a large circle on each end so that you can see if there is pre-existing soreness. Do this in front of the hoof care provider. And when the trim is complete, repeat the in hand walk and trot....This way you  and your trimmer can see if there is any change in how they carry their body or their feet....and if any soreness has developed "from the trim"....
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories https://ecir.groups.io/g/CaseHistory/files/Trisha%20and%20Dolly%20-%20Hope
Dolly's Photos 
Hope's Photos 
Primary Responder

Sherry Morse
 

Hi Barbara,

You can see the list of recommended pharmacies here: https://ecir.groups.io/g/main/wiki/1137

Thriving Pets, is not one of the recommended ones as per this message from Nancy: https://ecir.groups.io/g/main/message/248583 although some of our members have had success using their products.

Regardless of that, you will need to ask your vet to write the script as:script as "x mg of pergolide as pergolide mesylate" ,  rather than "x mg of pergolide"  That way, each capsule will have the same amount of pergolide as the equivalent number of Prascend tablets. So, a prescription for 3 mg of pergolide as pergolide mesylate will contain the same amount of pergolide (and pergolide mesylate) as 3 Prascend tablets.