Topics

Laminitic pain and nsaids

LJ Friedman
 

In the small animal population, the thinking that some pain is ok , for example to reduce further injury by allowing some pain to restrict movements  is outdated information. 

I know we Often mentioned that bute banamine, etc  has a negative effect Because the horse will feel less pain and do more damage to the hoof, etc .    Is this theory still true?
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

 

LJ, I can’t speak to your first statement except that NSAIDS can frequently cause GI issues, regardless of species, size or source of pain.  Small animals might be more likely than large to further injure themselves in an attempt to rid themselves of pain.

In horses with metabolic laminitis, you and I have each probably read enough here to know that NSAIDS do nothing to help laminitis as it is not an inflammatory process.  Aside from that, you don’t really want the horse to put all his weight on the already stretched laminae in his relatively small foot and do further damage.  Especially because when he begins to develop some propulsion, there is a lot force on that frequently too long toe which could further damage the laminae.

If the pain you are trying to address is related to an inflammatory process, such as arthritis, rather than laminitis, NSAIDS are probably good choices although I would give the horse frequent breaks from the drug.  There are other options, particularly herbal, that generally don’t cause the GI issues.  Their effectiveness is determined by trial and observation.
--

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

Eleanor Kellon, VMD
 

Outdated on what basis? The statement is too broad to have much meaning because of the variety of scenarios where pain could be involved. Aggressive postoperative pain relief for a dog in a cage is one thing but aggressive pain relief for a dog with a ruptured cruciate ligament that needs to avoid jumping and running is not a good idea.

 The pain relief in laminitis from NSAIDs is only moderate at best but the horse will still potentially move/stand more than it should. An even bigger issue is these drugs should only be used short term because of high risk of serious side effects but this is routinely ignored and the drugs abused. They can also slow the maturation and drainage of abscesses, likely make circulatory issues worse.

Something like chronic arthritis is a different story because movement is beneficial but the same side effect risks are there and alternatives should be used.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Tara Smith
 

So ,specifically ,what will address acute lamanitis pain or help our guys feels more comf.in an acute situation if diet ,trim ,balancing nutrition and pracend and metformin and jherb is on board and not helping with disomfort ?
--
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

 How about putting up current hoof photos and updating your case history so we can help you work through this to see if all those things are actually what they should be.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Lorna
 

Hi Tara,

Is this about Gavi ?
I went to his CH to see if I could help. 
Would you be able to update the 2017 information?

Are his last test results from October of 2018, or can you update with current numbers?

There may be something you can change to make Gavi more comfortable. But  without current information, we're sort of stuck.

--

Lorna Cane
Ontario, Canada
2002


 

Tara Smith
 

Dr.kellon ,as I have been struggling to get anything up into history and because of that opted  to have a personal consult from you and my farrier has shared with you upon you request details of last current trim that you said looked great.  .I can upload photos but not fast enough!My vet  has been reaching out to you upon your request for recommendations. We are in a consult with you to date waiting for a plan. I thought after you had all of Gavis current blood ,hay analysis, trim update in detail from kathleen ,drugs used to date, diet, minerals offered to date we were all set to move forward ?I've followed up with emails and so has my vet not sure where to go from here ?I cannot upload into history that is why I reached out to have a balance and personal consult.please let me know by email where we are at this point .GAVI is in so much pain and I need to be advised please .
-- 
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Tara Smith
 

Yes this is about Gavi .I found it impossible to upload into case history so I requested a private consult and balance with Dr.Kellon .all info and updates were sent to her but nothing has been put together yet While  Waiting for her suggestions  Gavi is declining quickly with pain in feet and puffy eyes .I was reaching out here to see if infact any meds are being used with success or recommended for acute lamanitic pain has been used to create comfort and something to reduce inflammation ?

while waiting for Dr. Kellons suggestions  from our consult .

Eleanor Kellon, VMD
 

Tara,

I sent information to your vet and will forward you a copy. This isn't about inflammation. Metabolic laminitis is not an inflammatory process.

Check your mail.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Tara Smith
 


-- Thank you Dr kellon .So trying to understand  what's is causing the fat pads above eyes then ? Is this,a sign of metabolic inflammation in the body from high insulin potentially? Gavi religiously has 2 things that usually present together ,fat pads above eyes and then foot pain follows .Up until about 2 weeks ago hes been a super star on pracend since starting in feb. Of 2019 and upping dose during fall rise .
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

The fat pads increasing is a sign his insulin is out of control. Three top contenders for factors in your situation are:

- weather getting colder
- 2 mg Prascend not enough
- not getting magnesium
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Nancy C
 

Hi Tara

Not Dr Kellon, but wanted to share my experience. Fat above the eyes is not inflammation, per se, but fat.

When Beau's insulin was out of control, usually this time of year from cold temps, it could rise in a a very short period of time.  Like with in 2-3 hours. He would then begin to have laminitis symptoms: ouchy feet, pulses. His PPID was controlled, usually at 17. His diet was squeaky tight. My go-to remedy that worked every time was an immediate review of the trim. Even taking less than an 1/8th of an inch off a heel or wall helped him to reload the sole and keep him from tearing more laminae. Pads cut within the wall to again, load teh sole, also helped.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

LJ Friedman
 

Confused,

if insulin is out of control actrim is needed. does this help control the insulin??? 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

celestinefarm
 

No LJ, I think Nancy meant that making sure her horse's trim was as perfect as possible helped make the horse more comfortable and protected him against further tearing and destruction of lamina , which were being weakened by high insulin.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Tara Smith
 

-- Dr.kellon ,I know we have been consulting and balancing ,.going to get all that's needed together asap .within .Should we look at adding more pracend at this time ?How would we know if he needs more without stem test ?Can we give to much ..I had started to go a bit higher when these symptoms started ,but you asked me to hold on more about 10 days ago .Could he still possibly need more ?Just an Fyi .Even thi Gavi has been IR ,and has had higher insulin since I've owned him for going on 4 years now ,as soon as we got to a 1 mg pracend with a positive stem test ..all crippling symptoms disappeared ,it was like a dream !!!Hes been fantastic since about 2 weeks ago now .So could he just maybe need more pracend ..I found it interesting that last fall before pracend gavi tested negative on acth with an acth of 17 .Then a positive stem ,started pracend and comfort achieved !This year acth on 1mg pracend it was 24 I believe on pracend !So ecir recommend up to 2 mg  during fall rise .I did get him to 2 mg ,slowly and happily for about 6 weeks now .Now declining. So again could he just need a bit more pracend and if yes how can we know and address ?can more hurt him ?Thank you everyone for all responses and support !
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

Gavi's decline coincides with the drop in seasonally increased hormones. He's also a mustang (red flag) who has been obese since the age of 3 (red flag) and you really don't know how many laminitis episodes he may have had with the previous owner. I do believe he's early Cushing's but that's not the major problem here. His EMS is. Once he is comfortable again you will be rechecking his ACTH and insulin and take it from there.

Cold (meaning temperatures reaching less than 40F) may also be playing a role here since he's likely had high insulins for a very long time - and the laminar damage and high endothelin that goes along with that.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

LJ Friedman
 


-just a reminder.  Some horses need increases in pergolide as they advance in age. I was never a fan of reducing doses after the  seasonal rise, so i never explored that option especially when there were no side effects from the increased dose  -
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Eleanor Kellon, VMD
 

 And a reminder to you, LJ - they may need an increase in cabergoline as well!

In people with growths responsive to this type of drug, they get shrinkage. We don't know what happens with horses but it's likely if control is not good either for all year or even just during the seasonal rise that won't occur. Because of the short half life of pergolide, we may be missing out on shrinkage effects even when ACTH remains controlled. Don't know. If cabergoline is slower to metabolize like it is in people (don't know), we may be getting better shrinkage results which allow you to decrease dose over time.  Again, don't know.

Another possibility is that "resistance" to the drug may develop. Don't know.

Too many don't knows.  Bottom line is you have to check (blood work).
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Tara Smith
 

Hi ,thank you Dr .kellon .,Starting new med.today hes a Little more himself today in general .


He  is a spanish colonial mustang  .How do you know he was obese from the age of 3 ?I heard for sure his previous owner did feed him anything and everything .When he was retured to the Center of Americas first horse ,With stephanie Lockhart  in vt.She got weight off him and then I came into the picture when he was trim down and only having IR at that point.. If any thing since I've owned him  hes been very thin. stephanie took him off thyroid l which  he came to her on and cut it .He did not have any issues with me the first year. Then the 2nd year spring lame ,fall a disaster, up and down w symptoms 2017 ,and 18 .Fall of 2018 again crippling pain ,then diagnosed with ppid . THEN  PRACEND CAME ALONG ,he became so very well and mobile and absent of outward  pain . TILL the  last couple weeks of course .  since I've owned him following IR blood work and  always running 104 range on insulin. I pray this med works that we just are starting to bring insulin down.Cold ?Should I always put light weight jacket on along with sox and boots ,or just depends on outside temps ?He usually tells me when he does not want that coat on for sure ,same with boots .He is to much ! Any great sox suggestion brand  blends? Anyone have a visual on how to keep socks a boots dry with DIY  ideas ?Thanks for all Tara


--
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

Obese from the age of 3 is in your case history. Blanketing depends on temps, same with boots and socks.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001