Topics

Moving forward diet, supplement and medication advice


lfitz66
 

I'm thrilled to have my case history and pics uploaded for May. Any thoughts and recommendations would be greatly appreciated. Wondering how to move forward with the diet, supplements and medication. Vet will not approve anything other than Insulin Wise and Isoxoprine until we have tried them. She feels Invokana has not been researched enough. She is citing the MSU study on Insulin Wise and other client input. I did share with her Dr. Kellon's feedback on that study.
Going to have bloodwork and x-rays done again on 29th.
***The most recent x-rays (1-26) were at the end of a longer than normal trim cycle due to farrier availability. The hoof pics are from a week and half after her most recent trim on Feb 4th. 
--
Leigh and May
Michigan
Joined 202
https://ecir.groups.io/g/CaseHistory/files/Leigh%20and%20May
https://ecir.groups.io/gCaseHistory/album?id=260799


Sherry Morse
 

Hi Lehigh,

Have you read the information in the welcome message regarding the emergency diet?  https://ecir.groups.io/g/main/message/261239  As noted, isox - nor any anti-inflammatory -is not indicated in cases of metabolic laminitis as they don't work.  Is May still on Bute at this time?  If your vet isn't willing to think outside the box you may want to reference the information in our files section on dealing with vets (https://ecir.groups.io/g/main/files/Veterinarians) or consider finding a vet who will work with you.  You can do a search on Insulinwise in the messages and you'll see that most of our members found it to not work for their horses.  The study from MSU found the same in a very small population so I'm not sure why she'd be citing that.

As far as medication for lowering insulin - we recommend starting with metformin as it's more easily available than Invokana and works well for many horses.  However, if you've just made changes to her diet based on her recent test results you may want to see if taking weight off helps before moving to medication.

There's definitely room for improvement in May's trim but it's not the worse we've seen by far.  If you want to get on Lavinia's list for markups it's best to send another message with her name and "Request for Markups" in the subject so she will see it. 



lfitz66
 

Thank you. I did put May on the emergency diet for 2 weeks after the blood work results, but that isn't a long term solution correct? She has been stall bound for the better part of the last 3 months due to the abscess and laminitis so getting weight off is a toughy as exercise is not currently an option. Right now I just have her on soaked and rinsed beet pulp (1/4 cup) Jiaogulan, cinnamon, Insulin Wise, Chaste Tree Berry, salt, Mag Ox and 16/18 lbs of hay depending on the temps. No Bute currently. If her current issue is Winter Laminitis the Isox won't help to increase circulation? I will request trim mark ups. Thank you again.
--
Leigh and May
Michigan
Joined 202
https://ecir.groups.io/g/CaseHistory/files/Leigh%20and%20May
https://ecir.groups.io/gCaseHistory/album?id=260799


Sherry Morse
 

As far as Isox:
Clinical trials appear to support the use of isoxsuprine for treatment of navicular disease. However, poor bioavailability, lack of cardiovascular effects following oral administration, superficial support in clinical trials, and new evidence regarding the pathogenesis of navicular syndrome indicate that the use of isoxsuprine for treatment of navicular syndrome or laminitis is questionable at best.

From 2008:
https://aaep.org/sites/default/files/issues/proceedings-08proceedings-z9100108000337.PDF - refers back to studies in 1997 and 1999, same as the 2014 study

Medications used to improve digital blood flow (acepromazine, glyceryl trinitrate, and isoxsuprine hydrochloride) do not appear to improve the clinical outcomes of horses with laminitis.

Cinnamon has not been found to be effective in treating laminitis (you can do a search on that in our messages as well). 




Lavinia Fiscaletti
 

Hi Leigh,

Thanks for adding the rads and photos for May.

As Sherry mentioned, May's trim is certainly better than many we see but it does need tightening up. Her toes are too long, heels are underrun and there is some flaring that needs to be addressed. Soles remain thinner than needed. From the series of rads in her album, these have been issues that have not improved over time. She has had some sinking and slight bony column rotation present since the 2018 rads.

Trim needs to back the toes up more, get the heels moved back. Soles need to be left alone - no trimming of any kind on them.

Please let us know if you'd like some mark-ups to help guide the trims.

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


lfitz66
 

Thank you so much for your input. Her sole has not been touched in many months and I noticed the flaring as well compared to photos from her hooves in 2017:( I will add a couple of those to her album. I would LOVE some mark ups to help guide my farrier. She is very open to input.
--
Leigh and May
Michigan
Joined 202
https://ecir.groups.io/g/CaseHistory/files/Leigh%20and%20May
https://ecir.groups.io/g/CaseHistory/album?id=260799


Kirsten Rasmussen
 

Hi Leigh,

The long term solution we advocate is dietary change, which means eventually transitioning from the Emergency diet to a diet with tested low-sugar grass-only hay and appropriate minerals balanced to that hay, plus vit E, salt and ground flaxseed.  Medications should only be added if dietary changes are not keeping the insulin controlled, largely because they aren't going to be as effective if the diet isn't already in place.

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


lfitz66
 

Thank you Kirsten,
I had May on a diet balanced by Dr. Kellon from October 11, 2020 until this Laminitic episode. I truly believe this was cold weather and not diet induced. I just didn't want to take any chances so I went back to the emergency diet just to be safe. 
--
Leigh and May
Michigan
Joined 202
https://ecir.groups.io/g/CaseHistory/files/Leigh%20and%20May
https://ecir.groups.io/g/CaseHistory/album?id=260799


Kirsten Rasmussen
 

Good idea.  With the high insulin, even if it is just due to cold temperatures, doing everything you can do reduce it by tightening up the diet is wise.  I'd be surprised if that high of an insulin was just due to cold weather though.  Are you planning to retest insulin now that her hay is being soaked to see if it has come down?

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


lfitz66
 

I have her scheduled for retesting on March 29th. That will be 9 weeks from the last one. 
--
Leigh and May
Michigan
Joined 202
https://ecir.groups.io/g/CaseHistory/files/Leigh%20and%20May
https://ecir.groups.io/g/CaseHistory/album?id=260799


riggslippert@...
 

Hi Leigh,

My horse Cadet (IR/EMS/PPID) is receiving Invokana and has been managed with ECIR protocol for 2 years.  I am nearby, so if you have any questions, don't hesitate to ask.
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




Eleanor Kellon, VMD
 

Aunna,

How is he doing?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


riggslippert@...
 

Hi Dr. Kellon,

Thank you for asking!  Overall, I think he is doing very well.  He was started on Invokana during an acute bout of laminitis in mid October and he has been sound at a trot on arena footing and grass since early December.  He has been wearing Clouds, socks, and leg warmers all round 23 hours/day due to the cold weather.  The only jiaogulan product I've been able to get into him is a capsulized human extract, but his mucous membranes are quite pink and my farrier sees its influence on his feet.  Because of the severe cold, I haven't submitted any insulin testing--I will as soon as we have a 40 degree day.  His urine continues to test 500 for glucose, even after waiting for 60 secs.  Most days he has decent energy and seems to feel better than he did before the Invokana.
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102