Olaf Check-In


Cecile Johnson
 

I'd like to check-in about Olaf and see where we're at.  We're about 4 months into this since his diet was changed and a new practitioner started.  His case history and photos are all updated and below is a summary of the timeline.   

In March my hay was tested and analyzed by Dr. Kellon.  Olaf was started on flax, salt, vitamin E, Stabul-1 and U-Balance (U-Balance was started in April because it was backordered).   Also in March is when the new trimmer started.  In April, I added in about 8 ounces of TC Timothy Hay Balance Cubes as a carrier for the U-Balance.  On June 5, Olaf started on Laminox (also added to TC Timothy Balance Cubes) and June 23, started Phyto-Quench.  

In February, Olaf's lab work included baseline insulin at 13.70 and Dexamethasone test at pre: 2.65 and post 1.59.  Since he was over 1, the vet diagnosed him with Cushings.  Olaf has been on 1/2 mg of Prascend since June of 2021.  I had requested the ACTH test, but the vet more or less insisted on the Dexamethasone.  I don't have his thyroid numbers, but he was tested and was in the middle of the normal range.  

Olaf has been in his run-in with deep shavings and boots.  He occasionally will come out and lay in the sand paddock but he is still considerably foot sore (on all 4).  He was trimmed again this last Friday and the practitioner is concerned about how sore his still is.  She likes the way his feet are progressing...his feet are getting rounder and there's less foot in front of the frog and his heels are getting a little wider.  

As I indicate in his case history, I have had Olaf for 6 years and he came to me with foot problems so he has always been foot sore to a degree but it has gotten worse over time.  Olaf is very animated and his attitude seems to be good.  He's a good eater (still working on the Phyto-Quench as he doesn't like the smell).  He's still a bit ribby but I think Olaf looks very good (except for his feet).  

At this point, what should we be seeing?  Should his pain be less and if so, what are others things I can look for?  Is it time for x-rays again to see where we're at with the bones?  I do think Olaf has arthritis that could be adding to the pain.  

Thank you!  Just want to be sure I am doing everything I can to keep him progressing.  


--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Lavinia Fiscaletti
 

Hi Cecile,

If the foot photos dated 6-24-2022 are current, his trim still needs a lot of work. His trim has deteriorated since the 5-27-2022 pix were taken. His toes need to move way back and it appears as tho his heels need to be lowered again. Nothing should be removed from his soles during trims right now.

If you could get a new set of radiographs, taken with the correct positioning and exposure (like the technique used when the ones in 2-2021 were done), it would help your pro see what the problems are.

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


Cecile Johnson
 

Hi Lavinia I just uploaded 6 comparison photos dated 7-8 the date of the last trim.  I thought I did that but they are there now.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Sherry Morse
 

Hi Cecile,

The comparison pictures clearly show where his toes have gotten too long. Getting current x-rays will help your trimmer know how far back they can come.  Getting them back will probably help Olaf feel better fairly quickly.



Cecile Johnson
 

Thank you Sherry and Lavinia.  So I know the practitioner has been conservative with his trims.  I wanted to take it slow due to the amount of time Olafs feet have been neglected and his level of pain since I’m not giving him Equioxx anymore.  To me, the shape of his feet now look letter than I have ever seen them in the 6 years I’ve had him.  He doesn’t look clubfooted anymore.  But Olaf is having a time adjusting to these trims.  

Aside from the trim, is there anything else I’m overlooking?  We have Bermuda hay coming next week and that will be a change from the prairie hay he’s been on now.  I will have it tested.  Any comments about his blood work?  

Thank you.  I feel like we have come a long way on his diet and trim so now just looking to see what else may be causing his continued pain.  I will get X-rays done.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

Just as a general comment, unless you are dealing with contracture, taking it slow doesn't really make it any easier to adapt to the trim changes. There will be a point where you engage the hind foot/frog/digital cushion to assume load whether you take 4 weeks or 4 months (arbitrary numbers) to get there. Backing up the breakover will never, ever cause damage of itself. Remember you have to work both diet/drugs and trim at the same time to get the desired results.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cecile Johnson
 

Thank you Dr Kellon.  How do you diagnose contracture?  Olaf has always walked “stiff legged” on the front.  I’ve included 2 body shots dated 7-10. I’m really at my wits end on his pain.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

Thar's a classical laminitis stance which makes it difficult to see contraction although there is certainly a good bit of tension in the back of the leg. Do you have any ACTH readings or insulin other than the one from February in your history? Was that insulin fasting?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cecile Johnson
 

Thank you Dr Kellon.  That’s the only testing he’s had.  The Dexamethasone and insulin.  It was not a fasting insulin.  

How can I help manage his pain?  He did much better on Equioxx and now that he’s on nothing for pain I can really tell.  He doesn’t handle the trims well snd
he is not liking the Phyto quench.  I finally put his Easy Boots on his hinds hoping to give him some relief.  Are there other drugs like Tylenol or Tramadol he
can take?  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

Do you have a copy of the lab report on the insulin that shows date sampled and date tested? That insulin level isn't high enough to explain laminitis. The dexamethasone suppression test has been discredited and replaced by TRH stimulation but you could start with just a baseline ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Also want to mention that if that insulin is a true level you have to consider other possible causes for the laminitis. Lyme is rare in your area, but not impossible https://oklahoma.gov/health/health-education/acute-disease-service/disease-information/tickborne-and-mosquitoborne-diseases/lyme-disease.html and other systemic infections, like a deep Pigeon fever abscess (which would not be rare in your area) could also do it. Maybe try testing CBC, fibrinogen and SAA.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cecile Johnson
 

The Cornell test results are in his photo album dated 3-3-22.  This is all so overwhelming.  Olaf has never been sound since I got him 6 years ago.  He has had rotation, sinking and from what I’ve been told loss of coffin bone.  He also probably has osteoarthritis.  I was hoping getting his diet right and trim right would make him more comfortable.  I can request these tests but do they cause years of chronic laminitis?  

I still want to get him on something for pain…what options do I have?  Since coming off Equioxx he doesn’t leave his stall.  The vet thinks I should put him down and I don’t know what to do.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Sherry Morse
 

I would retest his insulin as well as run an ACTH test on him now as an insulin of 13.7 is nowhere near high enough to cause laminitis in an IR equine.  (https://ecir.groups.io/g/CaseHistory/photo/272407/3391122?p=Created%2C%2C%2C20%2C2%2C40%2C0 is the link to the actual test result from February). I would also ask Lavinia for another set of mark ups (there will be a fee associated with this as she already did one for you) to show where the trim can be improved now.




Eleanor Kellon, VMD
 

Unfortunately, some cases are not reversible. Olaf's entire pastern is in the hoof capsule and I'm wondering about adequate circulation. Could your vet do a venogram? The severity of his pain is not explained by his insulin levels. It could also be neuropathic since this is so longstanding. It would be worth trying acety-l-carnitine https://www.uckele.com/acetyl-l-carnitine.html , 1/2 scoop twice a day. If he won't eat the Phyto-Quench, syringe it into him.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cecile Johnson
 

Thank you.  My expectation with Olaf has been to slow the progression and make him more comfortable using Diagnose, Diet and Trim.  

I ordered the acety-l-carnitine.  I also ordered capsicum cream.  I want to confirm I can use the acety-l-carnitine with Laminox as he is getting 1/2 scoop of Laminox per day.  

If this is neuropathic pain, wouldn’t Gabapentin help him?  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

Theoretically, gabapentin should help with neuropathiic pain but there are no studies and no case reports in horses that it does.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001