Phyto-Quench


HBRancher
 
Edited

Another day…
not improving at all…
Vandy has been on Phyto-Quench since June 5 - that’s 5 days now. No improvement. In fact, she can hardly walk. Her legs shake when she tries. She has NEVER been this sore - EVER!  In the 15+ years I’ve had her!  

She’s been on a full Prascend for 5 days. I’m sure she’s getting it.  Also I’m syringing the APF & Phyto-Quench so I know she’s getting that.

I try to take her for some walking exercise but she doesn’t want to even walk out of her stall. 
How long does it take for the Phyto-Quench to start working? She needs some kind of pain relief!  Bute?

Is it her arthritis?  Is it her feet?  Both?

Mary Moreau & Vandy
--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Eleanor Kellon, VMD
 

We can't possibly answer your question about where pain is coming from over the internet. What I can tell you is that insulin and PPID are not being well controlled so  you should speak to your vet about increasing Prascend.

How much PQ is she getting and how often? Do NOT force her to walk.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Mary,

Has Vandy been started on Metformin as well as the Prascend?  Are you using PQ pellets (which have Devil's Claw added) or just the regular version.  Has her trim been addressed?  Please do not force her to walk when she is obviously in pain.  If she wants to lay down, let her lay down but you need to make sure you're addressing the elevated insulin and her trim as well as using supplements. 




HBRancher
 

To Sherry & Dr Kellon

Has she even been on Prascend long enough to know if one pill is the right dose or not?  Something isn’t being controlled for sure!  I wonder if I should have ever had her tested. She was much better before I started her on this medicine. 

She is not on Metformin. My vet isn’t up to date on PQ or APF. 

Her trim is addressed. She was comfortable in clogs but one came off so I removed the other one. She is now in Cloud boots & is not happy.  She seems to like the hard soles & smaller footprint of the clogs.  I will have to Bute her to put the clogs back on because she is reluctant to pick up one foot at a time. 

I most likely will give her Bute tomorrow after the PQ has subsided some. 

Then call the vet on Monday. 

Mary & Vandy
--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Sherry Morse
 

Hi Mary,

You can retest after 3 weeks to see if the current dose of Prascend is controlling the ACTH. Elevated ACTH can drive up insulin in some IR horses but without getting her insulin under control she will continue to have hoof pain.  

Have you spoken to your vet about metformin?  Is she on PQ with Devil's Claw (which is what actually will help where NSAIDs will not) or on plain PQ?  Are you using APF?  

Can you please post pictures of her current trim as outlined in the Wiki: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help




Eleanor Kellon, VMD
 

Since she has only been on it a month and her ACTH is normal at baseline, the repeat TRH stimulation may not be normalized but it should be improved. She really should have been started on pergolide last December. One of your letters from LSU said "this is further supportive of our suspicion that Vandy's primary issue is her insulin dysregulation that is causing her to have an abnormal ACTH response". This is totally unsupported by the science. She needs pergolide." Most horses do have an adjustment period, and using APF or Jiaogulan can help with that.

I would also definitely try Metformin until you get her up to full 1 mg of pergolide.

It's difficult to evaluate trim through the wrap but her toes may be too far forward which is why she likes the backed up breakover of the clogs rather than a boot. You could accomplish the same thing with a proper bevel but there's no harm in properly applied clogs as long as she doesn't go too long between trims.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


HBRancher
 

Thank you, Dr Kellon, for looking over Vandys history again.  I added a few more hoof pics & xrays to our case history to help.  She is due for another bi weekly trim but it wouldn’t be much to remove.  

 

It’s really a mute point about starting pergolide last December. 

 

 I have been treating/feeding her like an IR horse since at least 2010!  I have followed your protocols  regarding DDT+E.   And, actually, if I were only testing her ACTH, she would be normal!  She is not a typical Cushing’s horse.  Not cresty, not overweight.  She sheds out.  She sweats & she is exercised more than any other 31 yr old horse I know.  But…here we are.  With her sore feet.  

I was hoping she wouldn’t have a bad adjustment period since I was giving her the APF & J-herb.  

 

 I don’t think I will start any Metformin yet.  She has only been on a full 1mg  Prascend for 7 days now.  I will test at the end of June & reevaluate then.   

 

I’m sure the clogs are her favorite because they support her hoof wall with the casting cover & rigid bottom.  They also give her relief at the toe with the indention under the toe area.  The DIM also gives her digital cushion & frog a much needed cushion.  

 

This is a summary of things that I believe are pertinent to her current condition. 

 

I’ve added pics of hooves at different stages to our files.  Would like to add videos but haven’t figured that out.

 

 

8-30-21  Vandy barefoot at our camp. She was “off” a bit but was sound in boots to trail ride. We evacuated here for Hurricane Ida. Came home a few days later to major hurricane damage. Trees down. Pastures not accessible. So Vandy’s home & routine was majorly disrupted.  Trees down everywhere & she was only allowed in her stall & one small pasture. Lots of big trucks & chain saws for days. 

 

10-25-21 Took Vandy to LSU to get Coggins & decided to get lameness exam because she still had been a bit “off” - mostly turning on the right front. Dx lame on right front. I relented &  Vet put on clogs with screws. She was much more comfortable. First time in more than 10 years that she had a “fixed” shoe on her feet. Decided to wait to get TRH Stim test because of stress & seasonal rise. 

Xrays & report included. 

 

11-24-21  Pictures of hooves after I removed clogs. Terrible!!!

Beginnings of thrush. Under run heels. Lamellar wedge. Sole growing crazy. 

I trimmed & booted her for a week or so before replacing clogs. I do not use screws in the hoof. I slide the hoof between screws placed in the clog & wedge the hoof in place. I also use Artimud in the collateral grooves & under the DIM to prevent thrush. Then cast. 

 

12-3-21  Vandy was very comfortable in her EasyBoot Gloves to trail ride.

 

12-15-21 

First TRH Stim pre 21.7

                          Post >1250

         Insulin  77.5

Report included. CBC included

 

And - no- I didn’t start her on pergolide or Metformin at this time. First test. Maybe still in seasonal rise. Just not enough evidence for me. 

 

12-22-21 Started Previcox for arthritis. 

 

**Then Christmas. Still cleaning up hurricane damage. Vandys home & routine was still very disrupted.   I changed clogs out a couple of times. Vandy was very comfortable with them on but gimpy with them off. So I would clog for a month, boot for a couple weeks, then clog again. We would go for short trail rides where she would be fine. But pretty tired after. So I didn’t push her.  

 

3-24-22 Took Vandy to LSU for evaluation of rt front.  She came up lame a few days earlier with a bad cut on her foreleg.  Dx:Rt front laminitis with secondary laceration of rt foreleg. I also deduced that she got that cut from falling down while trying to sleep. 

I had been noticing her not wanting to roll & not taking her afternoon siestas. So started watching her at her usual nap times (early morning & after supper) where I knew she laid down.  Her knees would buckle & she would almost fall but never let herself lay down. That’s how she got the cut on her rt foreleg. 

X-rays & report included 

 

5-10-22 2nd TRH Stim pre 18.3

                                          post 1176

                 2nd Insulin 126

                      Glucose 92

Report included.  H&P & letter from vet included. Chem panel included. 

 

**5-27-22 Pictures of hooves taken after removing clogs & doing a very conservative trim.

 

Took Vandy off Previcox before starting PPID meds

 

5-22-22  Started APF Pro

5-25-22  Started Prascend 1/4

                   4days

5-29-22  Prascend 1/2 / 2 days

5-31-22  Prascend 1/4 (lost 

                   appetite)

6-2-22  Prascend 1/2 / 4 days

6-5-22  Started Phyto-Quench      

                 w/DC

6-6-22  Prascend 1 full pill 

6-11-22 Replaced Phyto-Quench with Bute for leg pain. 

 

Vandy has been on 1 full pink pill for 7 days now. Appetite is better even tho she is still being very picky. She is now eating 1 cup dry r/s/r beet pulp 3X day, 1 cup TC Senior Gold & 1/2 cup TC Senior 2X day, 1 cup Standlee Timothy pellets 2X day, as much (not much) free choice tested low NSC Bermuda hay (not weighed). She quit eating TC Timothy Balance cubes and Stabul 1 feed (I used the cubes & the treats to hide the pink pill). 

She still gets 2Tblsp iodized salt/day in her feed.  APF Pro 10ml, HA 1/4tsp, Jiaogulan 4tsp, AAKG 1 tsp/day -all syringed. 

California Trace Plus, Ground flax, MovEase 2 tsp, Leucine & AlCar 1 Tblsp each will slowly be added back into diet as she will accept. 

 

 

6-11-22  I replaced the Phyto-Quench with Bute to see if it helps the pain in her legs/feet. Her legs shake with pain when she walks. I did not get a video of her legs shaking. I have not seen her lay down since fall.  The Bute has made her able to walk without her legs shaking.  

 

I feel like I’m rehashing everything, but I just want Vandy to be comfortable.  She is 31 years old.  She has given me so many good years.  I want to do right by her.

 

Thanks

Mary & Vandy

--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Eleanor Kellon, VMD
 
Edited

I understand your concern. She should have end of life comfort.

Your should stop the leucine and AAKG and the TC/Standlee products.

How much PQ are you givings?

There is really no question here that it is the PPID  driving her laminitis.  All the other hormones produced by the intermediate lobe also influence insulin sensitivity. She's not the first one to have baseline ACTH normal and no other "classical" signs to have this problem.

Please believe we do not ever want to see a horse shaking in pain - just trying to get to the SOURCE of that pain and remove it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


HBRancher
 
Edited

Dr. Kellon,
So if I stop the TC/Standlee products - That means she only has hay and beet pulp?
I stopped the PQ this past Sat/Sun - gave Bute instead. I will start PQ again today at
1 scoop/day.  How much should I be giving?
I've added a link to a video compilation of Vandy from Aug 2021 till now.
Thanks,
Mary and Vandy
 
--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Eleanor Kellon, VMD
 

I would try one scoop twice a day to start.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Mary,

The Triple Crown products are over the 10% ESC+starch cutoff which can be contributing to the elevated insulin which will cause laminitis so you do want to cut those out ASAP to help with the insulin.  The Standee products are also not guaranteed to be under 10% so cutting them out as well is just to be on the safe side. 

If you're already syringing you can add the Prascend to that syringe so you're not 'poisoning' feed and you're sure she's getting the full amount. Then you could add Stabul-1 or the Timothy Balance Cubes back in as a carrier, but beet pulp is fine for now.  Do remember that Timothy Balance Cubes are fed at a 3:4 ratio to the hay they are replacing so for a 960lb horse her total intake should be 19.2 lbs. If you feed 2lbs of beet pulp with her supplements the balance would be hay (17.2lbs) or the Timothy Balance Cubes (12.9lbs).  If you add Stabul-1 to the beet pulp you would need to adjust the hay/cubes accordingly.  

It's VITAL for Vandy's comfort that you focus on getting her insulin down to a safe level and the keys to doing that right now are:

DIET: remove any feeds that are over 10% ESC+starch, soak untested hay, use beet pulp/Stabul 1/Timothy Balance Cubes as a vehicle for supplements.

MEDICATION: Prascend to control ACTH which may be driving high insulin, Metformin to bring insulin down while diet adjustments have time to work

TRIM: Her xrays show long toes, lack of sole and ski tips on both front coffin bones so it's not a surprise her feet are bothering her in general.  If you can post a current set of hoof pictures with a request for markups from Lavinia she will be able to do mark ups for you to follow when trimming.  That will help but getting her insulin down is key to getting her more comfortable right now.

Just watched the video you posted and she's not moving that badly at all IMO.  




Kirsten Rasmussen
 

Agree that she needs diet tightened up while her insulin is still so high.  You could also soak her hay.  Getting the insulin down is critical and diet can be very effective.  Once she's at a therapeutic dose of Prascend and Vandy's insulin has dropped, you might be able to add in some of the TC and Standlee products, with caution. 

Another way to feed TC TIMOTHY NATURALS BALANCE CUBES is to steam them by pouring a bit of boiling water on them, just enough to steam them, and covering with a lid for 5 minutes.  This breaks them up into a nice dampened warm mash and it was the only way my horse would eat them after he started to refuse the cubes (I had been hiding his Prascend pill in a cube, too!).

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


HBRancher
 

Hi Kirsten. 

Thanks for the suggestion on the TC cubes. I see you are in Canada. We are in south Louisiana. It’s very hot here & warm mashes are only fed during the winter!  Maybe a cube popsicle would work!  But thanks anyway!

Mary & Vandy
--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


HBRancher
 

Hi Sherry 

I understand that Vandy should be consuming about 19 lbs total feed. She’s never been a big eater. I couldn’t get her to eat more than 4lbs of Timothy pellets a day when she was normal!  And she loves her Timothy pellets!!  She hasn’t been a big hay eater since she started quidding a few years ago. She has an older horse mouth. But actually a good mouth for a 31yr old. 

She always has Timothy Balance cubes & tested low/sugar starch hay available to eat. Whether she decides to eat them or not is up to her. I can’t force feed her. 

Regarding her feet: she has had thin soles & ski tips ever since I got her at 15yrs old. A vet recommended I put her down when she was 18. That’s the reason I have fed her a balanced low sugar/starch diet forever.  A balanced diet that was supposed to help grow sole. Sometimes- damage can’t be totally reversed. Dr Bowker once told me “maybe if she lives to be 40” she could grow a good hoof!

We are getting close!

But she’s the reason I have followed Dr Kellon’s teachings & took her courses on nutrition. She’s the reason I learned to trim from Pete Ramey & Paige Poss. She’s the reason I apprenticed through PHCP. And she’s the reason I’m here now. 

If you watched the timeline on the video, you will see mostly pics of her BEFORE Prascend medication. I haven’t been able to capture her moving since because - well - because she isn’t wanting to move. 

I do hope it gets better soon. 

Thanks for your suggestions. We will try our best to follow the “guidelines” but her quality of life is my priority. 

 

Mary & Vandy

--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Sherry Morse
 

Hi Mary,

I totally understand the quality of life issue. My mare had COPD (pre-PPID diagnosis) and I hit a point with my vet where I had to insist on trying Dex for her as the only other option was putting her down.  She lived another 6 and a half years after that so it was the right call for her.  

However, even after she developed PPID she was not IR and she was not laminitic so I had a bit more flexibility on her diet than you have with Vandy.  For her, getting her insulin down is going to help her feel better so I'd be looking at safer diet options for her.




HBRancher
 

Hey sherry
Im completely on board with the feed business. I purchased 2 50lb bags of Stabul 1 fenugreek feed & 4 50lb bags of TC Timothy Balance cubes for her. And the 5lb bucket of Phyto-Quench. But…what’s the old saying - “You can lead a horse to water (Stabul) but you can’t make him drink (eat)”!!  And she is a stubborn, very opinionated mare that has been around a long time (31yrs)!!  

  Do I just wait her out & watch her lose weight that she doesn’t need to lose?  Or does anyone else have any other suggestions??

Thanks
Mary & Vandy 
--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Kirsten Rasmussen
 

You could let it cool before feeding.  The steaming just helps the cubes break up without becoming saturated in water like soaking would do.  Something to try anyways.

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


Eleanor Kellon, VMD
 

What are her taste preferences?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Hilary McGregor
 

Just wanted to share my recent experience with our pony Jack having a laminitis flare that lasted several months until we started Metformin. He was also purchased in his mid-teens with x-rays that showed thin soles and remodelling of the tip of his coffin bones in the front. He was managed for 6 years with only one laminitis episode that had a known cause (got into winter grass). This January when he had another flare, the first thing we did was take x-rays and tighten up his diet and trim. I thought that would be enough. When this didn't resolve his pain, we got his insulin, glucose and ACTH tested. His insulin was 170 despite tight diet. We started Metformin and within 2 weeks he was way more comfortable, we weened him off Previcox, and when his blood test results came in, his insulin was down to 25. 

My difficult learning was that diet management alone didn't control his insulin. I'm realizing that as a horse ages, their metabolism might change and what worked before may no longer work. I'm so so grateful that we were able to get his insulin down with Metformin and that this significantly reduced his pain. 

--
Hilary and Amika
Prince George, BC, Canada
Joined July 2019
NRC+ proficient grad January 2022

Amika's Case History Folder
Amika's Photos Folder

Jack's Case History
Jack's Photos Folder


Suzy Berkowitz
 

Hi Mary, I also have a very finicky 31 year old pony. I was lucky if Scout ate a cup of stabul 1. He doesn’t like any kind of powders or flakes so he wasn’t eating the flax. Someone mentioned the flax oil from horseguard so I bought a bag to try. Wow!! Scout loves it. I mix one ounce on his stabul 1 and he now will eat 2.5 cups. They make a flax treat as well. Maybe Vandy would like it
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915