Need comments on new X-rays showing more rotation, was Trim & Booting Advice Needed for Khan


Jessica Gunderson
 

Hello,

I need help with trimming and booting for Khan to get her more comfortable.  Also happy to pay for an additional mark-up. Unfortunately my vet cancelled x-rays today which I was hoping to have when I started this topic but I will get new x-rays as soon as I can.  I also need to upload new front laterals (was planning to do that when we took x-rays).  I currently have soft rides with lamanitic gels (frog support cutoff) which she seems to like the best.  I also have easy boot cloud and stratus but I usually use this 20mm rubber insert in them, she does not seem to like these as well. I also have equine fusion boots but I have not used them, I have an insert that kind of takes the form of the hoof that I think I could use in them.  Am open to any boot or pad that is just what I currently have at home to work with.

As far as trim while she has definitely improved since September, she has never become fully comfortable and resists movement. Friday, November 19, she became quite a bit more sore and has not improved since then.

Thank you.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
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Trisha DePietro
 

Your soft rides  should work fine, especially if your horse already likes them- You might want to get a spare set of pads because they wear the boots 24/7 with few breaks...except for removing boots and checking feet and bulbs for rubbing. So, they will go through pads pretty quick. 

The trim is really the key to success as you know. And the boots and pads offer extra support. 

--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Nancy C
 

Hi Jessica

Go with what she likes the best. She will tell you.  That may change over time. Cut up interlocking foam floor mats were my pad of choice.  https://www.walmart.com/ip/Stalwart-Foam-Mat-Floor-Tiles-Interlocking-EVA-Foam-Padding-Soft-Flooring-for-Exercising-Yoga-Camping-Kids-Babies-Playroom-4-Pack/798176025

They still are.

If she's resisting movement, you should listen to her. You are two weeks from your last trim and given the angle of her foot adn coffin bone on 11.16.21, I would not be surprised that she is more uncomfortable. A trim every two weeks is not unusual and has is often needed at this point in the game, working for many of us, including my high heeled Morgan.

There's a lot of good info in Dr Kellon's and Lavinia's reply to you here:  and here

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

2021 NO Laminitis! Conference Video Recordings available to new subscribers until 12.31.21
  www.nolaminitis.org



Jessica Gunderson
 

I have uploaded new x-rays for Khan from yesterday, all my vet was willing to take is laterals in her soft-ride boots.  They look worse to me like new rotation or possibly even additional descent but would like someone to advise on them.  She is standing quite lamanitically today.  I am willing to try to do things on my own if her hooves should be worked on as soon as possible I would just need very specific instructions as I have never really rasped a horse or used a nippers.  Happy to pay for an additional markup and instructions I just don't know how to go about doing so.

--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

As these x-rays were taken with her feet still in boots and not flat on a block they don't say a whole lot to me beyond she has no sole to spare and a ski tip on the left front which says these are not new issues with her feet.  To have Lavinia do mark ups again you will need a complete set of hoof photos as outlined in the Wiki: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help




Jessica Gunderson
 

Yes, a trimmer I trust just told me that, wish my vet would have explained that to me.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Candice Piraino
 

HI Jessica!

I want to comment on your latest xrays (rads) which I am going to be very blunt and honest. These rads are not doing anyone any good! To be honest, who ever took them needs to redo them free of charge - unless you didn't pay for these? You are missing part of the hoof in the picture. You should see part of the mounting blocks within the rads for a better picture. The feet should have proper markers to determine angles and sole depth (these are missing, and they should have at least marked the dorsal wall with a radio opaque concoction), and would include a known measurement marker. 

At the same time, I am also not shocked since many who use an xray machine, don't know how to properly take rads, especially of feet! I see these same issues a lot, and I tend to just mark up the feet myself before they block up the horse. Also, no boots should be worn during the rads, and both front feet should be blocked up to the same level. 

Is there a reason why your vet did the things they did with these rads do you know?

We need to eliminate the trigger of the laminitis. I will say that if your hoof care provider touched the sole of this horse's foot with a knife or even scraped too hard with a wire brush to clean it- that was not a good decision on there part. Need to retain as much material as possible. Can you locate a barefoot trimmer who specializes in laminitis? The soft rides may NOT be a happy place for Khan, and you might want to try another boot or even Equicast wooden/evo clogs. I have found that a lot of similar cases like Khan, that they do love the equicast wooden clogs. The Evo foam crushes down where the horse wants, yet providing great stability. These are casted on and stay on for several weeks at a time. They will need to be removed to continue the trimming and then recasted. 

Have you checked the PHCP website for a trimmer closer to you?

BUT you are such a great owner and trying to do all the things and keep pushing for Khan! Just listen to Khan and be the best ambassador you can be :) 
--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Lavinia Fiscaletti
 

Hi Jessica,

I agree with Candice regarding the radiographs - the vet really owes you another set on their dime.

Although the rads are far from ideal, they do tell you that the pads in Khan's boots need to be flat - good that you removed the frog support part but you also need to cut the wedge off those Soft Ride pads so they are level. The wedge may be the reason it looks like there is some bony column rotation, although there's really no way to know for sure without getting proper rads taken with the feet bare and standing blocked correctly.

Her sole depth is definitely thin, toes are too far out ahead of where they need to be and there is sinking. The sinking and breakover issues have been the same all along - they haven't gotten worse. The trims are cosmetically improving the dorsal walls but are not doing anything about the toe being too far ahead at ground level. They are also continuing to remove sole where there is less-than-zero to spare - which is likely a large part of Khan's continued pain. Her heels are remaining severely underrun, which is adding to her discomfort.

You can certainly help the situation if you are willing to pick up a rasp. As mentioned, I'll need a full set of photos: the sole shots you have a re great; need a sole plane shot of each foot; laterals of the fronts from ground level rather than aiming down on the foot - like you did with the hind feet.

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


Jessica Gunderson
 

I have added new photos. Khan was quite sore without boots on particularly on the left front so it was hard to get a good lateral photo.  My vet said not to take off her boots because making her stand on three legs will cause more damage as well as non-padded x-rays on blocks.  Is that true? I hope not as how will we ever get x-rays or trim her if that is true.  My vet is also very much against nerve blocking for x-rays and/or trim because of additional damage. When my vet says these things it makes me feel very scared. What can I do to get her safely x-rayed and trimmed?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Jessica Gunderson
 

I have checked PHCP and the only person close to me was not willing to take on any new clients. I am willing to pay someone to travel here to get her trim turned around but I have not found anyone willing to do that either. Please, I can learn if someone was willing to come here and get the realignment started.

My vet x-rayed the way she did because she said we would cause damage if we x-rayed her on blocks.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

I'll be very blunt here and you may not like it but with the collected years of experience we have on this group we have not found that a horse will experience more damage from being out of boots for the time needed to take x-rays or pictures.  Nor will they be injured by using nerve blocks for x-rays or trims.  As your horse's voice you need to be willing to advocate for her and if your current vet is not willing to do what is needed you may well need to find another one who is willing to work with you if at all possible.

I do realize that finding a new vet (or any vet) can be impossible in certain areas so you may need to deal with the vet you have and in these cases you may have to be wiling to tell the vet that you are the owner and you want to do this because the only other option is putting the horse down and you're not willing to do that just because the vet won't work with you. 

I've been there/done that and it's tough to do but when it's literally life or death you do what you need to do.  In my case it was telling the vet I wanted her to prescribe Dex for my mare's COPD (this was prior to her developing PPID) because the vet was worried about the risk of laminitis.  I said if we didn't try it I was going to put her down rather than watching her struggle to breath so given a choice between death and it might work the vet agreed.  Scarlet lived another 6+ years, did develop PPID 4 years later and never had laminitis so that was the right call for her at that time.



Bobbie Day
 

Jessica
We’ve all been there with our vets resisting to do what’s necessary, hopefully Dr. K will chime in but my little mare was in pretty bad shape too and the nerve blocking didn’t add to her troubles. Remember as hard as it is, you and you alone are your horses advocate. There are many here (including myself) that had to pick up a rasp and get it done. This isn’t a easy journey for sure but it’s doable. Lavinia can help guide you. As for taking the boots off if you get a nice thick pad like a yoga mat or one of those cushy pads you can buy to stand on it will help her.
You learn to make adjustments for them, sometimes we just have to put our thinking caps on and get creative , there’s many ways to make it easier on her but what it comes down to is you can’t get the help you need without good X-rays.


--
Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


Jessica Gunderson
 

Posted x-rays for Khan taken today, new rotation.  So upset, vet and barn manager both want me to euthanize her, please help.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
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Lavinia Fiscaletti
 
Edited

Hi Jessica,

Who is saying there is new rotation and how are they determining that?

There has actually been a slight improvement in the RF bony column alignment and the LF is about the same as in the 12-02-2021 rads; sole depth is about the same as it was; sinking hasn't changed either. The last rads were taken with Khan in boots and wedged pads, which distorted the way things actually looked at that time. The laminar wedges are a trimming problem that needs to be addressed.

Trim has removed a bit of the bulbous laminar wedge but hasn't really actually moved the breakover back. It appears as though there has been some material removed from the bars and sole - which should NOT be happening.

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


Sherry Morse
 

Who said she has new rotation?  Everything looks about the same as the last set of x-rays - there are still trim issues to be addressed but I don't see anything that looks 'new'.




Eleanor Kellon, VMD
 

Just for the record, I agree with the posted comments. There is no worsening. The worst thing about them is no improvement which should have been evident if the last trim was correct.

True bone rotation is measured by deviation in the P2 P3 axis. RF has essentially none.  LF is mild and correctable with the correct trim. Long  story short, a derotating trim re-establishes a normal relationship between hoof wall and coffin bone, and ground and coffin bone.

That bulbous laminar wedge is acting like a toe brake on a skate. It impedes breakover and tears the laminae with every step which is why it keeps getting bigger.  That has to be stopped by taking it out of weightbearing - another way of saying bring the breakover back. Many trimmers/farriers are afraid to trim past what looks like the white line at ground level but in a foot like this the true live white line is miles away from that.

This is what needs to happen IMO:

Toe: Since there is no frog marker the measuring has extra steps.
1. Measure length of hoof at ground surface on X-rays
2. Measure length of hoof at ground surface in front of tip of coffin bone on X-rays
3.  Divide toe measurement by total hoof measurement above to get a fraction, e.g. 1 inch/5 inches = 1/5
4.  Measure length of hoof at ground surface in real life
5.  Multiply measurement 4. by the percentage determined in 3. - e.g. 5.5 inches x 1/5 = 1,1 inches.
6.  Measure 1.1 inches (or whatever your measurement 5 is) back from the center of the toe. That is where the tip of the coffin bone is sitting.

Now, as a conservative correction, set the beginning of the toe bevel at half the distance from toe to CB - e.g. 0.55 inches back from the toe on the above example. To make sure the toe brake is taken out of action, make the angle of the bevel at least 60  degrees with the ground and continue this bevel from 12:00 to 12:00 on the bottom of the hoof - i.e. the front half of the foot.

I personally think these heels can come down and need to come down. Working only at the back half of the hoof, lower the heels by 2 to 3 degrees. This will also bring the heels back and create a larger platform for weightbearing in the back of the foot. If this makes the toe "float" off the ground when the horse is standing flat, that's fine. In fact, it's good.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jessica Gunderson
 

Thank you, I tried a different vet yesterday and they is the one who said she had new rotation and that it didn’t really matter what the cause of the lamInits was but she did not like the look of her fronts she will never even be pasture sound and that I am being cruel by not euthanizing her. It was an awful day, the vet really struggled with the nerve blocks, broke and ruined I would guess at least a dozen needles, caused quite a bit of bleeding which I would not think is normal for nerve blocks and then insisted on sedating her because I don’t think she ever could manage to get the left front blocked. It felt more like medieval torture versus modern veterinary medicine. Poor Khan, I am so sorry I did that to her but I felt I needed the x-rays. It was all done over Mayo pads so hopefully that helped. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
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Bobbie Day
 

Oh Jessica, my heart hurts for you. It’s terrifying when things go that way. When I had my little mare blocked it was fast and although I’m sure the needle wasn’t pleasant my vet did a great job. My vets office is ran by a older stuck in his ways vet and his daughter. Most of my requests have been a first for them but now they just go along with me so I do feel what your going through. Not all of our visits went that well though. Before I found this group she was having lots of snotty nose episodes and because she was a rescue I was afraid she had guttural pouch infections so we had her opened up. My vets “operating room” is his front yard, after digging around in her neck for a good half hour my husband called it off. She had a big cut in her neck and I felt horrible. Now I know it was a sign of PPID, and after I made (all) the changes she never had another one, I guess my long winded point is sometimes it’s hard and it’s easy to doubt ourselves but the only way they can speak to us is through their bodies. And although what your being told by your vet is defeating if Dr.K and Lavinia think she can be fixed she absolutely can and you need to keep the faith because Kahn will know. 
--
Bobbie and Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021
ECIR Group Primary Response 


https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


Kirsten Rasmussen
 

Hi Jessica,

First, Khan is doing well metabolically.  Her insulin is under control and her ACTH is perfectly normal.  This gives hope that she will be fine because you've adjusted her management and it is working!  The biggest issue is her trim.  Unfortunately, a lot of the things you've had done since her laminitis have not helped her hooves and that is why she is still in significant pain 8 months after the main event.  Not your fault, you've been misguided by the professionals.  As far as I know, we have yet to see a horse do well in the Ultimates, and your previous farrier was too hasty in putting her back in shoes in June. 

Second, there is no reason why she can't become sound again for riding, let alone "drylot" sound (she should not be on pasture again), although she might need boots to be comfortable with a rider on.  Yes, there is some damage to the tip of her coffin bones but certainly not enough to base a euthanasia decision on, or give up hope.  Again, the professionals are misguiding you.  Obviously we are not there and cannot see the pain Khan is in, and perhaps that is what is guiding your vet and barn owner's recommendation to euthanize  (no one likes seeing a horse hobbling around in pain), but we CAN objectively see the situation from the information you've posted and tell you there is a good prognosis if you can work on her trim and support her in growing a new healthy hoof (as well as keep her insulin under good control so she doesn't get laminitis again).  As Sherry said, you are Khan's best advocate and you are going to make the decisions that you feel are best for her.  Do not let yourself be pushed into something you know is not right (easier said than done).

Don't forget that growing out a healthy hoof can be a rough road, with abscesses and sore feet.  We try to support them with padded boots but unfortunately it just takes time, even when you are doing everything right.  Improvements happen slowly.  You may need to seriously consider picking up a rasp and learning to trim her yourself since your hoof professionals to date have not helped the situation, even with rads to go by.  As someone who had to do just that I can say it is not easy at first, but it does get easier with practice and as the hooves become healthier and there is less to remove.  You don't need to do a full trim every 4 weeks.  Just rasp a little every day or two, or even once a week, and you will see progress. 

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


Sherry Morse
 

Hi Jessica,

That's really rough but that would be a one and done for me with that vet for a multitude of reasons.  Have you considered looking for a different situation for Khan where you might be able to get more support with her care going forward (if that's even an option in your area).