locked Updated x-rays and where to go from here


Mikaela Tapuska
 

Zahr’s latest x-rays are up in his photo album. Given the struggles he’s had since his previous set was taken in April, I wasn’t expecting them to be great this time, especially since most of the bigger changes we’ve made (soaking hay, pergolide increase, and trim) have been in the past 2 months.

On the positive, his sole depth is much better in the RF this time and the bone alignment actually doesn’t look that bad in comparison to where it has consistently been stuck for nearly the last 2 years. And alignment seems marginally better in the LF, too.


The bone loss and remodelling that he has now in both coffin bones worries me. In the April rads the LF bone loss was more advanced than the RF, but it appears the RF has caught up to it now. I have no idea what the weird, fragmented pieces at the tips of P3 are doing, it looks like they are calcifying further into bone spurs? My vet hasn’t seen P3 fragments progress to this extent or in this manner in other horses.


She also pointed out how the bone along the bottom and tip of the LF coffin bone is dark grey and shadowy in comparison to the density one would see in healthy bone, indicative that it is unstable and perhaps still actively remodelling. The RF doesn’t look so bad in that regard, at least.


It worked out well, the vet had barium paste with her so she was able to mark the tips of the frogs clearer than my copper tape could have. But that one trouble spot on his LF is super thin right under the tip of P3, and given the dried blood layer visible in that area (see: https://ecir.groups.io/g/CaseHistory/photo/274255/3481225?p=Name%2C%2C%2C20%2C2%2C40%2C0 ) she was very concerned about the integrity of his left sole after viewing the x-rays.


It doesn’t appear that he has had any new hoof wall growth coming in and attaching solidly to P3. My vet didn’t measure but she estimated based on the rads that there has been more rotation since last time. She also explained that at this point the next recommended steps for a laminitic horse would be de-rotational shoeing or tenotomy – neither of which she recommended for Zahr, she only gave as an example to demonstrate the severity of where he is.


The awesome thing is that she is very open to suggestions from the group. She gave me her opinion based on her experience, she hasn’t seen a trim like this before but she was intrigued. My farrier is also on board to go ahead with the group’s advice, and I’ll send them both this thread so they can read any suggestions you may have.


Now for the hard questions, if Dr. Kellon and Lavinia (when she’s back) could weigh in on this please.


1. What is the likelihood of the bone loss and remodelling coming under control at this stage in its progression? Assuming diet, trim and ACTH were all under control.


2. Does the above seem to be progressing abnormally quickly in his case, given the deterioration seen between April 4 and now?


3. Given the LF situation, and how far back Zahr’s toe still needs to come according to the recent x-rays, is it possible to trim his foot to the extent required without putting P3 in jeopardy of coming through his sole?


4. Even if we managed to get everything (DDDT) lined up, is it possible for him at this point to grow a better-connected hoof wall? Could the remodelled “bone spurs” (for lack of a better term) on the tips of P3 now be recognized by his body as the “new” tip of his coffin bones, that the hoof wall is now trying to come in parallel to? I have no idea if that is even possible, I am just wondering based on the growth patterns from his x-rays up to this point.


The team is on board to help Zahr and I with this if I choose to continue. What I am concerned about at this point is that winter is coming up, and his arthritis naturally tends to act up in the cold weather. If it was *only* his feet we had to deal with, I would continue down the path of correcting his trim and pergolide dosage to keep trying to get everything under control. If winters weren’t so harsh here, I wouldn’t be as concerned either. But it isn’t, and they are.


I don’t know if it is fair at this point, given Zahr’s overall condition and the other issues he has to contend with, to keep asking him to go through this. I know if I ask him to, he will keep going, but my feeling is that he is getting tired. I am scared at this point that something catastrophic will happen to him over winter that would force me to make that decision under the worst possible circumstances. I would much rather let him go gently while it is still nice out, if that is going to be the inevitable outcome of where we are. I just wanted to get the group’s thoughts/feedback before making any big decisions.


We are just waiting on his blood work to come back now. He was tested earlier than ideal once we hit his target does of pergolide (just over 2 weeks after) so I know his ACTH might not have lowered fully yet but given the time of year I don’t know if that extra week would have made a significant difference anyways. If it is still very high and he is likely to have another episode that might make the decision for me, as I don’t want to put him through that again unnecessarily.


Apologies for the length of this. I am trying hard to objectively come up with a pros and cons list of continuing. At the end of the day I just want to do right by Zahr.


Thank you for any feedback you may have to offer, it is always appreciated.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Eleanor Kellon, VMD
 

It's hard to know where to start here! I probably should begin by saying there is a lot we don't know about chronic laminitis and what the prognosis is in these longstanding cases.

I will say I have seen much worse bone changes in horses that became "pasture sound" if not in use but the degree of sinking and obviously poor connections all around the hoof are an issue.  I honestly can't tell you if it's possible to reform good connections again but I can tell you the trim needs to be drastically adjusted to allow that to happen.

His alignment with the hoof wall is one thing, and the alignment of the bones with each other is another. True rotation refers to loss of alignment of the bones with each other. He has had a very minimal true rotation on the right which has improved but the rest of the misalignment is capsular rotation - movement of the hoof wall away from the bones - toe flare and quarter flare. This is much easier to deal with than true bony rotation. The movement of the hoof wall away from the bone is being worsened by the laminar wedge of scar tissue. Here is an example of true/bony rotation https://images.squarespace-cdn.com/content/v1/599efd9a46c3c4d4bc7c2d6d/1508184667901-HLPYYNMVB3LG5WER46W0/laminitis.jpg?format=1000w .

I see the barium frog dot on the right but not the left. You need that information. On the right, the sole surface breakover point needs to be brought back 50% from where it was on 9-19 and personally instead of a bevel I would make that a square toe. The overhanging excess toe from the bevel acts like a toe brake on a skate and strains the laminae. Heel should be beveled. I'm sure you are safe in doing the same on the left. That most forward point on the sole should be marked with a permanent marker right after the trim and growth checked every 5 to 7 days to see if it needs to be moved back into position. The wall flares also need to be beveled so they are not bearing weight which will only make things worse. See this presentation https://hoofrehab.com/images/PHCP%20Handout%20%232%20--%202022.pdf as well as this https://hoofrehab.com/DistalDescent.htm . Also see this on how to make the boots fit the trim modifications https://hoofrehab.com/GloveMod.html . If you don't do that, the boots will interfere with the positive effects of the trim.

If he's not on Jiaogulan and acetyl-L-carnitine he needs to be. He also needs to have his hay correctly balanced. If you are doing Hoffman's with Mad Barn Amino Trace you are throwing high levels of minerals at him with no idea of whether it is correct or not , helpful or harmful.

You didn't mention his current comfort level. None of us have a crystal ball to predict what might happen in the winter but knowing his current level of comfort and exactly what joints are involved with arthritis could help make a better risk assessment. Does he have cold-induced hoof discomfort (which can be managed) or is it something else like trouble getting up with unknown joint involvement?

We know how difficult this is. Please know that we respect the decision is yours and yours alone, and we will honor it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Mikaela Tapuska
 

Thank you, Dr. Kellon. It should be his left front that has the white dot in the thin-soled area. On his right fore the old frog is so stretched out that it ends where his breakover begins (literally: https://ecir.groups.io/g/CaseHistory/photo/274255/3488430?p=Name%2C%2C%2C20%2C2%2C0%2C0 ). I had to look closely but the barium dot is visible in the right front rad as a very faint line right at his point of breakover, I think it got squished down under his foot as he was standing on the block.

He is not currently on either jiaogulan or acetyl-L-carnitine, the former because I remember the advice was not to feed it until the trim was in line so as not to accelerate growth and thereby mechanical damage. He was on it for a couple of months at the end of summer/fall last year, and I do remember his pulses coming down at least slightly at first and his gums becoming more pink. I still have 3 bags here that I've been waiting to use, should he start on that right away or shall I wait until the farrier can get out and make those changes to his feet first? She isn't due to be out for another 2.5 weeks but I can certainly ask and see if she can come out sooner.

The acetyl-L-carnitine I can have by Friday and can get him started on that asap. This is the one I just ordered: https://www.amazon.ca/gp/product/B07WFQPGFS/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1
Is the recommended 10g daily enough for him? And do you recommend feeding the 10g at once or does it have better effects if spread out as 5g morning and night? Will this be safe to feed with the PEA-um and devil's claw that he currently receives?

The Hoffman's mineral I can stop right away too. AT+ I had balanced to his old hay that he was on, Mad Barn's recommendation was to feed 1 scoop daily (half the recommended dose) to balance out his minerals. The hay he is currently on was in theory supposed to be temporary so I though a couple of months wouldn't hurt (new hay was expected to come in end of June)... but it has now been 5 months. The new hay is in but Equi-Analytical's probe is in high demand right now, so haven't been able to get an analysis on that one yet. Would it be recommended to pull the AT+ for now as well? I suspect the well water is high in iron, so part of the reason I've had him on AT+ was an attempt to counteract that.

Current comfort level is actually not bad when he is in his stall on squishy shavings with his boots on, and even when he's had little 20 minute breaks from them recently he doesn't seem to shift too much on the soft surface. Outside he seems reasonably comfortable as well. I believe he spends most of his time nibbling his hay at his feeder but he can and does amble around decently well to find shade or go hang out with the other horses across the fence for their afternoon snooze. On hard surfaces it is a different story, if I have him tied on the cement even in his boots he shifts back and forth pretty consistently and will be quite stiff in his forehand, taking very shuffle-y steps when I ask him to walk forward. I've started grooming him in his stall so that he doesn't have to deal with that discomfort.

He's still very bright and happy when he is standing comfortably, but I also realistically know I can't judge his quality of life on how he is in his stall. He's been moving a bit slow for turnout and bring in (the barn owner has been keeping an eye on that when I am not there) but does sometimes warm up pretty well. And there are some days when he is very eager to go out in the morning and I've been told he has pep in his step, but I think those ones have been less frequent recently. I have found that when I go out to hand walk him as well, he sometimes warms up out of the stiffness but often his facial expression gives it away that he is uncomfortable, as he'll have a mild grimace. Recently I have switched our hand walking routine from doing two 10-min walks with a break in between to two 5-min walks separated by a shorter break, a long break, and then another two 5-min walks. I can't say I've noticed an improvement by doing that, as he still seems to have a degree of discomfort there even sometimes when he is striding out well. So the walking itself is the biggest concern for his comfort levels, I would say.

Interestingly, I've not noticed his hoof pain gets significantly worse over winter (except when he's had his acute flares the past two Novembers). He seems to struggle more with hoof pain over the hot months of summer, which kind of makes sense given the pattern of the seasonal rise. I do have Back on Track wraps to start using once the days drop below 10 degrees Celcius. His arthritis in his hind end is specifically in his hocks and stifles, albeit I know he has some in his right knee for sure and has some arthritic changes in his front pasterns as picked up on his x-rays from this year. There are other likely locations as well, but the hind end is probably the most severe and when I used to ride him was always the biggest concern. As far as I know, he isn't having difficulty lying down or getting up yet nor is he lying down more than normal. But I've noticed really only in the last couple of weeks that he feels stiffer in the hind end when I go to pick up his feet to clean, and the last 2 trims he has struggled more with his hinds for his farrier appointments. 

I suppose based on that there isn't an immediate concern, but I also don't want to push him to the point where does start having those issues. Torque on those hind legs is hard on him, and a suspected slip on his RH after a good rainfall earlier this summer seemed to tip him into another laminitis flare up. The slips are mostly what I am concerned about going into winter when it gets icy, plus of course general stiffness from the cold. I don't think he has the wiggle room any more to compensate for a sore hind end should something happen.

I can get some video to post, if that would be helpful.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

I just want to add, Zahr did show a very positive response to his first trim based on mark ups. He started to slow down about a week and a half later, which is when I decided to triple his pergolide. Then he evened out, and has been doing okay but not great. I haven't seen that same improvement for the next two trims since. All of the observations I dumped into the last post were taken from a daytimer I keep my notes in for him. They probably aren't things that necessarily need to be in his CH as they can vary ever so slightly on a daily basis.

He has been doing okay, but I am trying to stay objective and not let his "okay" days inadvertently become his "good" days, if that makes sense? From watching other aging pets I know how easy it is for my own perspective to be skewed simply by getting used to their new patterns of good days vs bad days, and from there I know how easy it is to slip into denial until suddenly holy cow how did they get so bad all of a sudden. I am trying very hard not to let that happen to Zahr, so I am going over every little detail with a fine toothed comb right now.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

Here is some video from last night. Zahr seemed to be moving better than the past few days prior that I had seen him, so that was nice to see. Definitely has been moving better outside on the grass where the surface is spongy but firm than in the arena, where the footing is soft but deep. The first video was taken after a 10 minute hand walk outside, the second after 10 minutes of in-hand inside, so he was warmed up well for both.

Outside: https://youtu.be/6yvGHE1aGPw
Indoor: https://youtu.be/ERfOK1ES9rU

Browsing the forum I stumbled across a couple of posts stating that acetyl-L-carnitine should be fed at 1g per 100lbs BW twice daily for the first 2 weeks, then once daily following. Would that be recommended for Zahr's case, to get that into him as a loading dose for the first 2 weeks? Based on his weight he should get 9g per day.

Going back to jiaogulan, previous advice I have received was to wait to feed until his trim is corrected so as not to exacerbate mechanical stress on the laminae. Dr. Kellon said he should be on jiaogulan, so should I start that right away or is it still advisable to wait until he is trimmed? I asked in my previous post but I think it may have gotten lost in there (apologies for the length, I was trying to be as detailed as possible), if someone could please advise.

Additionally, Dr. Kellon you suggested using a sharpie to mark the most forward part of his sole and to measure every 5-7 days. Would I be using the widest part of the heel as a reference point to measure to?  

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Eleanor Kellon, VMD
 

You can do the loading dose of ALCar, then once daily. PEA might also be helpful. Most helpful of all will be to get that trim right and no Jiaogulan until that happens. Can you post a full set of new hoof photos?

Measure from breakover on the sole to tip of the frog but also mark the tip of the frog on the sole because once the toe comes back far enough the frog should start to recede.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Kirsten Rasmussen
 

Hi Mikaela, 

I have a few little comments.

Mad Barn's recommendation was to feed 1 scoop daily (half the recommended dose) to balance out his minerals. 
Please don't rely on Mad Barn's free balancing service.  We have seen questionable/poor advice from them a few times, and they will not account for the lower Fe:Cu:Zn:Mn ratio that horses with IR (whether its EMS or PPID-related) need.  (I keep meaning to enter my horse's diet to see if their recommendations for him match what I've calculated...)  Without any info on your new hay, I would feed AT+ at the full 200g dose since its designed to work well at that dose for most hays.  We know that every hay is different though, and this approach could have negative effects, but I think the odds of negative effects from under supplementing are slightly higher.

I personally would not do walking exercise given how sore he is, UNLESS you find it helps with his arthritis and he gets worse without it. There are so many supplements you can give for arthritis pain that may help Zahr's in the winter.  Try searching our messages for the various options that are safe for an EMS/PPID horse.

Try using boots with wedge pads on his hinds.  It might help his hind end be more comfortable.  I can see he's sore on his fronts, too.  Have you cut or hollowed out the pad in the LF boot to reduce pressure on the tip of P3?  You can add studs to most boots if slipping on ice is a worry.

Do you have updated ACTH and insulin values since you increased his medication?

Zahr has such a sweet disposition, you can see it in his face in the videos.  He's a beautiful boy.

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


Mikaela Tapuska
 

Thank you, Dr. Kellon. He is started on the loading dose of ALCar now, and he is getting PEA as well at 2400mg AM and PM, according to ElevationTerpenes' measurements.

I certainly can take another set of hoof photos. The last set is from just over one week ago (only 3 days before his most recent x-rays), would you like to see another one before his next trim, right after, or both? I talked with my farrier, and given the extent of the trim Zahr requires to make the correct changes in his feet she would like me to get another set of mark-ups to work off of before we go ahead with it. I understand Lavinia will be back in a week or so, so if she isn't too swamped by requests I will send her an email about those. If it works out it may time out well with when Zahr is due for his next trim.

In a recent thread with Cass I asked about marking the tip of the frog for x-rays, and she explained it should be done by marking the actual tip of the frog instead of the theoretical "true" tip of the frog. I would guess that would be the same in this case, but given where the tip of the frog is located on his RF currently is there another location I should measure as a reference for that one? Just thinking that any rasping of the toe/pushing back of the breakover on the RF will take off the marks denoting his current frog tip, so I'd have nothing to measure to.
 
--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

Kirsten, thank you. He really is an awesome little guy, I am so lucky to have him!

I didn't realize that about MB's ration balancing service, but I suppose considering it is free maybe it's not surprising. Yesterday evening I actually found out that the horses have started on the new hay for this year, so Zahr's been slowly transitioned over 2 weeks and is now back onto the brome grass mix - no more fescue in there! - he was on in 2021 (same field, new crop). I don't know where this one sits in terms of sugars, starch and protein yet but I would guess the mineral profile may be similar (high-ish iron, but not outside of "normal" values seen in most hay). Just waiting for a hay probe rental to be available in order to test it. He is off the Hoffman's and I'll get him started on the full 200g AT+.

Unfortunately we are kind of stuck between a rock and a hard place for the walking exercise. He stiffens up way and loses muscle way too fast if I don't keep him moving (learned the hard way last summer when he was going through a rough patch, not walking made everything far worse). I feel bad asking him to walk when he is so sore, as I know that will not do his feet any favors while the trim is off... he still tries so hard. What has helped his arthritis the most is our in-hand work to get him moving and carrying himself correctly and I can usually get him to "lift" somewhat, easing concussion of the forelimbs, so I do try to keep that up at least a little bit. He is on Devil's Claw currently for the arthritis, too.

I have not cut out P3 support in his LF bot pad but I can definitely do that. Do you just cut out a little half moon shape in the pad? And I will give the hind wedges a shot, as you suggested.

We are just waiting to get ACTH values back. The clinic sends them out in batches and the window is anywhere from 1 to 3 weeks, so hopefully it will be on the shorter side this time. But it is in the works and I will get those uploaded as soon as I hear from the vet. Thank you so much.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Kirsten Rasmussen
 

Yes, just a half-moon shape.

If the walking helps his arthritis then I would continue.

Are you getting insulin with ACTH?  It's insulin that determines laminitis risk so I think it's quite important.  His ACTH could be thru the roof, but insulin may or may not be high, too, and it would be good to know that.

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


Mikaela Tapuska
 

Thank you, I will get that done tonight for him. I do ice his feet after every walk, too, as I suspect given their condition there is probably mechanical stress stirring up inflammation in his feet.

Not this time, I was only doing ACTH. My thinking (perhaps flawed) was that based on his history I have a decent idea of what ACTH levels for him seem to be associated with an acute episode. When we tested insulin last time, it was higher than it should have been but not into scary levels yet, but at the time I thought his ACTH was controlled based on where it was in October 2021 - so unfortunately I didn't test it until a month later and found out how high it was. So right now I am presuming that he is PPID-induced IR until his ACTH comes down, and my plan was to get ACTH under control first and then retest insulin to determine if he is truly IR on top of everything else.
 
--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Sherry Morse
 

If his insulin is fluctuating with the ACTH you do want to get it checked each time as you need to know if you need to add in medication for that in addition to the other measures you are already taking to get his insulin down (diet and ACTH control).



Kirsten Rasmussen
 

Hi Mikaela,

Not sure if this is an option for Zahr's arthritis?

https://ecir.groups.io/g/Horsekeeping/topic/93883367

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


Mikaela Tapuska
 

That is a good point, Sherry. I remember we talked about getting those numbers to see if metformin over the seasonal rise would be beneficial, I guess I was just thinking to take it one step at a time with the bloodwork. But considering the time of year sooner rather than later for that would probably be ideal. I'll talk with my vet and we can make plans to get that test done. 

Thank you Kirsten, that certainly does sound hopeful based on the thread. The only drawback is that the main ingredients are glucosamine and MSM (and glucosamine at 2,500mg per scoop, which Zahr would need 4 scoops of daily), so it would probably only be an option once he is stabilized. But good to know about for down the road! He did trot the other day going outside, actually, and he was on a double dose of DC at the time to support his joints for his farrier appointment. He has slowed down again since, but maybe doubling the DC would be the best plan for helping his arthritis without risking insulin rise.
 
--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

This past Wednesday was Zahr's most recent trim, following his new set of mark-ups ( https://ecir.groups.io/g/main/message/284053?p=%2C%2C%2C20%2C0%2C0%2C0%3A%3Acreated%2C0%2Czahr%27s%2C20%2C2%2C0%2C93447214 ). His "after" photos are uploaded and hopefully we are off to a good start at correcting his feet after those last x-rays. A lot more bruising is visible after this trim, too, as can be seen in the photos.

I did notice his Soft Rides are a bit large on him now after this trim. As his feet have been changing, there's been a slight difference in fit and I hadn't ordered a new pair for him yet - partially planning to just use these ones to get us through summer, and also knowing any boots I ordered for him prior to some of these trim changes being made would make any boots I did buy fit incorrectly. My farrier suggested cutting a styrofoam insert to fit his boot and add a bit more padding and support for him, as well, so I will plan to get that done this weekend. Does anyone have further suggestions to help fill out the boots in the interim? I had read about using socks in the forum, although I think it may still be too warm for those right now (still getting up into the low 20's Celsius during the day).

Also uploaded in his album from last week are the half moon cut out in his LF boot pad - the black dot corresponds as best as possible to the barium frog dot in the x-rays - and the bevel my farrier rasped into his boots from both the side and underneath. I just started with a shallow cut out, thinking I could always take out more if he needs, is there usually a recommended depth? I realize I forgot to ask about that before. He seemed to respond well that day, although whether it was due to the pressure relief or starting ALCar is hard to say. Unfortunately the improvement was really only noticeable the one day, and he was back to being pretty sore and reluctant to walk a few days later and has been fluctuating in that range since.

Definitely can see that bullnose on the LH clearly now, boots and wedges are on the way for that so fingers crossed that helps him out a bit.     

The big change from this trim did seem to be a lot for him, he definitely felt it afterwards. I tried walking him for about 10 minutes with breaks in the arena after so he didn't get too stiff from standing on the concrete for so long. It didn't really help, he remained pretty tender. Yesterday he was still tender, but since his feet *should* mechanically be in a better place I tried walking him for three 5-min intervals, and during the last 5 min he seemed to warm up the best and move almost normally without too much hesitancy. If the change in trim is going to make a significant difference for his comfort levels, should I expect to see that within the week?

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Mikaela Tapuska
 

A little bit of good news, I received Zahr's blood results back today and his ACTH is down to 7.0 pmol/L!!
Truthfully, I was worried about how he was going to respond to the meds with all of the changes being made mid-seasonal rise. But this is the lowest I know of his ACTH being since he was diagnosed with PPID almost two years ago (CH is up to date). So that was a nice surprise to get this morning!

I tried the foam cutouts under the SoftRide pads in his boots, they seemed to make his boots fit better and he seemed slightly more comfortable at the walk with them in there... but I wonder if it caused some kind of pressure on his feet after he wore them for a while (the orthotic gel, now being raised in the boot, didn't fit as well as it normally would), as he was quite sore today as per the barn owner. We took the foam inserts back out  to see if that helps and are just duct taping the boots to keep them secure for now.

I'm not sure if poor boot-fit is part of the problem, but I would like to rule that out asap. He has a pair of Easyboot Clouds on the way this time, as SoftRide doesn't seem to have a size that would fit his current foot shape/size well anymore based on the tracings I took yesterday. The Clouds didn't fit earlier this summer when I tried out a couple pairs (size 1 was too small with his laminar wedge, and 2 was too big in general) but I am hopeful  that with the changes my farrier has made to his feet that he would be a good candidate for trying them out. Thinking about what Lavinia said about their comfort needs changing as their feet change, I wouldn't mind trying these with their foam wedge pads - maybe that will also help the broken back HPA axis in his front feet.

The worst soreness this time seemed to be in the RF starting last Wednesday and lasting about half a week, then evened out yesterday when I walked him (still tender on both, with slight improvement) but today he seemed evenly sore in both fronts. The x-rays didn't show anything in this regard, but does that sound like typical abscess symptoms? I did notice the other day when I took his RF boot off there seemed to be more moisture than normal in his boot around the frog area, but it didn't smell yucky as I would think abscess drainage would... and perhaps it is just normal perspiration. Nonetheless, would there be any harm in soaking his foot in some Epsom salts to see if that would draw anything out? That has been suggested before, but I've been leery of trying with his thin soles.

Also thinking of cutting a P3 relief half moon in his right front boot, too. In case it was missed in my last post, is there a certain depth that is recommended for the P3 cut-out?

Additionally, is one week generally when we should start to see an improvement if pain was primarily from mechanical dysfunction, to adjust or given the extent of change again in this last trim would it be more reasonable to give him 2 weeks and then evaluate?

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Lorna Cane
 

Happy dance,Mikaela !!
I know you are hoping for it to be lower still,  but this is so hopeful.

Did you have insulin tested this time,too? Sorry if I missed it in your CH .

--
Lorna in Eastern Ontario
2002


Mikaela Tapuska
 

Hi Lorna, agreed it could be lower still but this is off to a good start :)

You didn't miss it, I didn't get insulin tested with ACTH. Sherry and Kirsten suggested that as well, it was something I had overlooked being so focused on getting his ACTH down. So that is definitely the next test to have done.

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Kirsten Rasmussen
 

Great news on the ACTH!  It's a smidge higher than we'd like but a huge improvement regardless.

I would not be surprised if he has abscesses mobilizing.  I think at this point in the trim you could start jiaogulan if you haven't already.  His left front sole is too thin to soak, but I think you can soak his right front.

Sometimes too much foam padding can make them sore, too, if they don't get any relief from the pressure of the foam in the boot.  For the half moons, I think it's trial and error, I've never done it though.  You can try it for his right front, but unless something has changed since his last rads I don't think it's needed.  But play around with different padding/cutouts etc to find what works, and remember that what works 1 day might not work the next day.

Pain from mechanical dysfunction can take a long time if the mechanical issues are severe and in place a long time.  Usually abscesses are a big part of that, and can come and go, but if his hooves have been like that a long time his entire body has adjusted to it and now you are changing things back.  In an arthritic horse it can be even harder to readjust.

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


Mikaela Tapuska
 

Thanks Kirsten, I will get him started on jiaogulan tomorrow.

If his RF still seems to have that ooziness around the frog I'll try soaking only that foot one evening once he's inside and I can let it dry out fully before re-booting. He has an appointment for a massage tomorrow that will hopefully bring his muscles and joints some relief. His right shoulder is very tight, I can see/feel it tremble when he puts his weight on it so he is definitely protecting something in that forelimb (this he does appear to work out of).

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255