Date
1 - 20 of 33
Vinnie Update -Flozin meds- take 3
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Hi Dr Kellon and all,
Just wanted to post an update on Vinnie. For the last month we restarted Steglatro the first week administered daily, the second week every other day and then for the last two weeks daily. Labs; Insulin 48.84 was 99 Glucose 114 Tryglicerides 643 was 70 ACTH 18.1 was 17.1 GGT 20 was 36 Fibrinogen 400 was 300 Wbc still low Meds Steglatro 15mg CP 13.2 mg Diet: 10lb orchard hay in nets free fed 5 lb alfalfa hay 3.5lb dry weight beet pulp 2 cups wheat bran 6cups tc sr gold 10 cups cavalor fiber force 8 cups timothy pellets 4 cups alfalfa pellets 2 cups hygain zero 1lb flax He is probably getting most of his calories eating most of the soft feeds and alfalfa, but he nibbles on the hay in the hay nets leaving about 1/2 of the nets full. He is starting to put some weight in with a BCS of 4. He was quite ribby for a bit. Taping at about 893lb. Feet: new rads posted and I have to post the images I took after my first attempt at a trim from last night. The good news sole depth, the bad news more bone loss medially. He is still sore but not nearly as bad as he was. I think there is alot of opportunity with the trim for sure. I am learning as I go....help always appreciated:) I have some mark ups from my vet based on the last set of rads, so that is what I worked from last night. The abcess at the RF coronary is reolved. He still has two tracts draining under his mandible. The appearance of the tracts has improved, but the fact that he still has infection is worrying. We took xrays of the jaw to rule out teeth, but I am not sure what we ruled in.. 😀 My plan, keep working on the trim, I may need mark ups in the future :) Reduce steglatro to 15mg every other day to get the tryglicerides down. Edit to add, we are planning a TRH stim to see what his post stim numbers look like. I think he needs more pergolide which we may increase to see if things immune system wise improve. Thanks and any feedback welcome :) Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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As long as he's gaining weight I would leave the Steglatro daily and just monitor TG. Carnitine? Body Builder?
-- Eleanor in PA www.drkellon.com |
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Thanks Dr K
Yes forgot to mention; Body Builder 15ml L-cysteine 50g L-carnitine 27g Glycine 50g -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Thanks. Has he been on all of that for a month? Were his facial abscesses cultured? Any antibiotics? His fibrinogen is high. White count?
-- Eleanor in PA www.drkellon.com |
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Yes all the supps for the entire month.
We haven't cultured the abcess yet, no antibiotics yet. I wanted to try a course of Doxy but waiting on next steps from my vet. I am anxious. Wbc still low. -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Sherry Morse
Hi Nancy, I would definitely get some markups to help with the trim. Toes on both fronts are long and that's probably not helping with his comfort level right now. You can see on the x-rays where he's trying to grow well connected hoof in at the coronary band but it all gets out of whack pretty quickly.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Thanks Sherry!!!
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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For the jaw abcess we are going to start eq stim. I am increasing pergolide by 1 mg to see if that helps immune response. Also going to do a Tilden profusion for.both front feet to help stabilize.bone loss.
I made some positive progress today with the trim. Backed up the toe quite a bit and de rotated the hoof capsule on the LF. I am still taping clogs to his feet with yoga mat as padding which seems to work pretty well. Fingers crossed..... -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Hi, Nan.
I like how you marked the dorsal wall in the rads. Did you use duct tape? I am so impressed - not surprised - that you've taken on this trimming job! Are you using a hoof stand? It's easier for us arm chair trim evaluators to see what's going on with your lateral photos if you stand Vinnie on something firmer than perforated rubber mats when you take shots AND if you put your camera on the ground 18 inches away from the hoof. Do you have a sheet of plywood or even better a flat concrete pad? There are little shadows under Vinnie's toe that may be hiding how far back the breakover has been rasped. Its exact location is important and is often a bit of a mystery unless we're together looking at the sole in real time where we can see it in 3D. A good photo can give us hints. I marked the approximate breakover on a lateral hoof shot from last summer: https://ecir.groups.io/g/CaseHistory/photo/7296/3588951 The breakover is well behind the dorsal hoof wall, which is rasped away at an angle, along with a portion of the laminar wedge that is rasped at a different angle. https://ecir.groups.io/g/CaseHistory/photo/7296/3464282 I think I can see you're doing something similar, albeit with a different hoof? -- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Diamond's CH at ch.ECIRHorse.org Cayuse and Diamond Old Case Histories pre-2023Cayuse Photos Diamond Photos |
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Thanks so much Cass, I ordered a pink hoof stand that is on the way :) I purchased a grinder and a dremel tool. I have a couple decent rasps, but need to get a couple more tools.
I will say trimming is daunting. I joked with my vet that I thought learning sql queries was hard!!! Lol.. that aside I am trying to do my best for Vinnie. The rads were marked with a special tape that I hadn't seen before. I can find out what it is. So far I have done as much as I am comfortable with based in the markups. Vinnie is still sore but I think it is from sole pressure. He seems to do best when I use a yoga mat under the clog that is taped on the foot, but after the yoga mat compresses he acts more uncomfortable. My vet is coming back this week to work with me and try a couple more things. Thanks for sharing the images they help put things into context. I am really nervous about messing up. Edited to add: I keep re-reading the article on distal descent, because I am sure this will.help me. What I am not clear about is when the foot lacks concavity, and is fairly flat is it just trial an error to determine the best pad. I am terrified of doing more damage to the solar corium by providing too much sole support, yet we know he does best in a clog because of the bone loss medially of the LF P3. Thx Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Nancy,
You don't want to shorten his feet or touch the sole with a hoof knife but he actually has decent sole depth/ground clearance compared to many we see. What you need to do is spend some time staring at those films and picturing the blood supply as a hair net enclosing the coffin bone. Unless you get right up to the edge of that bone, you are not going to hit blood. He also has a HUGE laminar wedge that you should file back from above. On the RF, your landmark is that big subsolar abscess. Keep going back until you hit that. Even more needs to come off the left toe. Both heels can come down a degree or two, which will also move the heels back. -- Eleanor in PA www.drkellon.com |
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Thanks Dr Kellon. I did a bit more on the toes Sumday with my grinder. I will updated pics and get an idea. I noticed more comfort when I did this, and I definitely think I can do more in the RF.
When you say to remove some of the laminar wedge from above, do you mean rasping the wall top down (as in the wall) or from the bottom up removing loading? Or both? Thx Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Honestly, I've seen it done successfully either way. If he has clogs on it won't matter but when barefoot the bevel can interfere with breakover if not well out of the way. The compromise is to bevel then round it off.
-- Eleanor in PA www.drkellon.com |
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Awesome thank you :)
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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On Mon, Mar 13, 2023 at 11:39 PM, Nancy & Vinnie & Summer wrote:
What I am not clear about is when the foot lacks concavity, and is fairly flat is it just trial an error to determine the best pad. I am terrified of doing more damage to the solar corium by providing too much sole support, yet we know he does best in a clog because of the bone loss medially of the LF P3. I've never heard of damaging the solar corium by providing too much sole support using a clog that is taped to the bottom of the hoof. You need to hear from Lavinia or Dr Kellon on that possibility. Cass, Sonoma Co., CA 2012 ECIR Group Moderator Diamond's CH at ch.ECIRHorse.org Cayuse and Diamond Old Case Histories pre-2023Cayuse Photos Diamond Photos |
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Thanks so much Cass.
Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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i thought the group was overall against clogs??
In the late 70s i wore clogs.Little did I know that the dorm floor I was on called themselves the clog killers because they hated clogs So I am anti-clog as well -- LJ Friedman Nov 2014 Vista, Northern San Diego, CA Jesse( over the rainbow) and majestic ‘s Case History
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LJ, ur hilarious. We are using clogs for a few reasons, he needed protection as he had about half the sole depth 8 weeks ago that he has now. He has considerable bone loss of the P3 in the LF, he really needs help with an omni breakover due to ringbone, and we needed to unload some problematic areas with the RF abcess st the coronary band. Plus, he was just the most comfortable in the clogs. I am using elastikon to tape them on the bottom of the foot so I can remove them and trim and reapply as needed. Eventually I may cast them.
Thx Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Sherry Morse
LJ, We're not against clogs, we're against clogs (or any device) being put on a foot that doesn't have an optimal trim. Glad you survived the clog experience in college!
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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We're not against clogs, we're against clogs (or any device) being put on a foot that doesn't have an optimal trim....... and being left there too long. Nan, I can't remember if these have been suggested to you for review to compare what can be done with the lamina wedge, but I was present at several removals just like this one. https://ecir.groups.io/g/CaseHistory/album?id=77267 This was an older draft who basically had no coffin bone left. He had been brought to a point of some stability using casting and then stopped moving forward in this rehab. This horse had a new lease on life for most of his remaining years after his feet were addressed. He still needed boots but he was an amazingly different horse, even with most of his CB missing. Some professionals believe the wedge needs to remain for protection. We found boots and/or pads can do that. Others believe this is a resection. It is not. Dr Bowker prefers to not have the hoof wall rasped away on regular basis and I agree, however this is also not that. That same file also has photos from Pete that show a sagital hoof dissection. I have always been fascinated by the hoof wall collection above the lamina wedge. There are three shots of this foot but this is the close up and I believe shows what could happen when you leave the lamina wedge.. https://ecir.groups.io/g/CaseHistory/photo/77267/913087 The one caution is to not remove above the new growth line. You may also see this hoof wall growth release quickly, necessitating another bit of rasping to address hoof wall suddenly showing up. As Bowker says the interior is not rigid but fluid and I have seen in my own horses as well as others, how things can change very quickly. Having appliances -- boots, clogs, or just cut up anti-fatigue mats -- you can remove often, as I believe you have done will make revisiting the foot fairly simple. Pretty sure you know that Vinnie will tell you what he likes. :-) -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2023-2024 Skip and Sonny New Site CH links: Skip: https://ch.ecirhorse.org/case-history.php?id=1 Sonny: https://ch.ecirhorse.org/case-history.php?id=4 Beau groups.io CH links: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Beau ECIR Group NEW Case History site is now open Bookmark and save this link somewhere on your device(s). https://ch.ecirhorse.org/ |
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