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What else to manage pain?


Buzz
 

We are still struggling with Buzzy.  He seemed to be doing slightly better and the cold weather hit, which in turn seemed to affect him quite a bit. I wrapped his legs and kept him blanketed through the extreme cold. It has been 2 weeks since the trimmer was here and at that time she didn't see much progress with growth. Today we are going to see if we can address his toes and rasp a little, not touching his sole!  We also were going to try to apply hoof armour to his soles, if he can tolerate it.  This morning he did come out of his stall, but is toe walking especially on his RF with his boots on.  I don't know what to do as far as making him comfortable and not as painful.  This has been going on since mid Dec! This morning I gave him some Equiox so we can hopefully rasp his toes at noon. He is almost through the 2 lb container of Insulin Wise. I asked the vet about trying something else about 10 days into it, but she wanted to try the insulin wise a little longer.   Can you suggest what our next step should be.  Should we retest his insulin levels to see if it has improved?  I have tightened up his diet and keep cking his wt to be sure we are on target. His teff hay is being soaked and drained.  The vet gave refills on gabapentin and cyproheptadine, which he has been off for a couple weeks now.  Should I refill and keep that going?  I am trying to keep telling myself this is going to take time, but hate seeing him hurting.  He is eating and walking at will in the barn which makes me hopeful. I keep remembering "this is a marathon, not a sprint" comment!  Thank you so much!  You all are a wonderful, educated support system! 
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


 

Hi Marsha,
I’m hoping you can rename your photos according to instructions midway down this page.  The dates are a really important aspect of the name and most helpful for understanding the timing and progression.  I realize they are on each photo once you open it but that takes more time.  If you don’t follow the naming protocol exactly, some characters may prevent the photo from downloading.  Hoof growth generally slows down in winter so that’s not a surprise.
I also went through your case history and noticed some things that need your attention.  You tell us his age would be a guess but not what your guess is.  Is he 5, 10, 15 etc?  There are no weights for the hay you are feeding and the soaking needs to be included in his CH as well.  I understand that his weight is good but from my experience minis can be hard to judge.  How much beet pulp is he being fed?  You state that you have tightened up his diet but, from his CH, I’m not sure what that included.  Have you tried metformin?  I’m not surprised Insulinwise has not been effective as others have noted the same.

It’s not clear to me whether you’ve made progress with his trim.  Someone else may have a better eye that I.  Have you asked Lavinia for her help with mark ups for a trim?

Just mentioning these points as things you might look into and modify your CH to reflect.  Much better than putting all the info in a post which will soon be ‘lost’.

--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Buzz
 

Thank you Martha for replying.  I will get his case history updated as soon as I can.  Also, I'll work on the phots so they are easier for you all.
To answer your questions:
!. We think he is around 20 at this time.  He was dumped by someone and left in a field for 3 yrs before he was rescued. so it's all a guess!
2. His diet is 5.5 lbs ODTBC, 1.5 cups dry measure beet pulp which is RSR and divided into 3 feedings, 1/3 scoop Uckele Laminox( bid), 1/2 scoop Insulin Wise (bid),
    1/2 tsp salt (bid), 2TBS TC ground flax (bid). His hay is aprox. 1/2 lb  (1/2 flake) which is soaked and rinsed and drained. 
3. We have not tried metformin.  I asked vet and she wanted to give the Insulin Wise a little longer, but that was 10 days after he started it.
4. I've been in touch with Lavinia and I passed on her comments to our trimmer.  Our trimmer said she couldn't at that time take anymore off his toes as they just weren't growing.  I'm like you,          thinking maybe due to winter and his laminitis?? 
I appreciate your thoughts!!! Thank you!
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Sherry Morse
 

Hi Marsha,

Sounds like - not surprisingly - there's been no change on the Insulinwise.  I agree with Martha that at this point metformin would be the next thing to try.  Your vet may insist on rechecking his insulin prior to writing a script.  If the result comes in over 200 again she can ask Cornell to provide an actual number for you.  I would personally not spend money on gabapentin and cypro as you have already tried both and they don't appear to be working.  I would focus on the fact that he is up and moving and that getting his insulin down and trim optimized will help him feel better.

As the trimmer didn't do very much last time Lavinia's last set of markups can probably still provide a roadmap for this trim.




Eleanor Kellon, VMD
 

Hi Marsha,

I would get him back on LaminOx, half the horse dose twice a day and make sure he has heavy socks on inside the boots.

However, getting that insulin down is critical. Re InsulinWise, please see https://ecir.groups.io/g/main/message/249832?p=,,,20,0,0,0::Created,,InsulinWise+%2B+Eleanor,20,2,0,29018987 . The study is here https://www.sciencedirect.com/science/article/pii/S0737080620300216 . No one on this group has had positive results with it and some have worsened. I would try metformin or Invokana,

Why is he on cyproheptadine?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lavinia Fiscaletti
 

Hi Marsha,

Sorry that Buzzy is still having such a tough time of it. It is definitely encouraging that he is willing to walk around by himself.

His elevated insulin is driving continued laminitis to some degree. Until that is controlled, you will have limited success getting him more comfortable. Gabapentin won't help with that. Still don't know why he has been prescribed cypro, as it has no effect on insulin and there's zero research in combining it with pergolide to treat PPID. It was an older drug used to treat PPID before pergolide was available and it was found not to be effective. Metformin or Invokana would be the way to go at this point if his insulin number isn't improving. His ACTH appears to be OK, so his pergolide dose doesn't need to be adjusted. Jiaogulan can be added to help with increasing circulation, which will also speed up foot growth. It wil also tend to mobilize any abscess material that may be trapped within the hoof capsules.

Have you had his hay analyzed and mineral balanced? OR, just use straight ODTBC, at least temporarily, so that all you need to add is salt, vit E and flax to have a safe, mineral balanced diet. As others have noted, Insulinwise has not been seen to work in most cases.

The rads showed thin soles, sinking, long toes and some slight bony column rotation. His heels are underrun. Until the trim is tightened up, it will continue to keep the soles thin as the long toes stretch the sole. The sinking adds more pressure onto the already thin soles, compounding the problem. Being a mini is a bonus, as his size means gravity isn't your worst enemy as it is in larger breeds. Make sure his boots have strong bevels added to the treads at the toes and heels to optimize the breakover for him.They usually rebound quite quickly to getting the trim corrected and insulin controlled.

Blanketing plus socks inside of his boots, along with wraps or shipping boots over his legs (I know, makes him look like a mummy) whenever the temps drop into the 40's or below will help with any cold-induced pain.

If you can post a full set of hoof photos from after yesterday's trim, with the hair secured away from his coronary bands to they are visible, I can see how the trim is evolving.

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


Buzz
 


--Hi Lavinia!
He was so painful today, when we finally got his boot off it was impossible to try to do any trim.  He seems to one day be better and the next not as good.  Although, he has always been difficult a doing his feet and has to really trust.   I have been super careful making sure he is not getting anything scrounging along the aisle when he is out of his stall.  Mostly today he just stood in the same place not even wanting to move.  I'm thinking we should check his insulin again and see where it is now.  I asked the vet to get the actual insulin # from Cornell and not just > 200. She said she can ask but she thought that was as high as their range reads without doing dilutions. So, I have not heard back from her regarding the actual #.  I will post pictures we took this afternoon of his R front in a few minutes. The gal who was going to take off a little toe between the trimmer coming every 4 weeks  got hesitant to rasp when she saw he was uncomfortable and said she didn't think they had grown much at all ( he was barely trimmed 2 wks. ago). Also, I have straight J herb, but have been using the Laminox.  Should I just give him the J herb without giving him the Laminox?   If so, just cut the recommended amt. to coincide with his body wt.? I can try to check his gums, but he is rather head shy too.  I'm sorry to say he has trust issues as well!  Just trying to do the best I can for this little guy!
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Buzz
 

Hi Dr. Kellon,
I have had him on Laminox for months prior to his laminitis in Dec, however that time he was only PPID.  In Jan he was dx as IR as well.  I don't know why the vet put him on the cypro. She ordered it along with the gabapentin.  Both of which he has finished the quantity ordered and I haven't refilled as I did not see any difference.  Thank you for sending the study on Insuin Wise.  I have sent it on to her and requested to please have us try getting the insulin down with metformin or invokana  I don't know which would be best for him, but something needs to be done to get him feeling better.  I am really trying to advocate for him and appreciate your help more than ever! Thank you!
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Buzz
 

Hi Lavinia!
I tried to post more pics of Buzzy's RF hoof.  I am not too tech savy on this new computer!!   It is the only hoof we could get pics of.  I wanted to let you know, in case you didn't realize, the file has some pics with marks ups in it, but they were done by our trimmer.  She seems to think his hooves are not growing, which I know you said they are, just very slowly.  I think she is also afraid to trim back the toes anymore and perhaps rightfully so.  I honestly don't know!
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Eleanor Kellon, VMD
 

If you are not dosing LaminOx twice a day, do that. You could also try just adding a 1.5 tsp dose of Jiaogulan instead of the second LaminOx but the LaminOx also has nitric oxide precursors. As I said before, the insulin is the most important issue but that regimen should eliminate any cold-induced aspect.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Buzz
 


Sounds good! I'll start today. I'm so appreciative of the help. I'm on an uphill battle as others are wanting to stop tx and let him go. Thank you!
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Buzz
 

I am hearing from the trimmer after she saw the hoof pictures from yesterday, that it looks like he is not growing and it is due to strangulation. So I'm thinking she is saying his circulation has been cut off?.Is this what happens and is it time to put him down? HELP!!!!
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Nancy C
 
Edited

Hi Marsha

This is a difficult time for sure.  Buzz deserves the help you are trying to get for him. When I get stuck I find it helpful to look at the DDT+E road map. I have been where you are with a full size horse. The fact that Buzz is a little guy is in his favor. He does not appear to have a ton of bone loss, but we have seen little guys even with most of the coffin bone missing, still come back and live happy lives.

Diagnosis -- You need to address what is probably on going high insulin.  Your plan to recheck insulin is a good one. You've heard from others that Insulin Wise, Gabapentin and cypro do not work. If he were here I would be planning a new regimen.  Metformin would be where I would be focusing, but I'd also want to make sure his PPID is controlled

Diet -- having him on mostly cubes is good.

Dr Kellon has guided you on jherb and laminox.  Jiaogulan will foster more foot growth. That can be good and bad. You need to stay on top of the new growth and correct what is going on inside the foot right now.

Trim -- While you trimmer may be correct that there is not enough growth to do a typical trim, Buzz could very likely benefit from addressing some of the issues we see every day. Heels brought back; imbalances corrected; toe brought back. It may take just a swipe of the rasp every few days.  I have personally seen the pain relief the horse gets when we finally find that correct bit of imbalance and remove it.  Watching this immediately happen, has often brought me to tears. We can show possibilities of what is amiss to you and/or your trimmer, but we need photos as Lavinia described.

Lavinia said:  The rads showed thin soles, sinking, long toes and some slight bony column rotation. His heels are underrun. Until the trim is tightened up, it will continue to keep the soles thin as the long toes stretch the sole. The sinking adds more pressure onto the already thin soles, compounding the problem. Being a mini is a bonus, as his size means gravity isn't your worst enemy as it is in larger breeds. Make sure his boots have strong bevels added to the treads at the toes and heels to optimize the breakover for him.They usually rebound quite quickly to getting the trim corrected and insulin controlled.

I know pictures can be hard to get at first.  It takes practice.  Using  anti-fatigue mats can help. My boy Beau was clicker trained and that made a huge difference in cooperation.

Here's what Lavinia requested and a link to see how they should be shot. 

If you can post a full set of hoof photos from after yesterday's trim, with the hair secured away from his coronary bands to they are visible, I can see how the trim is evolving.

Taking Good Hoof Photos for Mark Ups

Securing the hair away from his foot and getting good clear pictures, will show you dramatically where/if he has foot growth.

Getting things loaded on the computer for the volunteers to help you also takes practice, but investing the time in getting the shots and loading them in your folder as requested, are the quickest way to be on the way to relief for Buzz.

I try to think of how good it is for my aging brain to learn all this new stuff.

Hugs to Buzz.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


Buzz
 

Thank you Nancy!!! I am trying to be there for him. It is hard when others are wanting to stop this process! I really, really think we can save him, but need to convince others. I'll keep working on getting proper photos and post asap. I posted a few last night for his RF. Only ones we got yesterday. I appreciate you.
--
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Sherry Morse
 

Marsha,

To add to Nancy's excellent post, I've also seen full grown horses walk off sound after a single trim that took their toes back to where they really needed to be.  It's very dramatic and may require your trimmer to take a leap of faith, or you may need to be willing to take up a file and bring his toes back yourself.  As a smaller guy the advantage - as it were - is that you don't need to remove as much as you would off a larger horse to see a change; but as long as he's up, moving and eating, there's definitely no reason to consider putting him down.




Buzz
 


-- Thank you for your vote of confidence!!! His owner, who travels a lot, is coming in a few minutes. I've been caring for him over 2 yrs now. I'm worried!!!
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797


Suzy Berkowitz
 

Hi. My little guy Scout was in a lot of pain also. Getting him on metformin and putting clogs on him made such a difference. I have a video of the podiatrist custom making them but I don’t know how to add it to this post. 
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


 

Hi Suzy,
You can’t post it here but you can save it to YouTube or similar and post a link to it instead.
-- 
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Eleanor Kellon, VMD
 

I totally agree that a correct trim can make a dramatic difference but remind you to keep the whole picture in mind because nothing will compensate for that insulin level.  Definitely correct all possible contributing factors but the insulin still needs to be addressed.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Buzz
 

Oh Suzy, Im so glad to hear your little guy did well. I totally trust we can get there with Buzzy. Some days he seems better than others. Once we can zero in on the proper meds and get the trimming proper I think he will begin to improve. I feel his diet is as it should be, so fingers crossed. I would love to see the video if you can get it up.  Thank you for your encouragement!

Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy
https://ecir.groups.io/g/CaseHistory/album?id=258797