With the ACTH of 20.3 and Emmie being only 9 yo PPID is not an issue at this time.
The iron results show Emmie's ferritin to be sky high, which correlates to iron overload as her other iron values are in the middle of the normal ranges. Have a read in this file, esp the folder Iron - Dr. Kellon on Iron Overload.doc:
This will make it harder to control her IR and makes getting her minerals balanced extremely important. High iron will magnify zinc and copper deficiencies, which are present in all your hay analyses (this is almost a given in any hay).
Which hay is Emmie currently eating? Sorry, I can't seem to access your case history for some reason. The round bale hay is a bit low in protein but safe in ESC+Starch. It is quite high in iron, which is a pretty common finding in hays from your area. The analyses done by Poulin do not give the trace mineral amounts and the lab they use processes the samples using NIR as opposed to wet chemistry methods. This gives less precise values, which can be problematic for ESC, Starch for IR horses as well as for doing tight mineral balancing. If you are feeding one of those hays, you'll need to get the EA #603 analysis done in order to be able to mineral balance her ration fully.
You can contact any of the people listed in this file for help with getting your hay mineral balanced. Look in the folder Getting Help with Mineral Balancing:
Compensated IR means that Emmie's IR is partly controlled. This is a good thing but it means that she is still at risk for complications (laminitis being the worst) if her IR status is not continually and correctly managed. This includes getting her diet tightly mineral balanced to both prevent more iron overload from occurring as well as to reduce the current excess; provide the minerals her body needs to function well in the optimal quantities and ratios; exercise her as much as is possible to help her metabolism utilize fuel effectively and efficiently.
Lyme is a real problem, esp here in the Northeast. Unfortunately, being infected with it does not prevent future infections from occurring. Has Emmie ever been vaccinated against it? If so, that will affect how the test results are interpreted. The results from Feb and April show that OspA went way up, OspC went down and OspF went up. This would be consistent with a chronic infection, as well as a possible new infection adding to the mix. IV oxytetracycline has shown more effect against the disease than oral doxy. Having been down this road myself, I would suggest discussing with your vet a month long course of IV oxytet followed by 3 months of oral doxy. You can get the doxy compounded into a powder, which makes dosing easier than counting hundreds of pills/capsules, and is more cost effective:
Underlying Lyme disease will drive IR and make it harder, if not impossible, to control.
The emergency diet is just that and is not meant for long term use. Now that you have hay analyses in hand you need to move onto getting a custom supplement designed so that you are supporting Emmie optimally from a nutritional standpoint.
From the latest xrays it appears that there are ongoing trim issues. The toes are still long, heels high. It appears the dorsal walls are being rasped to make them appear normal but the toe length/heel height are not actually being addressed. You might want to review the information that Linda gave you regarding the status of Emmie's trim here:
Pics of the actual feet would be extremely helpful if you would like more specific input regarding the trim. Those can be added to the current album.
Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team