Re: New Group Member - Need Assistance with my IR Cushings & PAINFUL Mare
Hi Pam in MD!
Welcome to the group! We are practically neighbors, as I live in VA--not too far down the road from Frederick, MD I see that Lorna has already sent you an invitation to join ECH8, one of our sister groups where we store case histories (CH's). We really need you to go and join that site and then put all this information about your mare into the CH form. With over 12,000 members, it's the only way we can keep track of everyone's story. Plus the CH form will prompt you to provide us with specific information that will help us to help you better. Try not to feel overwhelmed--it may take you a little time to fill out, but it's all important information for us to help evaluate your situation.
In the meantime, I will tell you about the group's philosophy, called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise. Let me break it down and give you some details and why each step is so important. When all four aspects are in place, you will see results, but it obviously cannot all be done overnight!
OK, Diagnosis: A very important first step! You say that your mare was diagnosed with Cushing's (PPID) about a year and a half ago and started on Prascend. And then in the fall that her levels were "off the charts". It would be great if you could give us the exact numbers, or if you have a hard copy of the lab work, you can put it in you CH folder. Additionally, there is a spot on the CH form where you fill in that information. Not just the lab results are important, but the dates of the labwork are very important too. All horses experience a seasonal rise in their ACTH in the fall, but PPID horses often experience an exaggerated and prolonged rise in their ACTH during the seasonal rise, which puts them at risk for fall laminitis. In fact, fall laminitis is often the first sign of PPID. Because PPID horses have this exaggerated rise in their ACTH during the fall, they require close monitoring of symptoms and ACTH levels to make sure that the dose of Prascend (pergolide) is keeping their ACTH under control. You can read more about the seasonal rise on our website here: http://ecirhorse.org/index.php/cushing-s-disease/seasonal-rise Once we have more information about the labs you have, we can help you better.
Additionally, many PPID horses are also IR (insulin resistant). IR is not a disease, but a metabolic body type that are usually described as "easy keepers." You mare's breed is one that is prone to be IR. SO--you have a double whammy--already a diagnosis of PPID and most likely a diagnosis of IR as well. To know for sure we recommend these four tests from a single blood draw: ACTH, insulin, glucose and leptin levels on a NON-fasting horse, preferably sent to Cornell. They are the only lab in the US that does leptin levels. The leptin helps to differentiate, when the insulin is elevated, if the horse is IR at baseline, or if the ACTH is "driving" the insulin up. The blood requires very specific handling as the ACTH degrades very quickly. The details about how the blood should be drawn and handled can be found on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis
So, a horse can have just PPID, just IR or both. The reason we need to find out is that PPID is treated with medicine, pergolide, which you are already doing with the Prascend, and IR is treated with diet. A horse that has both PPID and IR would need both pergolide and a carefully controlled diet for the rest of it's life. Because an elevated ACTH can make the insulin high all PPID horses should be treated as though they are IR until proven (through labwork) otherwise. So that brings me to the Diet part of our philosophy. Before I go into the details of the Diet, let me just say that while this is the diet that we recommend for an IR horse, it is actually the best way to feed any horse, and is particularly important for PPID horses as it supports their "challenged" immune systems. Ok, on to the details of the Diet!
The Diet that we recommend is a forage based low sugar/starch (under 10% sugar + starch), low fat (under 4%) mineral balanced diet. So we use tested low sugar starch (under 10% sugar+starch) grass hay and then we add minerals to balance the hay to the analysis and to replace what is lost during the hay curing process we add Vitamin E and ground flax seed. You want to feed 1.5-2% of you mare's BW in low sugar starch hay divided up into several small feedings/day. We love the small mesh hay nets to slow down the sometimes voracious appetite that many IR horses have. Here's the lab that we recommend for hay testing: http://equi-analytical.com/ You want the #603, trainer's package for $54. Once you get your hay tested one of our balancing folk can help you with balancing the minerals. In the meantime, until you can get your hay tested we recommend that you start the emergency diet. Details can be found on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diet It does involve soaking your untested hay for an hour in cold water or 30 minutes in hot water to remove up to about 30% of the sugar content. Make sure you dump the sugary water where the horse(s) cannot get to it! I know it's snowing up there right now and COLD, because it is here too. And believe me the thought of having to soak hay is not an appealing one to me or anyone else on this list who has had to do so in the middle of winter! Been there, and done it! But it's extremely important to get her on a low sugar starch diet right now. She needs to be in "intensive care" for now. And getting her ACTH under control, her Diet right, and her TRIM right are the 3 essential elements of getting her better! So that brings us to the Trim part of our philosophy.
Trim: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. You said that you have a new farrier who follows Dr Kellon's protocols. That's great! One thing you do need to know is that a "rehab" trim is not going to look normal for quite some time. And a new happy hoof does not happen overnight. It may take a year or more for the foot to grow out and be normal again--longer even sometimes when there is sinking involved. It's a commitment that you certainly sound willing to make! I would strongly urge you to post pictures and any xrays that you have for one of our hoof gurus to evaluate your mare's trim. Please follow the guidelines on this site below that explains how to take good hoof photos.
And then post the pictures and xrays to the PHOTOS section of ECH8, the group where you fill out your CH.
OK, on to Exercise--the best IR buster there is! BUT! A laminitic horse should never be forced to move!!! Since your mare is foot sore, she needs to be in boots and pads to try and get her more comfortable. Have you got boots and pads yet? We can make some recommendations in that area. Just let us know.
Now, a few more things I want to address. I have personal experience with Dr Reilly and his HEIRO and other recommendations. Without going into the grim details, let me just say this. The HEIRO does nothing, and the recommendation to put your horse on both previcox and bute at the same time is a dangerous combination that can certainly set her up for ulcers. In fact, we don't recommend bute after the first few days of laminitis because it interferes with the healing process. But the bute needs to be weaned off not stopped cold turkey. Read this post by Nancy for more information and please follow the links in the post for more information on how to wean the bute to avoid a NSAID "rebound" effect.
Please stop the ADM Growstrong as well. There are very few "bagged" feeds that are safe for your horse. At this point, the emergency diet is your best option. Once you get your hay tested, we will help you to get your diet balanced. We know this all sounds like a paradigm shift in horse keeping practices that most people are used to. It does all become second nature and then you will not remember life before ECIR.
I forgot to mention when I was talking about the diet that as import as what you do feed is what you DON'T feed! NO pasture, even dead looking winter grass. NO sugary treats, including apples and carrots. No molasses or molasses containing foods or supplements. No grain. No brown/red salt blocks. They contain minerals that will interfere with balancing and also iron which we don't want. Most IR horse are iron overloaded, but we won't go into the details of that right now. Let's just get your mare some immediate help and we will explore all of they why's of everything as we go along. Meanwhile, I would strongly encourage you to study all the parts of our website. Also, there is a TON of information in our files and also in the archived messages. I dare say, any question you could think to ask has been answered at some point in time and a "search" of the conversations will get you many results. Don't let that stop you from asking questions though!!
One more thing and I will close this book for the night. Coming to this group for help with a PPID/IR horse is like bringing your horse to a specialist. Though they may be well rounded, lots of vets are not up to speed on the latest information about PPID and IR. Dr. Kellon is the expert in this field and this group provides the largest field trial of horses with these conditions. We have a lot more information to offer you about how to help your horse. We are just a click away! Hang in there, Pam! And please do take the time to read the website, the files and messages. There is a wealth of knowledge to be gained there and knowledge is empowerment!
Maggie, Chancey and Spiral in VA
EC Primary Response