Re: Diagnosing PPID
Sorry that you're having so much trouble! Let's see if we can help you out. Did you first download the case history form to your computer? Once it's on your hard drive, you should be able to enable editing and then fill it out. Once that's done, go back to the ECHistory8 site and upload that file from your computer. Sorry if you've already done all this and are still having trouble. If you do or have done the above and are still having trouble, just shoot us another note and one of us can help you to get your CH uploaded. Meanwhile, I will give you some basic information that may get some of your questions answered. We DO have lots of information for equines that are just PPID (Cushings), but maybe you just haven't found it yet. Trouble is that lots of PPID horses are also IR, so you may find a lot of the information mixed together.
We follow a philosophy called DDT/E. That stands for Diagnosis, Diet, Trim and Exercise. If all four aspects are in place, you should see very positive results. So let me give you details about each aspect. Hang onto you hat, as you're about to get a LOT of new information!
Diagnosis: PPID and IR are two completely separate conditions, but have some similar and overlying symptoms, so getting a proper diagnosis can be a little tricky. PPID is a benign tumor or hyperplasia in part of the pituitary gland called the pars intermedia. IR is a metabolic type of horse, usually described as easy keepers, with regional adiposity (cresty neck, fat pads in the rump, etc). Any horse can have just PPID, just IR, or both, or neither of course, but then you wouldn't be here looking for answers :) To get a proper Diagnosis of PPID and/or IR, we recommend these four tests: ACTH, insulin, glucose and leptin levels on a NON-fasting horse, preferably sent to Cornell. Because IR can be a separate diagnosis OR the insulin can be elevated due to a high ACTH in uncontrolled PPID, the leptin level is useful in helping to differentiate. Two important things to know--Cornell is the only lab in the US that does leptin levels, and they have discount shipping labels which make overnight shipping very reasonable, so make sure your vet knows about them.
The reason getting a full diagnosis is so important is that PPID is treated with medicine (pergolide) and IR is treated with diet. A horse that has both would need both pergolide and a carefully managed diet for the rest of it's life. The blood draw requires special handling, so please read the diagnosis page on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis Our website is also a great place to send your vet for the most up to date information on PPID and IR. There's also TONS of great information for you to read about PPID in this file: https://groups.yahoo.com/neo/groups/EquineCushings/files/Cushings%20Disease%20-%20PPID/
OK, on to Diet....
Diet: The diet that we recommend is a forage based low sugar starch (tested to be under 10% sugar+starch) low fat (4% or under) mineral balanced diet. We use grass hay, tested to be under 10% sugar+starch, with minerals added 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. This diet is crucial for an IR horse, but it also supports the delicate immune system of the PPID horse. Until you get your hay tested we recommend that you use the emergency diet, which involves soaking the 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 soaking water where the horse(s) can't get to it. Details about the emergency diet can be found on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diet We like to send our hay for analysis to this lab: http://equi-analytical.com/ and ask for the #603, trainers' package for $54. As important as what you DO feed on the IR diet is what you DON'T feed! No grain, no pelleted or senior feeds, no pasture (even dead looking grass), no sugary treats (including carrots and apples), no molasses, no brown/red mineral salt blocks--white ones only. If you are having any laminitis issues, it's critical to get your horse on the emergency diet now! It can often turn them around within a few days. Small mesh hay nets are great for soaking hay and also for slowing down the voracious appetite that many IR horses have. Once you get your hay tested, one of our balancing folks can help you make a customized balanced diet that addresses the excesses and deficiencies in your hay and other ingredients in your diet.
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. If you'd like, and especially if you are having any hoof issues, you are welcome to post pictures of your horses' feet in the PHOTOS section of ECH8. Here's a site that shows how too take good hoof photos: http://www.all-natural-horse-care.com/good-hoof-photos.html
Exercise: The best IR buster there is!! BUT--a laminitic horse should never be forced to move! If your horse is footsore, boots and pads may be in order to help with pain relief.
OK, Christine, hopefully I haven't overwhelmed you! There is a TON of information here, most of it new to people coming here looking for help with their IR/PPID horses. I promise you that it all gets easier with time. Please do get that CH filled out on DJ! It really gives us the details that we need to help you better. If you continue to have problems, just let us know and we can help you.
We ask all members to sign their name, date of joining and general location (which helps us to source products), each time they post. Also, once you get your CH done, we ask that you add a link to it in your signature so that we can find it faster and answer your questions faster. One additional tip--the problems you are experiencing with getting your CH done, may not be related to you and/or your computer. It may simply be Yahoo's Neo having a bad day. Sometimes just trying at a later time is all that is needed. Hang in there!
Maggie, Chancey and Spiral in VA
EC moderator/Primary Response