Re: Polycystic Ovary Syndrome and Laminitis
Welcome to the group! You can never provide us with too much info, and you provided a nice summary of your mare's issues. But in order to get the best help we ask that everyone fill out a case history on their horse. To do that, you'll need to join one of our sister groups called ECHistory8. It's a filing cabinet for storing case histories, and keeps all the CH's in one easily accessible place. Here's a link to that group: https://groups.yahoo.com/neo/groups/echistory8/info It won't take long to get approved and then just follow the instructions for filling out a CH. You can copy and paste a lot of the info that you have already provided in the free form "time line" section at the end of the CH form.
Meanwhile, I will explain our philosophy called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise, and point you in the right direction for some more reading.
Diagnosis: Forgive me if I missed it, but I am not seeing any mention of lab work. Is that right? The first step in getting a good treatment plan underway is a good diagnosis. To get that, we recommend these 4 tests: ACTH, insulin, glucose, and leptin on a NON-fasting horse. At the age of 10, Jazz is just at the cusp of the age that we recommend you do the ACTH to rule out (or in) PPID (Cushing's disease). PPID is an enlargement or benign tumor in a part of the pituitary gland called the pars intermedia, not usually seen (though not unheard of) in horses under the age of 10. It's treated with a medicine called pergolide. IR is not a "disease", but a "metabolic type" of horse, normally, but not always, described as easy keepers with abnormal fat pads such as cresty necks, puffiness in the hollows of the eyes, excessive drinking and urinating, etc. IR is treated with a low carb, low fat, mineral balanced diet. A horse that has both PPID and IR would need both pergolide and a carefully managed diet for the rest of it's life. Any horse can have just IR, just PPID, or both (or neither). With regard to the labwork, the ACTH is to diagnose the PPID and the insulin and glucose for diagnosing IR. The leptin helps to differentiate if the horse is IR at baseline or if an elevated insulin is being driven by a high ACTH. Leptin is the hormone that says "stop eating", and insulin resistance and leptin resistance go hand in hand. More information about leptin resistance can be found in the first file in this folder: https://groups.yahoo.com/neo/groups/EquineCushings/files/Insulin%20Resistance/ The labwork does require special handling so please read more about that on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis
Additionally, you are going to want to read Dr. Kellon's ECIR 2013 Proceedings on Reproductive Abnormalities in Mares with Diet Resistant Insulin Resistance. Look here: http://ecirhorse.org/index.php/conference-proceedings-recordings/2013-proceedings-recordings-table-of-contents Scroll down to the free PDF's and it's the 4th one up from the bottom of the page. This will give you another diagnostic tool to consider.
Diet: To provide a low carb, (less than 10% sugar+starch) low fat (4% or less), mineral balanced diet, we use grass hay, tested to be under 10% sugar + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse. Until you can get your hay tested and balanced, we recommend that you use the Emergency Diet. It does involve soaking your hay for an hour in cold water or 30 minutes in hot water to remove ~30 of the sugar content. Make sure you dump the soaking water where the horse(s) can't get to it. Though not intended for long term use, the emergency diet addresses some of the most common deficiencies. More details about the emergency diet can be found on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diet Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing (first file in this folder): https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/ Or since you are in the UK, you will probably want to continue to work with Sarah at Forageplus.
A very important part of the IR diet is what you DON'T feed. No pasture, no grain, no molasses containing products, no sugary treats including apples and carrots, no unsoaked hay with an either an unknown ESC+starch content or ESC+starch that is above 10%. Plain white salt blocks only--the brown/red ones contain iron (and sometimes molasses) and unknown mineral amounts which interfere with mineral balancing. As I read your note, I was really struck with the need to keep Jazz completely off the grass. Many people struggle with this concept, but the fact is, many IR horse just cannot tolerate any grass at all.
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. Though important for all horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis. Here are the links to our website on a proper trim. Here: http://ecirhorse.org/index.php/ddt-overview/ddt-trim and here: http://ecirhorse.org/index.php/laminitis/realigning-trim You are welcome to post pictures of your mare's feet so our hoof guru can help you to determine if you have an optimal trim in place. Here's a site that explains how to take good hoof photos: http://www.all-natural-horse-care.com/good-hoof-photos.html Please put any photos and/or xrays in the PHOTOS section of ECH8. That's the group you join to fill out your CH. The CH's are in the "files" section, pictures in the "photos" section.
Exercise: This is the best IR buster there is, but only if the horse is comfortable and non-laminitic. Once she is able to tolerate increased movement, we recommend hand walking in long straight lines with no tight turns, which puts increased stress on the new laminae as they grow in. Boots and pads may be in order for comfort during the rehab period.
I hope you find some information in this that helps you, Julia. There is TONS of great information on our website, in our files and also in the archived messages. You can search for anything using the "search converstions" and "search files" boxes. But don't hesitate to ask any further questions that you have! Let us know when you have your case history done! We ask all members to please sign each time you post with your name (first is fine), date of joining, and general location (which helps us to source products for you). When you get your CH done, you will want to add a link to it in your signature as well so that we can find it faster and answer your questions faster! See my signature below as an example.
Maggie, Chancey and Spiral in VA
EC moderator/Primary Response