Date   

Re: Trouble with eating and giving pergolide

Buzz
 

Hi Martha!
-- Currently feeding Dame is very difficult as she really can not eat hay or at least very little. She quids most all of it. I give her a small amount with the hope it will create more saliva for her to aid digestion. I can only offer it when she has eaten all her feed, as she will get distracted by it and not benefit as much as she does from her feed and supplements. I feed 3 times a day and she eats some, then stops for awhile, then eats some more. It takes her a couple hours. She has never been an easy keeper and is more intetested in what the other horses are doing. On top of all this, I am trying to get her onto pergolide. Finally have put it in capsules so she can't smell it. I started her on APF 2 days ago and spoke with one of Auburn's vets today about her. I'm taking a break with her on the pergolide, using APF for four days and then will attempt to start her up again. I never got to 1mg in 1 dose. Only was doing .5mg twice a day. She backed off eating so much and I' m concerned about winter coming and wt loss.  I am totally open to any suggestions, ideas, whatever it takes to help her. She has had many obstacles over the years, but we have always been able to help her through them. Sorry for a lengthy note, but I think it may be better so you csn understand what I'm dealing with. I have nothing but praise for all of the people on this site. You are so appreciated! Thank you!!
Marsha and Dame - Buzzy TN 2019

https://ecir.groups.io/g/CaseHistory/files/Marsha%20and%20Dame%20-%20Buzzy


Re: Life Span of PPID horse

TERRI JENNINGS
 

My amazing therapy pony Cadbury was diagnosed with PPID at 22. She died last winter just a month shy of her thirty sixth birthday. We put her down due to an eye injury that left her completely blind in one eye and was very painful. She was mostly blind prior to the injury and there was not much hope of improvement in her pain level. So, it was not PPID related. And for what it’s worth, she looked pretty fabulous for almost 36. 
--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Re: Raleigh - new PPID diagnosis and IR??

 

Dana I am posting a link to a document in the ECIR files about pergolide. 
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf
Most horses need to tapered gradually onto pergolide/Prascend. This document will explain the "Veil" or depression that is a common side affect when initially started on pergolide. Use of APF may help reduce the Veil as the horse is tapered gradually onto the initial common dose of 1 mg Pergolide. The article explains everything that I have briefly mentioned. When I had to start my old horse on Pergolide I purchased APF and started him on a small dose of that first then began giving him a 1/4 mg dose which was gradually increased. He never lost his appetite or suffered and depression. Please read this well written document for the detailed explanation.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Donkey hoof realignment trim advice please

Lavinia Fiscaletti
 

Thanks, Philippa. What a wonderfully tolerant donkey Abraham is :)

Those cuts the vet made are in the laminar wedge material that can actually all be completely removed. It looks like the latest trim did back the toes up some more - which is a great step in the right direction.

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


Raleigh - new PPID diagnosis and IR??

Dana Wicher
 

Hi all.

 I first joined this group in July with questions about my other horse, but now I think my 19-year-old Arabian, Raleigh, may have more serious issues. 

I had my vet test him for Cushings and IR last week while he was out testing my other horse.  I have had Raleigh since he was two.  He has always been a hard keeper, been scoped and treated for ulcers over the years, etc.  The last year or so, I felt like he had a slight cresty neck and I have been battling white line separation with him.  

Vet put him on 1 tablet of Prascend daily for the PPID.  He started it on Saturday (9/26) and went off hard feed on Sunday (9/27) and seems lethargic.  My vet says to continue with 1 tablet and he should work through it.

Vet said insulin was normal and did not mention glucose (although it is low).  When I put the numbers in the EMS calculator, it looks to me that he is very high risk.  Can someone please take a look at his history and help me understand these results?  

He is not lame and has never had any hoof related lameness issues.

I have posted his case history here.  https://ecir.groups.io/g/CaseHistory/filessearch?q=Raleigh

P.S.  I need to start a case history for my other horse who is "normal insulin" and "borderline PPID", but I am super worried about my Arab.
--
Dana Wicher
Atlanta, GA  
Joined July 2020


Re: fish oil v spirulina (algea)

 

For humans, fish or algal oil is the best source of long-chain EFAs because we are poor converters of the short chain precursors, depending on our FADs (fatty acid desaturase) gene makeup. For horses, not enough is known. One paper has shown that horses have a novel FADs gene. Intuitively, this would suggest that horses have the genetic makeup for more efficient conversion from short- to long-chain forms, but there has been no work to confirm this. For now, it makes more sense to supplement based on the evolutionary diet.
--

Kathleen (KFG in KCMO)

Director and Research Advisor, ECIR Group Inc.

Missouri, USA, 2005

https://scholar.google.com/citations?hl=en&user=3-I7UI0AAAAJ 

 


Re: Donkey hoof realignment trim advice please

Philippa
 

I have posted additional photos of Abrahams rear legs with socks on to flatten the hair. They are a little loose at the bottom so if you can't see the bone angles for the mark-ups'- I can wrap them in vet wrap if that would be better? I have also added more up to date photos of his front feet as the vet trimmed them a week ago. As you will see - holes have been cut in his hooves as the vet thought there were abscesses in them. He is still a little tender on his right front. Looking forward to mark-ups so I can hopefully help to get these hooves in better shape! Thanks.
--
Philippa New Zealand 2020
Case History: https://ecir.groups.io/g/CaseHistory/files/Philippa%20&%20Abraham  ;
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=253721 ;


Re: Life Span of PPID horse

ferne fedeli
 

My Icelandic was diagnosed with PPID in 2012 and so is past the 5 year mark for sure.  He seems to be doing quite well and is now 26 years old...  He was diagnosed with IR two years before that--so it has been 10 years for IR.
--

Ferne Fedeli  Magic & Jack   2007

No. California
Case History

 

 


Re: feed ?

 

Renee,
I'm glad you are exploring our files. Here is a link to a good folder to explore:  https://ecir.groups.io/g/main/files/5%20Core%20Diet
There are many more folders holding various files. Safe Feeds is a good source of information. 

I should have mentioned that nearly every page has a "SEARCH" box at the top of the page. You can type a word or term into the search box then press your enter key. You can search our messages using the Main page search box. For instance if you type Nutrena in the the main page search box you will get a list of all messages that include the word Nutrena. Explore our files and do searches. If you  want an explanation of ESC then go to the files and type ESC into the search box. ESC stands for Ethanol Soluble Sugars. Here is one explanatory document you should read:  https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/1.Steps%20to%20Evaluate%20Safe%20Feeds%20for%20IR%20and%20Cushings%20Horses.pdf

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Trouble with eating and giving pergolide

 

Marsha, adding the pdf to your file name solved the problem for me.  It still downloads the file rather than opening it, which apparently is not uncommon, but I can now see it with both my devices.
I was reviewing the CH and noticed two things.  It says you are feeding 8 oz of Teff.  Is this correct or do you mean pounds, which would then add up to a reasonable amount of feed.
Also, you mentioned giving the smaller doses of pergolide bid.  Did you then switch to daily after reaching 1 mg?
Thanks!
--
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


 
 


Re: Life Span of PPID horse

Sherry Morse
 

Hi Bobbie,

As always when I hear blanket statements like that I always want to know the source of the information - is it something that this person was told by their vet, did they read it in a magazine or on the internet or ???

I think you've been on the list long enough to know we have quite a few horses who are in their 30s here and some of them have been living with a PPID diagnosis for quite a long time.  For horses that are well controlled with pergolide or prascend it's usually another old age issue that will cause their death, not specifically PPID.  For horses that are diagnosed later in life (my mare was 29 as an example) they may not live much longer than 5 more years, but that may have less to do with the disease than the age at diagnosis.  Scarlet passed away 3 months shy of her 32nd birthday after being on Prascend for about 2.5 years - would she have lived longer had she been diagnosed earlier?  No way to know for sure but she certainly had a good long life IMO.




Re: feed ?

Sherry Morse
 

Hi Renee,

Bonnie will address most of your questions in your welcome letter but the very short answer on Nutrena is that it is no good for a PPID or IR horse as the ESC+starch are well above our recommendation of 10% or less.  Most horses can maintain their condition on a diet that is correctly mineral balanced which starts with having an analysis done of your hay and then balancing minerals to the hay. 



Re: Audi Good Days & Bad Days

Frances C.
 

Thank you Dr. K. Good information on possible side effects of PPID not controlled by adequate medication
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Re: feed ?

 

Hello Renee,
All new members receive the attached informational information you/they send their first message to the ECIR Group. We try to get the primary "How-To" info into this New Member greeting and provide you with basic information about using this group. Below you will find blue colored clickable links that will open sections of information. The DDT&E sections are important to you and your horse. Please read each section then delve deeper into each section and click on those blue links. These sections are provide vital information for you and your horse.

Another important section to explore is our "Wiki". You will find a link below to the "Main Group" Wiki. The "Main Group Wiki" has all the  step-by-step "How To" information you may need. Need to find how to change/update your signature? It's in the Wiki. How to move around this group and the Case History group and understand the features are in the wiki.

Take a look at my signature at the very bottom of this message for an example of what should go into your signature. Create a permanent signature for you and your horse. Put your name (it can be just your first name or nick name) and your general location (Country/state/county) plus your date of joining (09/2020 for you). Your signature should include your horse's name also. When you create a signature (and save it!) it will automatically be attached at the bottom of every new post that you make. You should attach a link to your horse's case history FOLDER location so members and moderators can easily find your folder and files within it. 

All the links you need are below and the WIKI will provide the "How do I do this??" steps.

Please start reading below, Diet and Diagnosis sections will be very important areas to begin with. You'll soon get advice from our members and moderators to help you get answers to your questions.

Bonnie

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + 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 soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

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 equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Life Span of PPID horse

Bobbie Day
 

I was asked today by someone who’s horse was recently diagnosed that PPID horses will only typically live another five years. That Cushing’s horses don’t live long after diagnosis? Although I’ve never asked I’ve always gotten the impression that some members have had their PPID horses a very long time? I’d be interested in knowing how old some of the horses are and how old they were when diagnosed? This seems like a big misconception to me?
it just never occurred to me that they couldn’t live a long life with the right diet and meds?
is there any information on this in the files that I can be pointed to?
thank you !

--
Bobbie and Desi
NRC March 2020
Utah, Nov 2018

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: fish oil v spirulina (algea)

Cindy Giovanetti
 

I also have a chronically itchy horse, so I found this fascinating and googled “thymus protein horse allergy” and got some hits.  Other horse allergy supplements have thymus protein in them.

 

Dr. K, if you have any further thoughts on this, I’d love to hear them.  For me, it would fall under the category of “I’ve tried everything else.”

 

My horse’s itching is down A LOT since getting on the ECIR protocol, but not 100 percent gone.

 

Cindy


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Re: feed ?

rollykoal@...
 

I found the recent analysis of nutrena  that was in a folder here but what is it saying ?
sorry new to reading those things ? can someone help please ?
thank you 
--
Renee SD 2020


feed ?

rollykoal@...
 


--
good day 
i know grain is bad my horses are very picky 
they dont like the things i have tried 
money is a concern since i now have 3 with cushings 
question is nutrena that bad ?? special care 
it is affordable 
i got one on their senior feed by nutrene  and one pill per day he is doing well;  drops weight in the winter;  they can get harsh here !
my 2 mares both cushings and one is IR as well and lame right now another story for that however 
anyways they get a can the size of a regular can of corn 
i do not want them miserable and i want them to have a life and we do try and do anything we can
but now using 3 and half pills per day and many feeds I cannot get around here I could special order   again money concerns   
My gelding is not heavy or thin he is good as i mentioned knock on wood !!!! mares are heavy and exercising not an option now both sore and i am out of town working alot but my mom is home and knows as much as i do 
one of my main questions for now is that feed that horrible in that amount ???
i unfortunely probably know the answer .....i have tried to add and remove the mares grain with wet timothy pellets and they eat some barely  but i must use something for supplements and their meds etc   

any suggestions is welcome 
thank you 
Koal, Sandi and Kia 



Renee SD 2020


Re: fish oil v spirulina (algea)

celestinefarm
 

No the Flax Oil is from Santa Cruz Animal Health. I started that in May 2020 for all three horses, as the only ground stabilized flax I could get at that point was the fifty pound bags online through Triple Crown. I wanted something simpler and easier to store, less likely to become rancid. I buy four one gallon containers with pumps which are easy to use and I can store the extras in the house until needed, not exposing them to temperature or moisture like the ground was. 
The Platinum Performance Skin and Allergy was started in the early summer of 2019 and has been used continuously except for a couple weeks in July as noted in my earlier post.

Guaranteed Analysis: Per recommended daily amount (1/2 cup; 100 g):

Total Fatty Acids (min): 90%
 
Omega 3 Fatty Acids (min): 49%
 
Omega 6 Fatty Acids (min): 12%
 
Free Fatty Acid (max): 0.41%
 
Unsaponifiable matter (max): 2%
 
Insoluble impurities (max): 1%
 
Moisture (max): 0.04%
 

Ingredients: Flax Oil

https://www.scahealth.com/p/ultracruz-pure-flax-oil-horse-supplement;jsessionid=6y_V5BgrZq3fQbXv3xBHUpQpMqWsqLkwaBPoFFHIZmkSgCAEt7LI!-1470378127!1601316329515

Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Re: Arby and my first experience with laminitis

 

Hello Anne,
Thank you for getting a case history created for Arby. This is the link that you to add to your signature:  https://ecir.groups.io/g/CaseHistory/filessearch?q=Anne+and+Arby   This link will take everyone directly to your Case History Folder which is preferred because your case history folder is your storage folder for any documents relating to Arby. For instance you can create a sub-folder within your main folder for Hay Tests, another sub-folder for blood work tests, etc.  Please go back to the "Subscription"  area here in the "Main" group and delete that first link and replace it with the link that I gave you. Do be sure to do a save your changed subscription after making changes.

All the blue colored links below are clickable.  The "Wiki" for the Main Group is the best place to go to for "How To" information. It is the nuts and bolts section for this group. "Getting Started" and "Getting Around the ECIR" will give you the basic tools to using this site.

I want to urge you to focus your reading on the Diagnosis, Diet, Trim and Exercise area below. You will even more info at our web site, link below.

You will be getting replies and advice from our experienced moderators and members soon. It is uncommon for TBs to develop laminitis. Do read the Diagnosis section below and follow the links to learn more. It may all seem like a lot of info to take in but I am glad that your found this group!


Welcome Anne Kenny and Arby 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + 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 soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

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 equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album