Thanks so much, Pauline. Zoe wasn't sure--she said ask you!

cheers
--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

Yes - they can be given together-  I found this thread  

https://ecir.groups.io/g/main/thread/jiaogulan_apf/1038556?p=,,,20,0,0,0::Created,,%22+jiaogulan+apf%22,20,2,0,1038556
--

Pauline

Geelong. Vic

Australia Aug 07

ECIR Mod/Primary Response

http://tinyurl.com/7qbdyas

Thanks so much, Pauline.

Doh--check gums, of course. 

So it's ok to use the Booster FX concurrently with jiaogulan?

--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

Hey Maxine,

I think it would make sense to keep her at 1mg for a few days longer to see if the spaceyness resolves. If not- go back to .75mg  for a few days and see what results with that. In the meantime- hopefully Zoes mix will have arrived and she can have a bit more support with the induction. Are her gums getting pink with the dose of J that she's already on? - that would indicate that she's getting maximum effect.   You're doing a great job  getting all your ducks in a row. :) 
--

Pauline

Geelong. Vic

Australia Aug 07

ECIR Mod/Primary Response

http://tinyurl.com/7qbdyas

Hi Jessica,

Welcome to the group.

To get the best answers to your questions we need to get some more details from you about your horse.  To get those details, we ask all members to fill out a case history .To do that, go here:  https://ecir.groups.io/g/CaseHistory  join, and then look in this file for instructions on how to do a case history: https://ecir.groups.io/g/CaseHistory/wiki

Meanwhile I will give you a rundown of our group's philosophy and try to answer your questions.  Our philosophy is called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise.  Here's a synopsis of each part.

DIAGNOSIS: Is done with blood work. We recommend having blood drawn to test for Insulin, Glucose, Leptin and ACTH. ACTH is used to diagnose PPID (Cushings) while insulin, glucose and leptin are used to diagnose Insulin Resistance (IR). The samples should be drawn at home and NON-fasting as fasting will produce artificially low results and are a holdover from human testing protocols. A horse can be only IR, only PPID, neither or both.  It seems that he’s had a barrage of testing done so it would be great if you could post what tests he has already had with the results and the ranges- just add them to your case history file.

As far his neurological /traumatic brain issues go- I will leave that discussion for the vets in the group or for members that have experienced those issues with their own horses.

If his Cushings is not controlled- then hard to say how much of that is contributing to his ability to recover quicker from whatever he is dealing with. It is imperative that the DDTE is addressed, to put the horse in the best position health wise to deal with any assault that comes its way.

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.  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 this page of website:  http://ecirhorse.org/index.php/ddt-overview/ddt-diet  It does involve soaking your hay (if untested or over 10% sugar+starch) 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.  And then to a safe carrier such as rinsed/soaked/rinsed beet pulp, you will add the Iodized salt, Vitamin E, ground flax seed and magnesium in the amounts as outlined on the webpage.  It takes some horses awhile to acclimate to beet pulp as it has a different "mouth feel".  Some horses love it though!  Other safe carrier choices if you can't or don't want to use rinsed/soaked/rinsed beet pulp, are dampened Ontario Dehy Timothy Balance cubes and Nuzu Stabul1, soy hull pellets, to name a few.  

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

We like to use EquiAnalytical for hay testing.  You want the #603, trainer's package.  Call them ahead of time and ask them for some forage kits.  They are free and contain everything you need (except the hay probe) for sending your sample in for testing, including a postage paid envelope.  Here's a link to EA's "supplies" page:   http://equi-analytical.com/supplies/  If you don't have or know anyone that has a hay probe, try your local extension office or coop.  They often have one that they will lend out.

Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing .https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Getting%20Help%20with%20Mineral%20Balancing%20.pdf

I know you said that he is having problems eating- what are you currently feeding him (brand/s) and what is his  current body score?

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.  And it's often the missing link in getting a laminitic horse comfortable again.  Look on the following pages of our website for more information about 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 most welcome to post hoof pictures and any radiographs you might have so that our hoof guru can look to see if you have an optimal trim in place. This can all be uploaded to an album in the Photos section of the case history site - NOT your case history file, please.

 Here's a site that explains how to take good hoof photos:  http://www.all-natural-horse-care.com/good-hoof-photos.html 

Exercise: The best IR buster there is, but only if the horse is comfortable and non-laminitic. If there has been laminitis, we recommend no riding or exercising in tight circles until at least 1/2-2/3 of the hoof damaged by laminitis has grown out (at least 6-12 months, sometimes longer). Also recommend the use of boots and pads as needed for comfort vs shoes/appliances as frequent realigning trims will be needed, which is difficult to do if there are shoes. We also recommend using NSAIDs sparingly as they interfere with healing and can allow a horse to do more than its fragile feet are ready to handle.

Totally understand that he may not be up to any form exercise at this stage- is he able to be handwalked at all?

That highlights the main points of our philosophy.  Tons of information on our website, in the files and archived messages.  Don't hesitate to ask any further questions that you have!  

We ask all members to sign each time they post, with their name (first is fine) date of joining, and general location (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!  

Pauline

Geelong. Vic

Australia Aug 07

ECIR Mod/Primary Response

http://tinyurl.com/7qbdyas

F,orgot to say, thank you very much for replying, Lorna. My usual vet is on holiday and I haven't heard back from the substitute vet yet, and it's a bit cold and lonely out here on this limb. 

I've done more searches--please correct me if I'm wrong, but it seems the current consensus is that splitting the dose does not increase control, merely may extend it. So in my case, because I still don't know the dose that will control the ACTH, there is no point in splitting it, because doing so will reduce the effectiveness of control. 

To give her a bit more time to adjust, though, it would seem sensible to give her another day on 1mg before increasing to 1.25. In the meantime I'll order the APF-like stuff. She is already on jiaogulan--would increasing that help, maybe?

Thank you and the other mods, and members, for this list. I'd be a gibbering wreck without it. 
--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

Staring out over the fence, rubbing her neck on the fence and rocking. this is a behaviour she displays when locked in a yard or tied up when she feels stressed, not a new behaviour, but not usually seen in the paddock. 

Not wanting to come into the yard for breakfast--just stopping, not frightened of anything in particular. But ate all her beet pulp when she did come in.

standing on a box--hind legs underneath her. Again, she often does this when she is uncomfortable, and today it is windy with showers, so could be the weather. I checked under her rug and she is warm, not hot. 

Standing looking dopey with her friends, clingy with them. Low energy. 

Generally looking bleh. Not jumpy, not running around. Looks like I feel when I've got a cold and PMS (this is some years ago!) combined. Indy can look like this when coming in season, but she is not flirting at all.
--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

Hi Maxine,

Can you describe 'spacey' ?

--

Lorna in Eastern Ontario,Canada
ECIR Moderator 2002

https://ecir.groups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf

Yesterday I got an actual copy of Indy's latest ACTH test from my vet and it was 117 (not 107 as the receptionist told me). I have increased her Prascend from 0.75mg to 1mg. She has had three days on 1mg. This morning she was pretty spacey. Still has good appetite. Because the ACTH was so high even with her on the 0.75mg, I'd like to get better control as soon as possible, and was planning to increase another 0.25mg tonight--but now I'm not sure if I should.

But I see that "117" emblazoned in front of my eyes and look out the window at the green grass coming up from recent rain and start to hyperventilate...

I have been searching the archived messages for advice, and some messages suggest that giving the incremental 0.25mg increase at a different time of day for a while helps, while other messages suggest splitting the entire increased dose into two for a while.  However, these are all quite old messages. Is splitting the dose to avoid side effects still recommended?

We can't get APF here. While I'm aware there is a similar product available, it will be 3-5 days before I can order and receive any, so I'm wondering if there is anything I can do in the meantime to help. 

When I first started her, I gave her four days on 0.25mg, then four on 0.5mg, then went up to 0.75mg with no noticeable side effects. Or maybe the spaceyness doesn't really matter provided she's eating ok?

Thank you.

--

Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

Becky,

I think I got it from Roadrunner Pharmacy in AZ. It has been a few years so I could be mistaken. I used the powdered form. I also did a loading dose initially (one of the theories) and I treated for 30 days.

There are all kinds of theories out there about the best way to treat, best meds, length of tx, etc. I took a fairly conservative approach but wound up being pretty happy with his improvement. 
--
Lisa 2010-06

NE TX

Zippy (IR) https://ECIR.groups.io/g/CaseHistory/files/Lisa%20and%20Zippy%20-%20Bunny%20-%20Rita

Bunny, and Rita - IR

I am getting ready to take another run at starting my 20-year-old Appaloosa gelding Zippy on pergolide. 

Because his ACTH has been inching upward over the years and hit a high of 74.2 last year, I tried easing him on before. At that time I tried starting with a dose of 2.5 mg CPD, and could not believe that he did not seem to tolerate it well. His behavior became sufficiently zombie-like that I d/c the meds, then tested him several weeks later, relieved to see that his ACTH had actually dropped quite a bit, though it was in the middle of the seasonal rise. At that point I decided to test in the summer of '16 and try again with pergolide if his numbers were up.

His most recent labs are concerning to me: an ACTH of 41.7 (with no notable clinical signs) but an insulin of 41.87, which frightens me greatly. He is definitely IR and is showing some signs--puffy sheath, slightly hardened neck crest, etc. The insulin is likely the result of too much grazing, which I am attempting to curtail. Everything else is in decent shape management wise: he is on tested at less than 10 ESC+starch mineral balanced hay, that I soak when I am able; his trim cycle is not as short as I would like, but I keep his toes backed and flares addressed in between trims.

Here are my questions about easing him on the pergolide:

1) Ridiculous as it sounds, does anyone start with a dose less that .25 mg? I can do this if I need to.

2) I plan to use APF this time-- do most of you use the pro, and what is a typical dosage? 

3) Are there any tips or tricks for administering the APF--time of day, empty stomach, etc.?

4) Any other suggestions for helping him adapt to the pergolide? 

I cannot be sure that his response was not coincidence, but I'm not taking any chances. 

I am struggling right now to manage his IR as I have my two other IR horses dry lotted and on soaked hay and the work is killing me. However, I just tested both of them and while their numbers are not perfect, they are low enough that I suspect the sore-footedness they are experiencing is more mechanical in nature. They are both huge mares with typical chronically thin soles and pancake-type feet.

They will be the subject of my next post!

--
Lisa 2010-06

NE TX

Zippy (IR, and now PPID) https://ECIR.groups.io/g/CaseHistory/files/Lisa%20and%20Zippy%20-%20Bunny%20-%20Rita

Bunny, and Rita - IR

Hi Stephanie

Looks to be okay.  Can be balanced. Will need to up the Calcium b/c Phos is high.  Will also need Magnesium. Iron is high but doable. Protein a little high but not outrageously.
--
Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
ecirhorse.org

I don't think the image came through so maybe try this link? I uploaded it to my CH(hope that's okay). 

https://ecir.groups.io/g/CaseHistory/files/Stephanie%20and%20King/Capture.PNG

--
Stephanie & King
October 2014
Oregon
Case History 

Hey all! 

Can someone please take a look, and let me know if this hay would be safe for IR/PPID horses? If I'm reading it correctly, the ESC is 7.9 and the starch is .3(both from the 'As Sampled' column). It is an Orchard/bluegrass/native grass mix. 

Is this safe to feed? Do you see any issues with it? 

I took a screen shot of the results, which should be right below. (Hopefully)

Thanks so much. 

--
Stephanie & King
October 2014
Oregon
Case History 

Hi Helen, 

In case you need help making your ECIR Signature here is the link for simple directions:

https://ecir.groups.io/g/main/wiki/How-to-Copy-and-Save-your-ECIR-Signature 

--

HI Helen,

Here's the link to your CH:

https://ecir.groups.io/g/CaseHistory/files/Helen%20and%20Josie

We ask members to add their location,date of joining,and CH link to their signatures each time they post. Really helps volunteers help you help Josie. 

--

Lorna in Eastern Ontario,Canada
ECIR Moderator 2002

https://ecir.groups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf