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ECIR Group - Equine Cushings and Insulin Resistance - Spring Grass Laminitis #FACTS

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Spring Grass Laminitis

By ECIR Group - Equine Cushings and Insulin Resistance

Spring in here in the northern hemisphere.


ECIR Group - Equine Cushings and Insulin Resistance #FACTS

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By ECIR Group - Equine Cushings and Insulin Resistance


Re: Insulin, leptin levels question

Bonnie Eddy
 

Thank you so much Jani. Oh my gosh, thankfully I've been feeding her as if she's IR. But I'm shocked. This is the 3rd vet I've tried to work with.

That ACTH level was done before I'd started her on the Prascend  (all testing was). She's just been on the 0.5mg for less than a week now. 

Thanks again,
--
Bonnie with Racham from Southern California, Nov/2016


Re: LMF Complete questiom

 

Hi, Bonny - the difference in the Northwest and Southwest ingredients is not significant. Small amounts of soy meal or soy oil are acceptable, ditto alfalfa. (except for some very sensitive horses who react to any alfalfa). I will email the company and find out the relative amounts of soy and alfalfa in the product, if they are willing to divulge that information.  Animal feed labels are not required to list ingredients in the order of how much is in the product, so you can't always tell from the label what the relative amounts of each ingredient are.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Insulin, leptin levels question

 

Hi, Bonny - when I plug that insulin number into the IR calculator: http://www.freil.com/~mlf/IR/ir.html  (this is the old calculator, which will still do a RISQI if all you have is an insulin value), the result is 0.19, severe IR, at risk of laminitis.  Your vet is not alone in interpreting an insulin value that is within the lab's reference range as "not IR"; however, this interpretation is not correct. Not all vets are au fait with metabolic issues in horses.

You can plug the leptin into the calculator on the ecirhorse.org website:  https://www.ecirhorse.org/ir-calculator-leptin.php This shows an intermediate level of leptin, meaning that Racham's insulin is probably driven by PPID as well as IR.

"Normal" reference ranges for equine insulin include everything from a fasted horse to a horse that has just had a grain meal. An insulin of 28.8 uI/mL would be normal if the horse had just had a higher sugar or starch meal in the last four hours; but for a horse on pasture or hay, it indicates metabolic.

The group has found that for PPID horses, keeping the ACTH below about 20 pg/mL provides the best result.  If Racham were mine, I would be titrating the pergolide up by adding 0.25 mg every 4 days til you get to 1 mg, then re-test.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




True or false? Compounding pharmacies can only use Prascend, not bulk pergolide

Barbara Rosensteel
 

The reason I'm posting is that a friend of mine has a gelding that she and her vet think, based on symptoms, has PPID.  The veterinarian has no experience with PPID.   The vet suggested a dexamethasone test, but they didn't do it.  They also did not pull blood for an eACTH test.  They are basing the diagnosis on visible symptoms (muscle wasting, weight loss, loss of topline, sheath swelling).   The owner started her horse on 1/mg prascend per day about 2-3 weeks ago. She is waiting for 8 weeks after starting Prascend (1 mg/day) to test ACTH to get an idea if the 1 mg Prascend is working (without a baseline I think it will be hard to know if it is or isn't, but I could not prevail on her with my recommendation to get an initial, pre-Prascend eACTH).  

I told her that many people get the pergolide in capsule form from compounding pharmacies, and if her horse has to go on a higher dose, it would be something to consider.  She then went on an internet search for information about compounded pergolide, and found this research paper, and two Horse.com articles.  This paper and articles are causing her to have strong doubts about the legality, efficacy, and quality of compounded pergolide. 


This 2012 Horse.com article presents the argument for not using compounded pergolide, under the headline "FDA No Longer Supports Compounded Pergolide Production".  http://www.thehorse.com/articles/28896/fda-no-longer-supports-compounded-pergolide-production

The next Horse.com article, written by a veterinarian in the May 2014 edition, talks about compounding pharmacies and compounded drugs, http://www.thehorse.com/articles/33541/careful-compounding  and includes the statement:

Compounded drugs may not be made in bulk, says Stanley, and if there is already an FDA-approved product on the market, pharmacies compounding any form of that drug must make it from the FDA-labeled product rather than from raw materials. For example, let’s say your horse with Cushing’s disease doesn’t care for his Prascend. Your veterinarian might write a prescription to a compounding pharmacy to have the medication made into a different flavor or form for your horse; however, the pharmacist must make the drug using Prascend rather than bulk pergolide.

According to this, the FDA prohibits compounding using the raw material of bulk pergolide, and that to compound using anything but Prascend is a violation of FDA rules. 

Related to this are the findings of a 2014 paper by Dr. Scott D. Stanley and H. D. Knych (UC Davis).  I only have this as a PDFThe purpose of the study was to assess the potency, and stability over time, of different formulations of pergolide mesylate obtained from various veterinary compounding pharmacies.

https://aaep.org/sites/default/files/issues/proceedings-10proceedings-z9100110000274.pdf

  One of their findings was that the initial concentrations of pergolide in all formulations (liquid, powder, capsules) were highly variable between products, with many having concentrations well below the label claim.  In addition, they found a high degree of variation in pergolide concentrations between two containers of the same product ordered from the same pharmacy on the same date.   Final assessment on product stability was difficult to determine, because 16 of 28 of tested products did not meet the FDA requirement for potency at the onset of the study.  (They did not name the compounding pharmacies in the paper.)

This is alarming if still true.   How can anyone know that the concentration of pergolide in the capsules they receive is the concentration they ordered?   The paper does close with the words:  "To ensure effective therapeutics, veterinarians should be vigilant and thorough when selecting a compounder.  Compounded medications should be prepared in a state-licensed facility, with strict quality control measures, byan experienced pharmacist who adheres to USP guidelines for good compounding practices." 

Unfortunately, they neglected to mention if the compounding pharmacies that produced the errant formulations met All, Some, of None of these criteria.  Or if the compounding pharmacies that did NOT have errant formulations DID meet all of these criteria.  That would have been a valuable piece of information.


I would very much like to get Dr. Kellon's, and others who are "in-the-know" on this subject, to comment on this. What do compounding pharmacies use to make the pergolide capsules and powder that so many on this list buy?  Can the compounding pharmacies so many on this list use be trusted to produce quality products that contain the concentration of pergolide that was ordered?  Under what circumstances can compounding pharmacies compound pergolide products that are essentially the same, except perhaps for dose, as Prascend (especially if they are made from Prascend)? 


Thanks,

Barbara Rosensteel

Baxter, Tennessee

September 2007 (?)



Insulin, leptin levels question

Bonnie Eddy
 

In looking over the new FAC's on your wiki that was just posted, I read that in "what is lab normal?" that insulin levels above 10 indicated IR. My vet says that my mare is not metabolic, her insulin is normal. He also did not do the glucose I'd wanted, saying it wasn't needed if the insulin is normal.

Her levels (non fasting) insulin 28.8ul/ml

The labs normals are 10-40

Leptin 12.68ng/mL

ACTH 45.2pg/ml (now on Prascend 0.5mg)

So she is metabolic? 

I have not been able to do a CH due to help and computer issues. Trying so hard to get it going

Thank you, 

--
Bonnie with Racham from Southern California, Nov/2016


Re: ECIR Group 2017 NO Laminitis! Conference Update

Lorna Cane
 

On Wed, Mar 22, 2017 at 02:52 pm, Nancy C wrote:
Speakers:    Eleanor M. Kellon, VMD
                    Robert M. Bowker, VMD, PhD
                    Jaini Clougher, BSc, BVSc
                    Kathleen Gustafson, PhD
                    Lisa Lancaster, DVM, PhD
                    Lavinia Fiscaletti, BS - Trimmer, Moderator/Senior ECIR Group Member
                    Paige Poss, APF, Anatomy of the Equine, LLC        
                    Carol Layton, BSc, M.Ed, Balanced Equine Nutrition

Topics:     How Did We Get Here: Historical Review of Diagnosis and Treatment of PPID and IR
                A Tiered-Management Approach to EMS and PPID    
                Informed Dietary Decision Making – the Benefit of Forage Analysis
                Minerals and Hoof Health
                EMS and Inflammation
                Endocrinopathic Laminitis: How is it Different?
                Acute Care for Endocrinopathic Laminitis    
                Multimodal Treatment for Chronic Foot Pain in Horses
                Case Histories Using Multimodal Treatment for Chronic Foot Pain in Horses
                Understanding the Anatomy of Foundered Feet
                The Courage Not to Know
                Understanding Laminitis: How We View “Normal” Function    
                Avoiding Consequences of Laminitis through an Understanding of Fascia, Microvessels, and Dissipation of Energy
                The Coffin Bone: How does Adaptation to Early Changes Impact the Hoof During Laminitis        
                Considering the Live Horse: The Impact of Nerves During Laminitis and Rehab    

 Stellar !!  Bravo !!!
--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002




LMF Complete questiom

Bonnie Eddy
 

I noticed LMF Complete has been recommended as a carrier a few times.

The Northwest and Southwest ingredients are somewhat different from each other.

My question is, they both contain alfalfa and soy products, oil or meal.

Alfalfa is second ingredient in Northwest with soybean oil as 4th. 

Is this safe for IR?

Thanks!

--
Bonnie with Racham from Southern California, Nov/2016


ECIR Group 2017 NO Laminitis! Conference Update

Nancy C
 

We have our full roster of speakers and topics, listed below.

Breaking today — "This event has been approved for 21 American Association of Professional Farriers (AAPF) Continuing Education Credits.  For more information visit their website - www.ProfessionalFarriers.com"  AAPF was helpful in getting a number of farriers to the 2015 conference.

Application has been made to AAVSB RACE committee for veterinary professional continuing education credits.  We hope to have the final details in early April.

The web team is working hard on 2017 nolaminitis.org website, currently under construction and should be on line by then as well with complete details on topics, venue, transportation and registration.

Several of you have asked for copies of the flier and we will have those available as well - again, early April.

Attendees of the 2011, 2013, and 2015 conferences welcomed the latest in research and specific protocols used to improve the welfare of equines in their care. The 2017 NO Laminitis! Conference will continue to build on that mission:

When:      The weekend of October 27 - 29, 2017
Where:     Tucson Hilton East, Tucson, AZ

If you are ready to book your room, you may do so online.

Speakers:    Eleanor M. Kellon, VMD
                    Robert M. Bowker, VMD, PhD
                    Jaini Clougher, BSc, BVSc
                    Kathleen Gustafson, PhD
                    Lisa Lancaster, DVM, PhD
                    Lavinia Fiscaletti, BS - Trimmer, Moderator/Senior ECIR Group Member
                    Paige Poss, APF, Anatomy of the Equine, LLC        
                    Carol Layton, BSc, M.Ed, Balanced Equine Nutrition

Topics:     How Did We Get Here: Historical Review of Diagnosis and Treatment of PPID and IR
                A Tiered-Management Approach to EMS and PPID    
                Informed Dietary Decision Making – the Benefit of Forage Analysis
                Minerals and Hoof Health
                EMS and Inflammation
                Endocrinopathic Laminitis: How is it Different?
                Acute Care for Endocrinopathic Laminitis    
                Multimodal Treatment for Chronic Foot Pain in Horses
                Case Histories Using Multimodal Treatment for Chronic Foot Pain in Horses
                Understanding the Anatomy of Foundered Feet
                The Courage Not to Know
                Understanding Laminitis: How We View “Normal” Function    
                Avoiding Consequences of Laminitis through an Understanding of Fascia, Microvessels, and Dissipation of Energy
                The Coffin Bone: How does Adaptation to Early Changes Impact the Hoof During Laminitis        
                Considering the Live Horse: The Impact of Nerves During Laminitis and Rehab    

Attendees:     Any professional or owner who has one or more horses in their care.

Ticket Pricing: $280 Lecture Admission
        $250 Early-bird (Registration prior to 09.23.17)
        $100 Guest (Social functions only. No lecture)
        $175 Veterinary students      

        (No children under 16 at lectures.)

Pricing includes Thursday Night Meet-and-Greet, dinner Friday night and lunch Friday and Saturday.

It may be spring but our wind chill temp in NH is about 9 degrees right now and plummeting.  Can't tell you how much I am looking forward to going to Tucson! Hope to see you there too!
--
Nancy C in NH
ECIR Moderator 2003

Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
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



OT - NRC Plus and PPID/IR classes

Eleanor Kellon, VMD
 

I've now had three people tell me they tried to reserve a seat through the drkellon web site but got no answer and I have not received those messages. Are the classes still on?  Yes, dates on web site are correct.  No need to reserve a place. Just go ahead and register when you're ready.
--
Eleanor in PA

www.drkellon.com 

EC Owner 2001


Re: Dutch and his new problems

Eleanor Kellon, VMD
 

Have you considered trying a short course of GastroGard to see if that makes a difference?  Gastric ulcers are extremely common in horses that have other intestinal tract issues.

Young cuttings of grass are preferred by pellet makers, especially if they don't use a binder.  They hold together better than lower sugar/starch cuttings with higher fiber.  This makes all pelleted products that don't actually guarantee their levels risky.
--
Eleanor in PA

www.drkellon.com 

EC Owner 2001


Re: Strangles in my IR mare and PPID gelding

grandmalynn44
 

Jaini,
Thanks for the quick response. I will not use rice bran as a carrier, which had stuck in my mind somewhere as a no no. I just couldn't find confirmation on what I thought I remembered. I tried stevia with my LMF low carb pellets to which I had added salt this morning and it was a no go. So I stringed into him salt water which he accepted well. I diluted the two tablespoons of salt in about two cups of water. It took a while but it seemed to slowly cause him to push out more drainage over the approx. 20 min. it took to do this. Afterwards he went over and began to eat his hay.....a good sign.
My IR mare, Mica, also refused the stevia with pellets so since she is still eating her hay fairly well I'm sprinkling salt on her hay.

Thanks again, for the help!

Lynn and Mica (and now Bodie, who I need to add to my case histories)
https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Mica/Mica.doc
N. Calif. May 2011



--
Lynn McKechnie

N. California, May, 2011

Mica:  https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Mica ( https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Mica )


Re: Dutch and his new problems

 

PS - I do realize that the timothy pellets can not be guaranteed to be below 10% ESC plus starch, but in Dutch's case, one has to do the best one can, and they are a safer bet than the TC products.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Dutch and his new problems

 

Although the timothy pellets might say 13% NSC, it is the ESC plus starch that we look at to be below 10%.  TC Senior has an average of 11.7% , but the fat is 10%, which may cause more problems. and the starch portion is high at 6.4%, which will definitely cause problems.  Because the published TC numbers are averages only, some of our members sent samples of TC Lite to be analyzed. The starch numbers came back at 9.9%, 11-something %. and 10.4%, all of which are much, much too high for an IR horse. In addition, TC is now adding iron to the feeds, in the form of iron amino acid complex and ferrous sulfate (phooey!!!!!!!), but the iron levels are not listed in the analysis. This makes virtually all TC products (except the Timothy Balance cubes) unsuitable for IR or PPID horses.  

Will he eat the LMF Complete? That appears to be very safe, and when combined with the timothy pellets and other supps would be the way to go.

What a balancing act!!!!!!!  
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Dutch and his new problems

Rebecca Reddicliffe Bigelow
 

I got the ok from his medical vet (as opposed to his surgeon) to try the cubes.  I'm a little nervous about the longer fiber than in the pellets although he said it would be ok. I've tried those before when he was in his picky phase and he didn't care for them so much. I'm thinking now he might be so bored with pellets that he would like some variation in texture and might eat them. My local vet and I were thinking of trying Triple Crown Senior pelleted feed which is 11.7 NSC mixed with grass hay pellets to bring the overall sugar/starch number down. It's certainly higher than I'd like but the timothy pellets I'm feeding now are supposedly about 13 NSC. Any thoughts? If I can't get him to eat a fortified feed I can't balance his minerals because I clearly can't pay to analyze each bag, I just have to go with generalized whatever general analysis that I can find. This makes for a lot of guessing. This is why I'm stumped. At least with the timothy balance cubes I can get a reliable analysis. 

Rebecca and Dutch


Re: Hello from France!

 

PS - two more thoughts on this subject. Even the most sensitive Type II Diabetic human could eat fresh grass all day long,and not suffer much in the way of glucose spikes. We know this is not the case with horses (whose glucose spikes are immediately followed by the insulin spikes, that induce laminitis).  

Secondly, and I realize this is strictly anecdotal (but we have seen many similar such stories): a horse who was being re-habbed from a single case of clover-induced laminits continued to have low-level foot pain, despite the diet being supposedly in place. (the foot pain manifested only as a stiffness turning on the concrete barn aisle). It turned out he was getting a couple of tiny (slightly bigger than crab-apple size) apples a day. Once the apples were stopped, the foot pain resolved completely.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Hello from France!

 

Oh, dear - I will have to email Andrea and have a talk about this. Two things: 1) The glycemic load information is for humans.   2) If you look at the dry matter % sugar and starch, it is 52%.  Carrots can have much the same effect as fresh pasture, in my experience.  Can you get any hay pellets, or even just use handfuls of hay for treats? Alternatively, there are some great treat recipes here:  https://ecir.groups.io/g/main/files/Treats%20for%20Horses   You could likely make something up without too much trouble, using the Agricobs as a base.  I use a modified ground flax, ground soy hull pellets, stevia and aniseed recipe (similar to Omar and Lesley's treats or Maggies treats); I roll them very thin, they bake up nicely and keep as dry for ages (although I keep most of them in the freezer). It's nice to have something on hand for treats. (all you clicker trainers out there, the various low starch treats work fab, as do the Timothy Complete Cubes= ODTB cubes)
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: New Wiki Page! #Wiki

 

Thanks once again, LeeAnne, for your tireless efforts to help people in the right direction!  I absolutely love the new website.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




New Wiki Page! #Wiki

LeeAnne Bloye <ecir.archives@...>
 

FAQs - Most often asked questions 

Okay, it isn't really a wiki page but a link to the ECIR's website's Frequently Asked Questions.  

It also is a wonderful aid for focusing on what needs to be learned to quickly help their PPID and/or IR equine.  

Also a great way to be sure you are up to date on the topics discussed.  I found some holes in my knowledge. 
--


LeeAnne,
Newmarket, Ontario. 

ECIR Archivist March, 2004
​ 

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