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Re: Shiraz suspected cushing's case, now full blown laminitis

Sherry Morse
 

Hello Riana,

Welcome to the group! 

The ECIR 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.

In order to help you and your equine quickly and effectively, we need you to explain your equine's situation by following the instructions you were sent upon joining. Your completed case history form and ECIR Signature will save days of back and forth questions. If you haven't done so yet, please join our case history sub-group. Follow the uploading instructions so your folder is properly set up and then upload your case history. If you have any trouble, just post a message or email the case history group explaining specifically 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, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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.

I see two other members have already posted about using boots with pads to help with Shiraz's comfort level and I will add that we recommend that as well until you are able to get his trim in order and his overall level of comfort better than it is now. 

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.

We ask all members to sign their first name, general location, date of joining and link to the case history and photo album every time they post. It helps us to find your info faster to answer your questions better. You can set up an automatic signature so you don't have to remember to do it. 

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. 

Thanks,
Sherry and Scarlet

EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scarlet/Scarlet%20Case%20History.doc

           


Re: How to feed vit E gel caps?

Sharon Manning
 

I found the 400mg go un noticed while the 1000mg are left in the feed pan.
sharon
E TN
2015


Re: feed specialist question on commercial feeds

 

Daryl Ann,
I live in Michigan also, up North of you. I have talked with another Michigan ECIR member about switching to Stabul 1. She has gotten a TSC in the Ann Arbor area to stock the Stabul 1 feed. That is not too bad of a drive for you. Maybe you could just purchase from them?

I have a lot of soyhull pellets that I just purchased so cannot switch at this time. Not sure I want to change over as the soyhull pellets are a safe, palatable feed and cost me around $6 for 50 lb bags. I do drive to Clare for the pellets every 4 months. 

You might want to try the soyhull pellets. Since you have to feed a mineral mix to balance your hay anyway the pellets would work for your horse. The Stabul 1 pellets have the advantage of palatability but since I have switched to a sugar free peppermint "syrup" my gelding is really cleaning up his "feed" with minerals.

My horse is also on free choice grass hay now. When first diagnosed he had to loose weight so I bought a lot of 1" hay nets, various sizes and was able to keep hay in front of him nearly very consistently as he was at home. Now he is boarded but his extreme appetite has really reduced down. He has a whole bale bag available round the clock now and is much calmer about eating. Getting his IR under control made it much easier to feed him

Is your horse at home or boarded? Since I am fairly close to you feel free to ask me about feed resources, etc.
--
Bonnie Snodgrass 07-2016

ECIR Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Next Steps, where do I go from here?

christinecull33
 

Thank you!  I have the ferrier coming Monday so will do a full set of photos'. And will check blood work sometime in the summer too.  I think our season rise here in Ontario would be more into the fall, cooler months.  thoughts on that? 

thanks for your help!


--
Chris
July 29, 2017, Belleville, Ontario
Minnie Case history link; https://ecir.groups.io/g/CaseHistory/files/Chris%20and%20Minnie

Minnie Photo Album;   
https://ecir.groups.io/g/CaseHistory/album?id=8561


Re: Shiraz suspected cushing's case, now full blown laminitis

LJ Friedman
 

you will get a proper reply from a moderator soon... have  you tried boots and pads??  a must,,,, you can also make your own sytrofoam pads,, if you have to wait for boots via mail.. etc..  there is a you tube video on how to... all the best..
--
LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos

 


Re: Traveler's new trim.

Stephanie Emery
 

Lavinia, Thank you very much. I will pass the information on to my farrier.
--
Rhillranch Stephanie and Traveler PPID Jan 2018 Harvard IL. Usa 
Tucker, Wilson ,Black Jack, Cruiser 
Case History Folder
Traveler's Photos


Re: How to feed vit E gel caps?

Lavinia Fiscaletti
 

I keep a pair of scissors handy - just snip the very end off the gelcaps (if you sip them in half they squirt all over the place), squeeze them out then toss the empty caps into the feed as well. If they eat the caps, fine - if not, no problem.

You can also use a liquid form instead and just squirt out the correct amount. Pricier but simpler to do:

https://uckele.com/liquid-e-50.html

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


Re: Traveler's new trim.

Lavinia Fiscaletti
 

Hi Stephanie,

Some good things are happening - medial-lateral balance looks good, toes have started to come back, flares are starting to be addressed but need to be more aggressive with both.

Need to be a lot more conservative with what is being trimmed off the soles, frogs. Based on the rads from Dec, the soles were already too thin so leave them completely alone. Frogs should only be trimmed to remove loose flaps, not all over to get them looking symmetrical and "clean" - they need to be allowed to make ground contact.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


Re: test results for Smokey posted to CH

regina bruno
 

Dr. Kellon, many thanks for your answers.  I really appreciate it.  coming here and being able to ask these questions is like glue that helps me put the different pieces of what i'm learning together so that i can make good decisions in caring for Smokey.  that means the world to me.
--
Regina and Smokey
June 26, 2017
Laurelville,  Ohio

 https://ecir.groups.io/g/CaseHistory/files/Regina%20and%20Smokey  .
https://ecir.groups.io/g/CaseHistory/album?id=8316  .


Re: How to feed vit E gel caps?

Lorna Cane
 

Or use an 18g. needle, in one end , and squeeze.


--

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

 


Re: How to feed vit E gel caps?

Josephine Trott
 

Hi Tina,
I've done the same thing as Jessica only using a safety pin to poke a hole might be safer on your fingers than a knife :)  I have tough teeth so I bite the end off and squeeze.  My fussy horse just sifts through his beet pulp and eats around the capsules, even when they're soft.  Doesn't trust it's not a poison capsule.
Josie
Davis CA 06/09


Re: feed specialist question on commercial feeds

Eleanor Kellon, VMD
 
Edited

The first thing to remember is if you go to a Ford dealer the only cars you will hear about will be Fords. It's a very rare company that will ever have its representatives tell you their product is less than perfect, or won't work for your situation, or something better is out there.

If the horse is fed at least 4 times a day (3 to 4 hours between meals), or never goes longer than that without having something to eat, there is no risk of inducing ulcers. Even if there was, the claim this product would hold them over between meals makes no sense because once it has left the stomach it's not doing anything.  There is ZERO, and I do mean zero, evidence that Strategy feeding prevents ulcers or that Strategy fed horses do better in any way than horses on any other diet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: feed specialist question on commercial feeds

Daryl Ann Letts <Daryl.ann.letts@...>
 

I have just ordered 2 20lb boxes of Stabul 1 for my horses. Will be hoping there are other horse owners in my area of Kalamazoo, MI that will go in on 10 bags of Stabul 1 feed with me in the future to get the cost down. 


Re: How to feed vit E gel caps?

larockj@...
 

I had the same problem with Mimi.  So I took the 1000 IU capsules, and a small sharp knife, and poked a hole near the end of the capsule.  Then I squirted the Vit E over her supplements, and stirred it all up.  She ate that just fine.

CAVEAT:  You have to be VERY careful to angle the knife, away from your fingers!  And don't puncture it on the actual end of the capsule, but slice a small hole in the side near the tip, then squeeze.  Otherwise you can stab yourself.  I became quite adept at it with practice. 
--
Jessica - July 2015
New York

Mimi (over the bridge) - https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Mimi

Photos - https://ecir.groups.io/g/CaseHistory/album?id=1874
 


Re: New Member - possible laminitic mare

Daryl Ann Letts <Daryl.ann.letts@...>
 

I am in Kalamazoo MIchigan and have one horse that has foundered and another one that is IR. I will be killing off the grasses in their dry lot after the rains stop. Thank you


Re: New Member - possible laminitic mare

Daryl Ann Letts <Daryl.ann.letts@...>
 

No one in my area is selling the Stabul 1. Is there anyone else who would be interested in going in on a pallet of this Stabul 1? TSC will ship it in in large quantities. 10 bags at a time??


Re: test results for Smokey posted to CH

Eleanor Kellon, VMD
 

To answer some of your questions, yes, the calculator is based on the pony field study and yes, horses are often different but ponies are typically more IR than most horses so if your horse tests normal by pony standards, he's normal! The goal for "normal" is a G:I ratio 10:1 or higher.  If glucose is 100, you want insulin 10 or lower. There is actually a grey zone in there so if glucose was 100 and insulin 12 or 13 I wouldn't be panicing.

An insulin of 28.4 on a diet with ESC+starch less than 10 is indeed "high" but it's well below the threshold for triggering a laminitis episode.

The range of "normal" includes all diet types, including grain feeding in close proximity to the test. An insulin of 40 would never be normal on a low glycemic diet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: feed specialist question on commercial feeds

Daryl Ann Letts <Daryl.ann.letts@...>
 

Thank you


Re: Shiraz suspected cushing's case, now full blown laminitis

Daryl Ann Letts <Daryl.ann.letts@...>
 

My horse too has foundered. 14 - 15-degree rotation of coffin bones in front hoofs. I have him wearing Soft Ride boots with orthotic inserts made especially for foundered horses. Without these boots we would be in a world of hurt. Bute helped a lot. Now 3 months later and he is moving freely with boots. I can take them off and walk him on the soft grass and he looks normal. I take them off twice a day to check his hoofs. 


Re: test results for Smokey posted to CH

Eleanor Kellon, VMD
 

I'm not sure which results you think look too low but if you're just talking about the pre ACTH, it's entirely possible that's real. Early PPID horses can test perfectly normal except during the seasonal rise. Mild hemolysis is common and won't influence the results.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

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