Date   

Naproxen instead of prevacox

LJ Friedman
 

I've searched recent posts... I'm interested to know who is CURRENTLY  using naproxen instead of prevacox,,,,?  thoughts on how it works compared to prevacox?  side effects?? dose you use,, etc??  
-- THANKS
LJ Friedman  Nov 2014  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: New Case History - Test Results HELP!!

LJ Friedman
 

Wondering why we use metformin as its effect is short lived?  Is it for emergency purposes?  why?  thanks.  My experience with it was very minimal
--
LJ Friedman  Nov 2014  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: acetyl-L-carnitine

LJ Friedman
 

Some members,,, myself included.. tried insulinwise... I did for 6 weeks... zero improvement,.. returned product for a refund
--
LJ Friedman  Nov 2014  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Jesse sore

LJ Friedman
 

I will soon start invokana,,, I got 300 mg tablets which I can split or give whole,,,  ( $2.00  each US from a pharmacy  walk - in pick up from some friends who live in Tijuana, Mexico, and use a reputable pharmacy,, How often should I test creatinine and bun?  I'm thinking  after one month?  2 weeks?    when I test insulin, can that be done by stat labs,, etc  the lab my local vet uses, or do I need to  send to cornell?     anything I can look for ie side effects besides blood labs?   thanks..  very happy to try and plug this hole in Jesse's treatment...
--


LJ Friedman  Nov 2014  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Question and Case

Lavinia Fiscaletti
 

Hello Beth,

Welcome to the group! 

Breathe. Firstly, you are doing NOTHING wrong by not making a hasty, irrevocable decision to euthanize your mare - you are listening to your gut feelings and what your girl is telling you. Although penetration is not a good thing, it doesn't mean that the horse must be put down - they can, and do, successfully rehab from that on a fairly regular basis once the underlying causes are removed and the trim realigns the hoof capsule with the position of the bony column within.  Appliances of any kind need to be viewed as band-aids that may help to some degree but are not a substitute for getting the mechanics correct. Good that you have a hoof pro that is willing to work with you on this. There is certainly a very real possibility that she can come back from this to become your riding partner again but there is no way to know that answer for sure at this point.

Good that you have had blood work pulled. Being an Azteca may make your girl genetically predisposed to IR, a type of super-thrifty metabolism rather than a disease. Given her age of 16yo, she may also be developing PPID (aka Cushings disease), the main risk factor being advancing age. The timing of the laminitis event is suspicious for PPID being at least one of the underlying causes here. Again, more in-depth info is found below in the DIAGNOSIS section.

Yes, when we refer to "all grass" it means to pasture of any kind. Pasture is a complete unknown, with sugar levels that fluctuate constantly throughout the day, so it is playing Russian Roulette, esp. when a horse is laminitic. While alfalfa generally tests low on ES + starch, many horses become footsore on it so we recommend not feeding it unless you KNOW your horse is fine on it. Best to err on the side of caution, at least until all the confounding factors have been identified and addressed. More info in the DIET section below.

This is not about "too much nutrients" unless there are toxic levels of something involved - which is rarely the case. Being overweight is never a good thing but Starvation does NOT help as it just reduces the nutrition the body needs to feed healing plus it places the body into hyper-conservation mode, which will only exacerbate the likely underlying IR condition that triggered the laminitis in the first place. Need to sensibly feed for weight loss by providing her with 1.5% of her current weight or 2% of her ideal weight in total safe intake. This includes soaked hay (if not yet known to be safe); a small amount of rinsed/soaked/rinsed beet pulp, wet soy hull pellets, or Ontario Dehy Balanced Timothy cubes to use as a safe carrier for the emergency diet supplements. Further details are found below in the DIET section.

Although grazing a pasture is our idyllic picture for the perfect life for a horse, the reality is that being on a drylot, with hay supplied in hay nets, fulfills a horse's need to "graze" just as well and they can be perfectly happy (and healthy) that way.

The remainder of this message contains a boatload of in-depth info and links. As this can result in information overload, it can be helpful to store it somewhere easily accessible so you can find it for future reference.


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.

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, 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 sub-clinical 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.


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


Re: acetyl-L-carnitine

 

So is their a benefit to adding acetyl-L-carnitine to an IR horse along with Lysine?

--
Nancy 
3/20/2018  Burkesville KY

Case History: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Akira


Question and Case

Beth Haggett
 

Hello,
I still have so much to read and study and learn so was waiting to be more educated before posting...however I am confused about one issue. I keep reading "KEEP HORSE OFF ALL GRASS" and also "Do not feed alfalfa but feed Grass hay after soaking." So, when someone says "keep off all grass, no matter what kind" do they just mean grass that is growing in a field? I have a barn full of hay which is 80/20 grass alfalfa. I just started soaking it and plan to have it tested on Monday and feeding only two flakes per day as an emergency measure for a horse that has very recently had an acute case of laminitis and then sadly a serious rotation already with only 2 mm of sole before coffin bone protrudes. Very passionate shoer willing to work with her that says he has had great success with founder. He put clogs on her last night and she seems much more comfortable. Willing to give him (shoer) and her (love of my life mare age 16 whom I've had in my life for 9 years now). She has always had thin soles. Vet has me starting her on Farriers 2x strength ONLY. He doesn't want her on any other supplements that I've bought hoping they would help because he says she has had TOO MUCH nutrients and is overweight and has crusty neck too. Breed is Azteca (half Andalusian and half foundation quarter horse). Vet consulted with his whole team and 4 vets strongly suggested putting my mare down. Had already made arrangements, trying to "do the right thing" by her and get her out of her pain etc. but felt like the walking dead as I made arrangements. Now I have just a tiny bit of hope with this shoer who will come as often as needed and not charge much and says he is hopeful. Rotation is very bad but she is standing now pretty comfortably with these clogs on. IS THERE REALLY ANY HOPE that she will ever be ridable? Or am I keeping alive a friend that will be a pasture pet that can never really even eat any pasture grass? Lastly, vet took blood a few days ago and testing for metabolic syndrome and results should be in next week. Sorry for the long post. Glad I found this group and know I am not alone. Videos were fantastic on this sight and have read emergendy diet also. Confused about Beet Pulp as an addition at this stage??? Gratefully yours, Beth
--
Beth Haggett, Ph.D. Mind-Body Medicine
Lucia's owner


ECIR Group - Equine Cushings and Insulin Resistance #FACTS

main@ECIR.groups.io Integration <main@...>
 
Edited


Re: Numbers just in should I increase Pergolide for Pabatsa?

Eleanor Kellon, VMD
 

As  long as he normally handles it well no need to postpone routine dental. You can do an intranasal EHV.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Numbers just in should I increase Pergolide for Pabatsa?

Laura and Pabatsa in CA
 

Dr. Kellon,

Pabatsa is scheduled for his annual dental exam/float on 8/22. Would it be wise for me to postpone until the numbers drop down? Also, I had titers run for WNV, etc. in May (in my CH).
He would need to receive an EHV since titer was low. Should I postpone that also?
--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )


Re: New Case History - Test Results HELP!!

Eleanor Kellon, VMD
 

Yes. Your vet must order it. Minimum dose is 30 mg/kg, twice daily.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is there an App for that?

Eleanor Kellon, VMD
 

I understand, and many will do that, but it doesn't solve the problem of knowing if the information you are getting is correct.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New Case History - Test Results HELP!!

Deb Walker
 

Thank you Dr. Kellon. So if I understand correctly, my vet must order the Metformin. Is there a standard dosage?
--
Deb and Scotty I/R Probably PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Re: Numbers just in should I increase Pergolide for Pabatsa?

Eleanor Kellon, VMD
 

The group's experience has been that to minimize laminitis risk the horse's ACTH should be well within normal range going into the seasonal rise and any rise  minimized. He's already above normal in an early August sample with peak not coming until end September. This is especially important for horses with a history of fall laminitis, which he doesn't have but there's no way to say for sure it couldn't happen. There is no rule for how much to increase but usual increment is 1 mg.  Discuss with your vet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Numbers just in should I increase Pergolide for Pabatsa?

Laura and Pabatsa in CA
 

I just re-uploaded the CH file.
--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )


Re: Numbers just in should I increase Pergolide for Pabatsa?

Laura and Pabatsa in CA
 

--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )


Re: Is there an App for that?

Debra
 

I'm a visual learner so I envision some sort of graph that would change size and color when you changed foodstuffs or quantities. I do well with charts and graphs, things that are colorful...just how my brain works best :-)
--
Debra Doerfler
San Marcos (San Diego County), California
Lady Sierra Snarf n' Snort AKA "Sierra"
2009 TB rescue mare, adopted 2017
Member since March 2019
https://ecir.groups.io/g/CaseHistory/files/Debra%20and%20Sierra

https://ecir.groups.io/g/CaseHistory/album?id=91011


Re: acetyl-L-carnitine

Eleanor Kellon, VMD
 

There's not enough lysine in Insulinwise to  make a difference.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Increasing CP

Eleanor Kellon, VMD
 

There's no easy answer to the pergolide question. If you wait to see clear signs it's too late. Talk to your vet about how much of an " insurance" increase during the rise may be warranted. You can plan to lower dose again late winter and retest.

I'm assuming this is weight loss he didn't need. It's important to keep him separated from the other horses long enough to eat his full daily requirement. Another option depending on how large the dry lot is would be to divide the daily hay into nets, one more net than there are horses, and hang these as far apart as possible. Riding him when he's undernourished is a stress and only makes weight gain harder.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: acetyl-L-carnitine

Stephanie Boyles
 

Thank you for this information!

One more quick question... I read a report by Dr. Kellon that states L Carintine is derived from Lysine.
https://drkhorsesense.wordpress.com/2019/03/23/acetyl-l-carnitine-the-powerful-versatile-nutrient-you-never-heard-of/
My horse receives Lysine via Insulin Wise. 
http://www.kppvet.com/insulinwise/
Does that mean he is also getting the l carintine from this?

Steph
--
Stephanie

 

Joined March, 2017

Ontario, Canada

 

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