Date   

Re: Acceptable values for iron and nitrate in hay

Gisele Sassen
 

Hi Cass,

I uploaded two hay tests.  I am considering buying the first cutting; I would like to also add some of the second cutting, but the nitrate/nitrogen is too high.  I do all my testing at Equi Analytical, but the second cutting test was provided by the grower, but I don't think it is worth it to retest it given the high nitrate-nitrogen values.  What do you think of the first cutting?  The iren is a little more than desired, but lower than a lot of hay I can get here.

Thanks for any advice!
--
Gisele & Fiona, Washington State; 06December 2010
https://ecir.groups.io/g/CaseHistory/files/Fiona%20Case%20History


Re: Preparing Laminitic Mare for Transportation? [KEVIN]

 

Hi Chuanni!  Good to have you here.  I see you have your signature in place and your Case History posted so you are really on top of things.  I will follow my post with a standard greeting from ECIR which speaks to its goals and protocols.  There is plenty of reading here so don’t feel you need to do it all at once and don’t hesitate to reread as some things that might not seem important to you now may have a totally different relationship to your interests later on.

I don’t know much about trucking a horse with possible laminitis but I’m sure someone will.  I would thInk a well bedded box where she can lie down might be a consideration.  One thing that crossed my mind was the possibility of your drawing a blood sample from your horse in Malaysia and taking it to Singapore for analysis.  It would give you a project to work on while waiting for her shipping date and put you further ahead in planning for her care.  I don’t know if this is even feasible.

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 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. 

 




--
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: Preparing Laminitic Mare for Transportation? [KEVIN]

Lavinia Fiscaletti
 
Edited

Hi Chuan,

Thank-you for providing the radiographs and hoof photos - great job.

The trim has improved a lot from April 2019 to now but still has a ways to go. The most recent rads show there is sinking, thin soles, long toes and underrun heels. The coffin bones are sitting almost ground parallel, which is contributing to the broken back HPA across the board - with the LH being the worst in that regard. There is evidence of pastern arthritis, more advanced on the RF than LF. RF has a pronounced ski tip.Frogs are elongated and walls have flared, although there appears to be some work done to alleviate some of the flaring.

All of these issues are combining to keep her tenderfooted. Possible abscessing makes sense - sometimes you never find an exit point.

Trims need to leave the soles completely alone as there is absolutely NOTHING there to work with. Toes need to come back further and the breakover needs to be set back further so it is in alignment with the needs of the bony column. She should be in padded boots until these issues can be corrected and she is comfortable.

If you would like mark-ups to guide the trim, just let me know. Would also need photos of the hind feet.

From the info provided, it doesn't appear there is any reason to postpone the move.

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


Re: Blood extraction protocol

Maria Duran
 

On Wed, Jan 15, 2020 at 06:13 PM, Eleanor Kellon, VMD wrote:

You can't spin a serum sample until after the blood clots.
--
Yes allowing to clot and then centrifuging isn´t it? Points 2 and 3.

"

Insulin Testing

The plasma sample collected for ACTH can also be used for insulin testing or serum can be collected as detailed below.

  1. Draw the blood specimen into a “plain” red-top collection tube.*
  2. Allow whole blood adequate time to clot prior to centrifugation to ensure sufficient yield and avoid fibrin formation – this may take place at room temperature for up to1 hour or refrigerate specimen if longer time is needed (within 2 - 4 hours).
  3. After centrifugation, transfer the serum into a vial suitable for shipping or frozen storage.
  4. Refrigerate sample if shipping the same day, freeze if shipping the following day or later. Insulin is stable frozen for at least 5 years." 
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album
_._,_._,_


Preparing Laminitic Mare for Transportation? [KEVIN]

Chuanni Loh
 

Hello there

As background, my mare (KEVIN) was diagnosed with laminitis in July 2018 with significant rotation (see case history for details). We are unable to do a blood test (for IR/PPID) in the country she is currently residing in (Malaysia), and thus the cause is still unknown. She had gotten laminitis shortly after arriving in Malaysia from New Zealand. Her condition has stabilized with diet management and corrective trimming over the last 18 months, and we started slowly bringing her back to work (starting with some lungeing). I have made plans to export her to Singapore, where I am based, in order to get better access to medical care. Her location currently is quite remote and there are no equine vets based locally. My vet needs to travel 4 hours from a different part of the country to get here, and is thus not able to come as frequently as I would like. Once she is moved, we can also get access to the requisite blood tests and frequent x-rays etc.

Recently though, she had two bouts of sudden onset lameness in the right fore followed by the left fore a few weeks later. The vet thinks the symptoms are consistent with an abscess as it was very pronounced on one foot. The acute lameness itself did resolve, and she is now walking comfortably in boots, but she continues to be tenderfooted barefoot on both feet. I am not sure if it could be a laminitic episode since it is impacting both feet, and now the pain seems more low-grade (which is a similar type of pain when she first arrived - we did not know it was laminitis at that point in time until she had foundered and I do not want to inadvertently miss it again until it is too late).

She had done vaccinations about 3 weeks before her first acute lameness on the right. We had followed recommendations to give her antihistamines and anti-inflammatory medication before administering the vaccinations, and she had been well the few weeks directly after. There was no change to her other diet and management protocol as far as I am aware, although the vet did mention slight lameness during her trot-up even prior to administering the vaccine (he attributed it to increased work).

We have done a recent set of x-rays, and I consulted two vets independently who both believe she is not currently having active laminitis. They feel her tenderfootedness are likely caused by her lack of sole depth. The most recent set of x-rays can be found in https://ecir.groups.io/g/CaseHistory/album?id=238509 dated 20200115. I have also done a comparison of the last 4 sets of x-rays here for easy reference (20200114_Case History Trim Comparison.jpg), and attached her current body condition and latest hoof pictures. 

I wanted to seek a view on what the x-rays are telling us, and whether she is likely to be actively laminitic or what the cause be for her recent lameness issues. I did find what appears to be an abscess exit wound on the right fore, but I am not sure about the left. Is there anything from the information provided so far that points to us not being able to transport her? We have arranged for it to be done on 31 January 2020, and as far as possible I am keen to continue to target that date, as it took me more than 5 months of procedures and coordination with various parties to secure the date. She will definitely get better care long-term in this new location and access to the important diagnostic tools so we know what we are dealing with. I believe the journey itself is not long, not more than a couple of hours as it is less than 20km away, but as it is a different country, import procedures and quarantine (2 weeks) apply.

Thank you in advance! 

--
Chuan, Malaysia / Singapore, 2020
Link to Case History : https://ecir.groups.io/g/CaseHistory/files/Chuan%20and%20Kevin
Link to Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=238509


Re: Help - prescription delay

ladyofthewood3@...
 

ok thank you

 

Heather and Rosie
Ontario, Canada
Dec 2017
Rosie's Case History https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Rosie  
Hoof photos   https://ecir.groups.io/g/CaseHistory/album?id=15867&p=pcreated,,,20,1,0,0


Re: Blood extraction protocol

Eleanor Kellon, VMD
 

All pages are very short, information concise and very clear.

You can't spin a serum sample until after the blood clots.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Blood extraction protocol

Maria Duran
 

OMG Dr. Kellon, thank you will take a week reading to find out the answers to my questions haha.

I have read that for insulin, blood can be left to coagulate before centrifuging it, am I right? And for ACTH and insulin it is allowed a 4 hour period before centrifuging, right?

Thank you!
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album
_._,_._,_


Re: Help - prescription delay

Eleanor Kellon, VMD
 

 Most horses are OK for a few  days without it but you can also get Prascend from your vet.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Blood extraction protocol

Eleanor Kellon, VMD
 

 These are guidelines from Cornell: https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Links%20to%20Blood%20Testing%20Information%20at%20Cornell%20University%20Animal%20Health%20Diagnostic%20Center.pdf

Blood not separated from cells within an hour should not be used for glucose.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Help - prescription delay

ladyofthewood3@...
 

Island Pharmacy was delayed sending out Rosie's prescription and I was late calling it in.  The result is we ran out.  Any suggestions on what to do?

She is on 1.5mg Pergolide

**her case history is not up to date....I have had chronic computer problems and have not been able to do it on my phone.  

Heather and Rosie
Ontario, Canada
Dec 2017
Rosie's Case History https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Rosie  
Hoof photos   https://ecir.groups.io/g/CaseHistory/album?id=15867&p=pcreated,,,20,1,0,0


Blood extraction protocol

Maria Duran
 

Hi all!

Yesterday was talking with my vet about the protocol for testing glucose and insulin and there were some differences and interrogants. Could any knowledgeable person fill in the blanks of these sentences please?

Blood is extracted in horse eating hay but no concentrates at least 4 hours after the first meal if there is not hay available during the night and no longer than 6 hours after the first meal to avoid a "fasting" state (know it is not a real fasting). Can be extracted anytime if hay is available ad libitum or in periods of time of no more than 6 hours since the horse started eating in the case of meal feeding routines.

The blood is extracted and collected in a color ____ tube, then it has to be centrifugated before ____hours since the extraction and sent refrigerated at ____°C to the lab and arrived there before ____hours.
If an arriving time of ____hours to the lab is not possible, then the plasma has to be frozen at ____°C in a period of time of ____since collected and sent frozen to the lab. The frozen plasma can be stored frozen for ____days before sent to the lab.

If centrifugating the blood after extraction is not possible, then it must be sent refrigerated, sent and arrived to the lab before ____hours after the extraction.

Both glucose and insulin will lower if this protocol is not respected.

Thank you very much for your help.
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album
_._,_._,_


Re: Trouble Uploading Case History

 

Hi Terri,

it looks as though you have not yet joined the Case History subgroup.  There are two Terri’s there but I don’t think either is you.  Along the left side of the ECIR page where you read messages is a listing which includes ‘Subgroups’.  If you go there, you will have the choice of joining several subgroups, including case history, hooves and Horsekeeping.  Each needs to be joined separately with its own signature file.
Once you find your way there, the instructions should make more sense.
--
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: re-running bloodwork

Eleanor Kellon, VMD
 

Did her ACTH go down with the Prascend increase? Do you have a case history? Can you get ODTB cubes instead of the Standlee timothy?

You only have to wait a few days to retest after a diet change. If you want to know if the change made a difference, wait to start Metformin.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Message Posting Etiquette - Keeping ECIR User Friendly - Wed, 01/15/2020 #cal-notice

main@ECIR.groups.io Calendar <noreply@...>
 

Message Posting Etiquette - Keeping ECIR User Friendly

When:
Wednesday, 15 January 2020

Description:
Message Posting Etiquette

This is a high volume group that can be difficult to follow. Help make it easier for everyone by following the Message Posting Guidelines below:
1) Sign your posts. This is a very large group.  Whenever posting a message, identify yourself and your equine by using your full ECIR Signature with your first name, location, the date you joined and the links to your Case History folder and Photo Album. The volunteers need all this information to provide quality responses and suggestions for local support, vendors, vets and hoof care. 
 
2) Be clear in your posts. If you need to quote a line this is most easily done using the web to reply (not from email). Once you have the message you want to reply to on your screen, copy the text you want quoted, then paste it into the reply message composer.  Highlight the text you are quoting and then click on the quotation marks in the toolbar.  
3) Be considerate of the Support Team. They volunteer to help members in their spare time. Many have full time jobs. Unless you are in an emergency read the Start Here Files and check the archives to see if your question has been answered before.  Many new member's questions are answered there.
4) Discussion should always take place on the forums so all members can learn from the conversation and the support team can help clear up confusion.  
5)  Try not to hijack threads.  Start a New Message or change the subject line to discuss issues not covered by the subject line.
6) Don't immediately re-post.  Give “missing” posts a few hours before reposting. For unanswered messages, be patient. A lack of response is not personal or a reflection on you in any way. With so many posts some do get missed. Unless in an emergency situation, wait roughly 48 hours before re-posting and edit the subject line with "2nd Try". 
7) Off-topic but horse-related discussions: ECIR Horsekeeping Forum provides a place to discuss issues involving non-PPID/EMS horses, general horse keeping practices, other equine health issues, alternative therapies and any equine related philosophical debates.
8) All discussion about horses with PPID and EMS takes place in the ECIR Forum. Hoof related discussion for horses that do not have PPID/EMS takes place in the ECIR Hoof Forum
 Thank you for your cooperation.
 
- The ECIR Group support Team
 
 


re-running bloodwork

TERRI JENNINGS
 

I'm taking my 30 year old Shetland pony (IR, Cushings, Low Thyroid) mare Teeny off of Stabul 1.  Her insulin went from 70 to >200 after mineral balancing, transitioning from alfalfa pellets to Standlee Timothy pellets, raising her Prascent from 3 mg to 3.5 mg and adding 1 cup of Stabul 1 AM and PM.  I'm hoping it is the Stabul 1 that caused the increase.  How long after removing it should I wait to retest?   My vet is suggesting Metformin.  Should I wait for the next blood draw to make that decision or start it now?

I'm having trouble posting my case history but hope to have it up tomorrow.

Thanks for your help,
--
Terri Jennings
Arcata, CA
Joined 2019


Trouble Uploading Case History

TERRI JENNINGS
 

Hello,
I finally got my Case History Form filled out (mostly).
When I click on the link to make a folder, I don't get the option of making a new folder. I get a message that says "I am not subscribed to this group with this email".  However, I am obviously subscribed.

Help would be appreciated.

Thanks,
Terri
--
Terri Jennings
Arcata, CA
Joined 2019


Re: Transitioning from prascend to compounded pergolide

Jan Petersen
 

Thank you both!! I appreciate the information.


--
Jan and RC
Stockertown, PA, USA
Feb 2018
RC Case History ( https://ecir.groups.io/g/CaseHistory/files/Jan%20and%20RC )
RC Photos ( https://ecir.groups.io/g/CaseHistory/album?id=42022&;p=pcreated,,,50,2,0,0 )


Re: Logan Insulin increase

Nancy C
 

It could explain why some horses are not as sick as we might expect them to be but it's not a reason to not treat because that high ACTH is a marker of the disease and how well, or not, it is controlled.
This is a fundamental reason why ECIR Group needs the details of a Case History. Just one of many fundamental reasons why.

The devil is in the details.


--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA


Re: Logan Insulin increase

Eleanor Kellon, VMD
 

LJ,

There are only 2 studies on this. The first from 1982 and a second in 2011 which hasn't actually been formally published. https://www.tapatalk.com/groups/thelaminitissite/acth-bioactive-v-immunoreactive-t19.html

They show that there are ACTH forms or ACTH-like substances in the pituitary of PPID horses that do not have the same hormonal activity but will cross-react on antibody based test assays.

This does NOT mean you can ignore the number. For one thing, the high number means that the pituitary intermediate lobe has uncontrolled output. It may not be all active ACTH but some certainly is and there are other active hormones being overproduced as well. It could explain why some horses are not as sick as we might expect them to be but it's not a reason to not treat because that high ACTH is a marker of the disease and how well, or not, it is controlled.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

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