Date   

Re: Dr.Kellon Blood Test Results Please Advise

Lorna Cane
 

Hi Marjorie,

"I’m sorry that I am full of questions but I just want to do what is best now that I have the knowledge your group has given me. Before the fall of 2019 he had been boarded at a vet’s farm whose approach to the IR diagnosis(if you can call it this without bloodwork or any diagnostics) in 2013 was to remove him from round bale feeding & only allow him a few flakes of first cutting. I trusted what I was told & will forever feel like I failed and have regret. I’m very grateful for all of you, your knowledge, dedication, & help!"

Questions are good things. That's what we're here for ....we can all learn someting from answers to other people's questions. So.....ask away.

Also, we don't allow members to beat themselves up ! (  "...will forever feel like I failed and have regret " ) That's a waste of energy, which is needed to  improve the quality of life for our equine partners.

Re: APF , it is a good idea to begin it several days ahead of beginning pergolide meds ( although I never had veil issues with any of my 7 PPID boys ). I think the regular APF is fine for this purpose.

Onward and onward. 😊

--

Lorna  in Eastern  Ontario
2002


 


Dr.Kellon Blood Test Results Please Advise

Marjorie in MI 2020
 

Hello All,

 

I got Harley’s blood test results back last night and our suspicions were correct, he is positive for PPID and IR. His blood was drawn during active snow & cold weather so I’m hoping his results are a bit exaggerated but regardless they’re too high to be anything but positive. My vet is prescribing Prascend starting with 1/2 tablet for a week and then increase to one tablet per day.  I have downloaded and read Dr.Kellon’s advice on helpful ancillary supplements to help with the veil effect but I still have a few questions. 

 

Facts

-Blood drawn after eating “unlimited” hay during the four hours prior to each draw but it was actively snowing & in the twenties here

-ACTH Stim Test Results Pre: 75.8pg/mL(normal 9-35pg/mL) Post: 830pg/mL (normal 9-110pg/mL)

-IR Results: Glucose 80mg/dL (normal 71-122mg/dL) 

Insulin 79.33uIU/mL (normal 10-40)

Leptin is still pending

G/I Ratio=1 RISQI=0.11  MIRG=11

-Harley has lost 1.5” off his cresty neck just since finding your group & introducing your emergency diet followed by Dr.Kellon’s balanced diet in January

 

Questions(please forgive me if I’ve missed this info in previous posts but my brain is currently overwhelmed & anxious & I’ve been searching but haven’t found these exact Q&A’s):

-Do you agree with my vets suggested dosing & introduction of the Prascend? He is a picky guy at times so it is my plan to use the syringe/dilution method until he hopefully accepts the bitter taste.. is this the right way to start the program?

-I’ve ordered APF. Do I need to have him on this for a few days before starting the Prascend? What dosage of APF should he be getting for the best results? Is there any added benefit with using the APF Pro vs the original APF?

-Jiaogulan.. his Lung EQ supplement has 1500mg in it but do I need to buy this separately and increase his dose or would he be better served if I add a supplement such as Laminox so that he’s getting the extra amino acids too?

-Phyto-Quench: I’ve ordered this to have on hand if he gets sore but do I need to introduce it during this veil period or only add in if he shows signs of soreness? I realize it has great antioxidant properties so I’m questioning if he needs to be on it as part of his daily regime or saved and added for sore days that could be headed our way?

-Biotin: Har currently only gets 2.5mg of this from his Uckele U Balance Foundation  should I increase this to the recommended 20mg?

-Dr.Kellon, you balanced his diet and stated, “I would stop both the Uckele Grass Balancer and CA Trace, start a half dose of U Balance Foundation https://uckele.com/u-balance-foundation.html plus 1 oz of iodized salt, E and flax.” Can you please verify what dose of salt, vitamin E, & flax you want him on total? I have stopped the other two mineral balancers and he has finally accepted the U balance foundation & is up to a half dose(113.4g). Insert happy dance as this was a feat! 

-Alfalfa Hay: I know this is not recommended by the group as some horses are sensitive but Harley has had a small mix of alfalfa in his hay his entire life. He currently shows no sign of laminitis from his current third cutting hay(hooves are cool, no bounding pulses, no obvious signs of soreness) which is a mixed grass & alfalfa and the hay analysis came back at ESC of 5.0% and starch of 0.5% which was used with my diet balancing. Do I need to remove this or try & replace any of his daily 12lb of third cutting with TC Naturals Balanced Timothy Cubes? (He also gets 10lb of first cutting which is ESC 6.3% and starch 1.2% but little to no alfalfa) What other signs of intolerance do I need to be on the lookout for?

 

I’m sorry that I am full of questions but I just want to do what is best now that I have the knowledge your group has given me. Before the fall of 2019 he had been boarded at a vet’s farm whose approach to the IR diagnosis(if you can call it this without bloodwork or any diagnostics) in 2013 was to remove him from round bale feeding & only allow him a few flakes of first cutting. I trusted what I was told & will forever feel like I failed and have regret. I’m very grateful for all of you, your knowledge, dedication, & help!

 

Thank you in advance! 

--
Marjorie in MI 2020
Harley's Case History:  https://ecir.groups.io/g/CaseHistory/files/Marjorie%20and%20Harley


Re: hind gut

 

Probably not, LJ.  There was a point when each of us didn’t know that as well as an earlier one when none of us knew that.  It’s all evolving.
--
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: Stabul1

 

I feel like someone else reported a similar experience fairly recently, as in months, rather than years. I think it was about the same time that Stabul1 became available through Chewy.  Have you posted about this before, Dona?  So much of figuring out how to best care for these guys involves determining out what does or does not work for them.  Fortunately, Guinness gives you good feedback so you don't go too far astray.
I don’t think of my guys as being all that sensitive but I have a bag of Stabul1 I’m about to open, not having used it in several years due to TSC insufficiencies.  I will definitely be watchful, once I start feeding again.  My horses get Cavalor F/F as well, but only by the cupful.
--
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


 
 


hind gut

LJ Friedman
 

general knowledge:
am i the only one that didn’t know the hind gut is the large intestine?  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Chasteberry question

 

Thank you Dr Kellon...that is the only thing I could glean from everything I read. Having dealt with a Newfoundland with cushings and going round and round with vets who insisted she only needed her Rx med once every 24hrs only to find how quickly the half life was in the system and she needed it every 12hrs...every single day....this didn't make sense to me. I realize Chasteberry doesn't work the same but I gave it to her alongside her compounded med and never gave her a break. It just didn't make sense to me. But this is my longest living horse I have owned and he just started showing symptoms this past summer where I needed to body clip him so I hadn't planned on doing labs til spring when I get the vet out to test my IR mare. 

--
Nancy and Akira
3/20/2018  Burkesville KY

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


Re: Stabul1

Lorna Cane
 

Hi Dona,

"And no in the last month since starting the Stabul 1 I have not had any blood work done, nor do I have time with Guinness to keep going to with the Stabul 1 and have blood work done. "

I had actually wondered if there had been blood work since last May , not last month. But I'm guessing the answer is no.

Just trying to help you  suss out  what's going on with your boy.

--

Lorna  in Eastern  Ontario
2002


 


Re: Stabul1

donabcalhoun@...
 

The diet in his case history was the same until I made the most recent change - removal of cavalor, inclusion of Stabul1.  I had not updated his diet because i was just in the process of making that change in the last month and it was not yet finalized, so it would have been premature to update.  And no in the last month since starting the Stabul 1 I have not had any blood work done, nor do I have time with Guinness to keep going to with the Stabul 1 and have blood work done.  He can go from fine to critical in no time, so I have made an immediate change 3 days ago stepping back and already I am seeing improvement - the only change is in the removal of the Stabul 1 and reinclusion of the Cavalor Fiber Force starting yesterday (when I could purchase a bag).  I was interested to hear if anyone else has reported similar findings - it may just be us.  I know there is not a lot of Alfalfa meal, but .....
--
Dona and Guinness
December 2017, Rougemont, NC
Guinness Case History:  https://ecir.groups.io/g/CaseHistory/files/Dona%20and%20Guinness 
Guinness Photo Link:  https://ecir.groups.io/g/CaseHistory/album?id=69379


Re: Old case history details...?

 

The Case Histories that make the most sense to me (not my own, please don’t check!) are the ones that have an entry for starting a supplement and another entry for when it was discontinued.  It gives the most complete picture, in my mind.  I don’t believe striking them out allows us to see when it was stopped.
Thanks for asking about that!
--
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: Old case history details...?

Lorna Cane
 

Hi Joy,

If it were me I would leave everything there,to provide a history,let me see what I've tried,what didn't 'work',etc.

I like your idea of striking out those items no longer used.

i defer to what the Support Team suggests,though,if this isn't what is wanted.

--

Lorna  in Eastern  Ontario
2002


 


Old case history details...?

Joy
 

Good morning all from me and my mostly cranky mare.  (is it PPID or PMS? we need a study.)

I'm updating our case history and was wondering if I should be deleting the old information from feeds, herbs and supplements given in the past.  I guess the word case "History" makes me think I should keep the old info. and add the things I'm doing now.  But there are things I'm not doing anymore and no place to indicate that I've stopped them.  Thoughts?  I thought about striking through the the entries of things not being done.

thanks for your help.
--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy


New Study

Eleanor Kellon, VMD
 

I just uploaded a study looking to see if high soluble fiber lowers glucose and insulin responses in horses like it does in people. It didn't. The glucose and insulin numbers reflected the sugar and starch levels, just like you would expect, with one exception.  Despite very high sugar levels, almond hulls caused a low response. Researchers thought this could be because they were eaten slower but there's another possible reason.  The sugars are difficult to extract, requiring long duration soaks, multiple soaks and a high ratio of liquid to hulls. This could work in a  cow's rumen where high fiber foods will remain for up to 48 hours but a horse's stomach empties out within 2 hours and food packs down rather than being agitated in a high fluid environment.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


New file uploaded to main@ECIR.groups.io

main@ECIR.groups.io Notification <main+notification@...>
 

Hello,

This email message is a notification to let you know that the following files have been uploaded to the Files area of the main@ECIR.groups.io group.

Uploaded By: Eleanor Kellon, VMD <drkellon@...>

Cheers,
The Groups.io Team


Re: help with deciding how to move forward - new PPID diagnosis

Eleanor Kellon, VMD
 

Lucinda,

I meant hay balancing. You're set.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Chasteberry question

Eleanor Kellon, VMD
 

I'd like to add the 3 weeks on, 1 week off was based on human reproductive cycles, not equine, so it never made sense.  Even in people there's really no basis for it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New TRH stim results for Ruger

Eleanor Kellon, VMD
 

Hi Aunna,

I didn't see any mention of APF in your history. If you didn't use it, you should try it next time you start pergolide. There's also a good chance his response in terms of lowering ACTH was poor because it was started at the peak of the seasonal rise.

It's reasonable to give him a break now when his levels are good. Start APF early August and after 2 or 3 days try 0.5 mg pergolide. Increase to 1 mg after a few days if everything goes smoothly. Test ACTH end of August.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


New TRH stim results for Ruger

riggslippert@...
 

Hello,

Ruger has improved since my last message.  Honestly, it seemed to me that getting him off of the Prascend did the most good for him.  His attitude and energy level have returned to normal.  It is also interesting to note that while on Prascend, his social status fell from boss horse in his group to lowest.  This also reversed once he was off the Prascend.

I implemented all of Dr. Kellon's suggestions for helping his muscle mass.  I increased his flax intake, although he was unable to eat 1 lb/day, it was probably about 3/4 lb.  He was also started on double dose Top 3 Aminos and HMB and DHEA at the recommended doses.  His muscle mass has improved in spite of minimal work.  I do think his hair is longer this winter, but he started shedding in late January, which is typical for him.

I have updated his CH--the new ACTH results are:

Pre TRH ACTH 15.7 pg/mL (range 9-35 pg/mL)
Post TRH ACTH 201 pg/mL (range 9-110 pg/mL)

So he is clearly in the PPID range after stimulation, although his resting level is not.  Does this mean I should treat with pergolide only during the seasonal rise?  If so, when should I start it?  Should I wean him onto it and monitor his response similar to how I did it this year?  Our first experience with pergolide does not encourage me to give it any more than is absolutely necessary, although I know most horses respond positively and Ruger's reaction is atypical.

Thank you to everyone for your ongoing advice!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




Re: NEW MEMBER - QUESTIONS

 
Edited

Welcome to the ECIR group, Joe!  Thank you for being so organized and having everything already in place.

I think you’d be smart to follow the ECIR protocol in terms of how much hay to feed.  Most laminitic horses are not moving around a lot.  Ambling around the yard does not count as exercise.  

Horses are grazers so their guts do best on small, frequent meals.  I’m sure there will be some interest in what you’re doing for interval feeders.

Exercise is indeed a crucial part of the plan, but only once they’re comfortable enough to participate willingly.  We tend to focus on the other aspects of the plan, probably because they’re more quantifiable.

Depending on how long ago your hay was tested, they may still have the sample there.  I don’t know what the time frame is but I’ve seen that possibility discussed.

What follows is an official ECIR site greeting, introducing our approach.  You have most likely read through this already but let us know if you have more questions.

 

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: Louis the mini - Starting on Pergolide

Lavinia Fiscaletti
 

Hi Glenys,

Thanks for adding more pix.

Whether the heels need to be dropped or not is going to depend on what the rads tell us regarding the alignment of the bony column. The "pressure on the DDFT" argument is a persistent belief that just won't die. There is absolutely no actual research to support that theory.

It looks like he has a lot of extra hoof capsule in general, but there is also a significant amount of sinking that needs to be accounted for as well. Lots of evidence of past problems but at the moment, there is nothing horrible that warrants major changes before the rads are done. The heels are somewhat underrun, so that will need to be addressed moving forward, breakover may need to move a smidge further back but lets wait for the rads to make the decisions on exactly what needs tweaking.

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


Re: Stabul1

Sherry Morse
 

Hi Dona,

As Lorna already mentioned - we really need some more information from you.  Is the diet still the same as it was when you had the bloodwork done or did you change it after you got the results back?  If you changed it, did you have any follow up bloodwork done to see if his levels improved?  It could be just a coincidence that he started to have an issue after you started the Stabul 1 but without more information we're just guessing.