Date   

Re: Now: WELCOME NINA / Was: "cabergoline. just planning. just in case"

Kirsten Rasmussen
 

Sounds good!  I'm assuming you have an iPad?   My tablet is an android and I can use Google docs to open and edit a word file on it.  It's kind of painful but it works.  If you're using an apple device you probably already know how to view and edit a pages doc?  If not, just Google it to find out how.  Some people have managed to do their CH on their phones, I am in awe of them.  I think the key is having the right app on the device however you do it.  A computer is by far the easiest option.

Good luck!

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Re: Now: WELCOME NINA / Was: "cabergoline. just planning. just in case"

NinaJW
 

I did want to give you some quick information. Jadon (horse) was given the blood test on non fasting/ his hay and water for 12 hours only. No feed no grass. His insulin and glucose where mid range of the normal ranges. The cut of for normal ACTH is 45. With Jadon testing at 59.
no history of any hoof issues. He is barefoot. In 13 years he has never had any colic. Our only issue is weight. He previously had been 2-300 lbs overweight. He is within normal weight at this point with still a little to lose body score 6. He has quit passing iron in his stall over a 12 hour period as well as starting to have tacky gums. Obviously, dehydration/colic seem more immediate a threat than the PPID. I stopped the Pergolide again yesterday. I have access to recent radiographs of his front hooves and will try to get those uploaded. I’m still in a place where I feel like I’m doing more harm than good and am mentally exhausted. He has had a crest neck for the 13 years I have owned him. It was his long hair that got my vet to the test. Although he sheds out well barring the feathers up the backs of his legs. He eat Teff hay mixed with our boarding farm hay. McCauley’s 30 has a total nsc of 15 which my vet said was fine as he only gets 1/2 lb a day and no other grain. I have started supplements to support the PPID and any possible IR. I’ll try to get all this and more details on his case history. 
--

Nina  KY 2020


Re: Now: WELCOME NINA / Was: "cabergoline. just planning. just in case"

NinaJW
 

Thank you. I have read this but will re read it carefully and the information on PPID and IR you referred to o this site,
I am using my iPhone and clicked the forms for that device but I cannot type anywhere except the signature area. I’ll try it on my tablet this afternoon too.
Thank you for your help and I will let you know if I simply cannot get the info online.
-- thanks again 

Nina  KY 2020


Re: CocoOmega Effect on Insulin

Eleanor Kellon, VMD
 

Hi Sherry,

Yes, since she failed metformin she's a candidate for Invokana.  Ask your vet to drop me an e-mail, or give me their e-mail address, and I'll send an information file.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: CocoOmega Effect on Insulin

Sherry Hite
 

Dr Kellon,  I am reposting this message hoping that you can respond.  Thank you for your time.  
--Dr. Kellon,

I started Pepper back on the Metformin but had challenges with getting the medication into her.  After she developed mouth irritation with syringing (tried both water and oil) I changed to sprinkling the medication on her soaked hay.  She most often leaves some of her LMF/ supps behind so mixing it in with them was not a good option.  Her blood was drawn on 3/10/20 after two weeks of Metformin and the insulin result was higher (81.25 ulU/mL) than it was before I put her back on the Metformin (73.79 ulU/mL)    She started to refuse her hay after the blood was drawn so I stopped the Metformin on 3/15/20 since it didn't appear to be helping.  Would you consider her a candidate for Invokana?  Thank you for your assistance!  
-- 
Sherry & Pepper, August 2015, No. Calif

 

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

Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=5798  .

 

 



Re: Invokana dose and pharmacies

Eleanor Kellon, VMD
 

Yes, they can be split. I would suggest using a pill splitter/cutter, available on Amazon, Walmart, from drug stores. You need one that can hold tablets.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Hoof evaluations

Judy and Bugsy
 

Wow!  That's awesome information Lavinia.  Thanks so much.  I will reread this several times tomorrow and I will print out the message along with the photos for the trimmer tomorrow. 

Thanks again!
--
Judy and Bugsy
Regina, Saskatchewan, Canada
Feb. 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Judy%20and%20Bugsy
https://ecir.groups.io/g/CaseHistory/album?id=243358



Re: Hoof evaluations

Lavinia Fiscaletti
 
Edited

Hi Judy,

I've added mark-ups to Bugsy's album:

https://ecir.groups.io/g/CaseHistory/album?id=243358&p=Created,,,20,2,0,0

The overall issues are that the toes are enormously too long on all four feet, heels have underrun and the walls are flaring badly. Fronts are much more affected than the hinds - which is very common. The trim needs to shorten the toes at ground level so that the breakover gets set back where the bony column dictates it should be. That should be the number one priority right now. You won't be able to accomplish everything in one trim but you should be able to make a huge dent in the toes and some of the flaring. Leave the rest alone and plan to go at it again in a week or so. There is enough excess toe length that you could literally use a hacksaw to remove it to make the job more manageable (which I have done in similar situations). The mark-ups are showing where things need to end up within a relatively short period of time: 2-3 weeks tops on the toes and flare removal, heels will depend on how much depth there is to work with. There has been some beveling of the wall flares - just need to get more aggressive with it. The frogs are elongated and narrow, with deep cracks in the central sulcus that run up into live tissue. The sole has run forward like it's on a conveyor belt and is bunching up at the toe, burying the white line. Have a read here:

http://www.hoofrehab.com/Breakover.html

LF dorsal: Blue lines follow the angle of the new growth coming in under the coronary band toward the ground. Blue Xs are what can be brought in even more to align that lower 1/3 of the hoof capsule with the new growth.

LF lateral: Green line (NOT a trim line) follows the angle of the new growth toward the ground. Blue area is all the toe that needs to be removed. Orange line shows where the heels should be. Pink line is how the bony column lines up and is parallel to the pastern angle. Note how the green line and the orange line are parallel to the pink line. Yellow arched line follows the coronary band, purple line shows how it should be if the hoof capsule were correctly hugging the internal structures. Part of the arching is due to the heels pulling the back of the coronary band down and forward so it will level out as the heels move back into position.

LF sole: Blue line is about where the actual hoof capsule should be. The blue hashed areas correspond to the blue on the lateral and dorsal photos = all the flared excess that needs to be removed. Purple squares mark where the heel buttresses are now, orange squares are where they should be: even with the widest part of the frog and with each other. Inside the lime circle is the "butt crack" that should be the central sulcus. This develops when the heels underrun, pulling and crushing the frog and heel bulbs down and forward. That crack goes up into live tissue so is painful, making the horse resist heel first landings. It also increases the likelihood that pathogens will take up residence inside. It will decrease and heal over with time as the heels move back into place.

RF dorsal: Same as LF.

RF lateral: Same discussion as LF.

RF sole plane: Show the "butt crack" from another angle. You can clearly see how it goes right up to the hairline.

RF sole: Same idea as the LF. The purple hashes along the leading edges of the bars are where you can do a bit of bar management as those areas are already loosening up and cracking off. Don't get overly aggressive here as right now, the bars are helping shore up entire foot due to the walls being so heavily damaged and disconnected. Just maintain them where they are for now. Once the rest of the hoof capsule becomes healthier, they will start to crumble and crack away and can be removed at that point.

LH dorsal: Same as fronts.

LH lateral composite: I manipulated the photo to give you an idea of what the hoof capsule should look like when healthy and strong . You can't trim it into this shape right now but that is the goal over time.

LH lateral: Blue area is the excess toe length. Orange line where the heels should be located, green where the dorsal wall should be. Pink line shows how the bony column aligns inside and again, the green and orange lines run parallel to the pink line. Yellow line follows the arch of the coronary band, which should be straight like the purple line.

LH sole: Same as the fronts.

RH dorsal: Same as LH.

RH lateral: Photo is more of an oblique so it distorts the angles somewhat, but the blue area is the excess toe length.

RH sole: Same parameters as the other three feet.

Although the heels need to come back on all four, right now that can't be done as the HPAs (hoof-pastern axis) on all four are broken back. This means the back half of the foot is lower than it should be relative to the height of the front half of the foot, leaving the coffin bones in a ground parallel or even negative plane orientation. If you move the heels back now, that will lower their vertical height even more as an unintended consequence and make the HPA situation even worse. For now, just add bevels 9rockers) to the very backs of the heel buttresses in their current locations but nothing more. Please see the following for more in-depth i nfo:

http://www.hoofrehab.com/HeelHeight.html

http://www.hoofrehab.com/Coronet.html

http://www.hoofrehab.com/HorsesSole.html

He should be in padded boots any time he doesn't land solidly heel first when moving at any gait faster than a walk. At walk, flat landing is acceptable. Toe first never is.

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


Re: water filter to take out iron

Kim Rice
 

This is the RV filter that I hooked up to my horse's water line before going into his waterer.  Easy to install

https://www.amazon.com/dp/B0006IX87S?psc=1&ref=ppx_pop_dt_b_asin_image

--
Kim R, Lafayette, CA  2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee


Re: CoVid -19 and out horses

Lynn
 

It's not in opposition if their own personnel are doing it.

Dr. K is right.  Ohio's directive was forwarded to us boarders at the barn where I keep Relevante...We are classed as a “Full Care Equine Facility”.  The Ohio directive allows for travel and interaction for “care givers” only.  Documented care givers (as listed on insurance etc.) don't include boarders.
Our barn owner's entire family and the full-time caregiver that lives on-site are working round the clock to ensure care continues as usual. For Relevante it is a little more complex since our exercise sessions have been curtailed due to the shelter in place order.
However, I had extra pergolide shipped to our barn owner, we arranged a no contact drop off method to replenish oils and supplements and i hired our barn owner's 16-year-old daughter (since kids are home from school) to take him to the arena, walk him every day and keep his feet picked out. It's not ideal but it is for the protection of our caregivers so that they can keep caring for our horses. Our stay at home order is supposed to end April 6. Hopefully that happens and we can just practice social distancing. Everyone - human and equine - is in my prayers.
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Re: ECIR Donations

Nancy C
 

Oh my gosh Joy! Thank you for letting us know.

You are not alone and we understand that many have to make tough choices and changes.

Hang in there.

Stay safe.


--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 23 - 25, Harrisburg, PA


Re: Invokana dose and pharmacies

LJ Friedman
 


-- why 136 mg??). 
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Invokana dose and pharmacies

Kim Rice
 

My vet has prescribed invokana for my horse at 136mg per day, however, it only comes in 100 mg or 300 mg.

Does anyone know if the pills can be split?

Also, how have response been dealing with Global Drugs?

Thank you.
--
Kim R, Lafayette, CA  2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee


Re: Sweet P meds

Eleanor Kellon, VMD
 

Good. He needed to. Could you post a current picture?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Cushings clipping

Sherry Morse
 

Hi Victoria,

You'll be getting a full greeting email shortly but part of what allows us to help so many people is the all important case history.  Since you don't have that yet can I just ask what medication your horse is on and when was he last tested for ACTH?  Once you get that number under control you may find that you don't have to do as much clipping.  Some of our members have also found that using Chasteberry can help with shedding issues but by itself it will not help treat PPID.

As far as clippers, you're going to need at the very least a large head blade attachment (if you're just planning on a low trace clip) or preferably a set of body clippers.  I trace clipped for a few years using a 2 speed clipper with the large head and it's serviceable for that, but takes about 4x longer than doing the same job with a Clipmaster or other full size clipper.  To do a full clip I wouldn't even try that option.




Re: Cushings clipping

Kirsten Rasmussen
 

Hi Victoria,

Welcome to the group!  I am not very knowledgeable on clipping but I expect someone will chime in shortly.  In the meantime, please take a read through the following message, which summarizes briefly (with links) the ECIR recommendations for horses with PPID and/or insulin resistance.  Questions regarding general horse care should be posted in our Horsekeeping Group, which you can join as well, unless it is specific to Cushinoid or insulin resistant horses.

You've already received an email with instructions for creating and posting Case History for your equine.  Please do take the time to fill one out for us, including putting in your horse's pergolide/Prascend dosage history, bloodwork history and current diet, and after uploading it please add the link to your Case History to your signature.  That way, if you need more specific advice in the future, our members can quickly access the information they need in order to advise you more quickly.

---

The ECIR Group 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.





--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Re: Crab grass hay

dbellusci
 

Thank you Dr Kellon- at least I have something I can try. 


--
Donna and Caz

 

Nov 8, 2016

Chesterfield, NJ

Caz Case History.pdf 

https://ecir.groups.io/g/CaseHistory/album?id=3907

https://ecir.groups.io/g/CaseHistory/album?id=3907&p=pcreated,,,20,2,0,0


Re: Sweet P meds

KATHIE DORVAL <bokayarabians@...>
 

Thank you Dr. Kellon, I am just worried about him. He has gained 50 lbs on the canola meal you suggested for added protein in the diet.
--
Kathie with Libby and Sweet P
Cobble Hill, BC, Canada
Aug 2018
Case Histories
Target Photos
Sweet P Photos
Addy Photos
Cherokee Photos


Re: water filter to take out iron

Eleanor Kellon, VMD
 

  This summarizes options https://www.hillwater.com/resources/iron-removal.aspx and it depends on both level of iron and other properties and contaminants in your water. You need a professional.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


ECIR Donations

Joy V
 

I wanted to apologize to the admins, I've had to temporarily halt my monthly donation to mighty cause for the this group.  My husband is not working and unfortunately, we're not able to continue the donation until he does start working again.  We aren't sure when that will happen, but most likely once the danger of Covid-19 passes.  

I hope everyone is staying safe and being so careful.  

I am very grateful to this group and will be happy once I can start the donations once again.

Take care!
--
Joy and Willie  
(aka FLS Boxcar Willie)

Nevada County, CA - 2019


Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526

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