Date   

Re: Vinnie back on Equioxx

Eleanor Kellon, VMD
 

I agree with Arnica.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Vinnie back on Equioxx

Joy V
 

Cathy,

Good to know!  I loved how Surpass made my arthritic hands feel ;)  I had no idea voltaren is OTC now, that's wonderful news.

Joy


--
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


Re: Stress from Move Precipitating PPID/IR/Laminitis??

lindsaykrauland@...
 

I am also interested in hearing everyone’s thoughts regarding our general management.  

First, the horses are living on a Paddock Paradise track.  The track is grass & dirt.  I do try to keep the grass to a minimum by mowing/scalping and by grazing with other species (cattle & goats).  Further, I chose to build the track in an area of our pasture that was already poor.  Most of the track is built along the worn truck path that we use for access to the back of the property.  I have included a couple photos in my album of the track.  Judging by those, is the amount of grass on the track “safe” for IR horses?  They do nibble what they can from the track, but I honestly don’t think there’s much there.  (And at any rate, I’m not sure how I could completely eradicate the grass, and I’m not sure that would be environmentally safe to do, as the ground is rolling and empties into a creek bed.  I wouldn’t want large amounts of run off washing into the creek below.). Is an IR horse likely to need a muzzle on a track like mine?

Secondly, someone suggested that Audi’s woes may be partly due to a lack of crude protein in his diet.  The hay is low in protein, and we supplement lysine & methionine per Dr. Gustafson’s recommendations.  (Hay analysis & mineral recommendations are in my case file.)  The horses are also getting ground flax.  Are they likely to be deficient in protein?  If so, what is a safe way to supplement that?

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Re: Stress from Move Precipitating PPID/IR/Laminitis??

Sherry Morse
 

Hi Lindsay,

As mentioned in the rather long welcome letter you received if the pain is due to laminitis set off by IR or PPID the NSAIDs will not help with that.  From reading your emails and your CH I would venture to guess that Audi's prior management of being in a dry lot and being exercised daily was helping to keep his IR symptoms in check.  There's a very good chance his being 'a baby' about his feet was due to subclinical laminitis and/or needing better foot care.  Being out on grass in addition to the decrease in work may have helped contribute to his becoming laminitic but our focus here is on getting him better, and it sounds like you've already taken a lot of steps in the right direction before you even got here. 

Once you have his ACTH results back you can plan a path forward with regard to medication for that and we usually suggest a recheck in a minimum of three weeks after reaching the target dose.  At that point, you may want to check his insulin and glucose levels as well to see if they're in the normal range or if he may need more tightening up of his diet to help keep him on track to feeling better.




Re: Stress from Move Precipitating PPID/IR/Laminitis??

lindsaykrauland@...
 

That’s an interesting point, Kelly.  To add to the anecdotes, Audi always seemed considerably more stressed than the other gelding who arrived on our farm with him.  Whereas Mogley took the new surroundings more or less in stride, Audi was noticeably upset by some of the sights which must have been new to him, such as our goats, pigs, turkeys, and (especially) guinea fowl.  He also seemed rather bothered by things that go bump in the night in the woods across our fenceline.  Even before any major dietary changes or the loss of his shoes, Audi seemed unsettled, and then the big changes came, and he never seemed 100% comfortable in his time living with us.  I agree-  I have no idea whether that’s at all germane to the issue of PPID/IR, but that was my observation.
--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Re: Stress from Move Precipitating PPID/IR/Laminitis??

lindsaykrauland@...
 

Thank you for your reply, Dr. Kellon.  I’ve uploaded a photo album.  I am very interested in your thoughts.  

Regarding other horses, yes, we have one other gelding.  His name is Mogley.  He and Audi came from the same farm and were purchased together.  From the moment they arrived at our farm, they’ve been housed together and provided nearly identical management.  Notably, Mogley is considerably younger than Audi (age 9 vs 21).  Mogley came to us already barefoot and has no noticeable arthritis/pain.  However, I think it’s quite interesting to compare the two horses.  I’ve included a single photo of Mogley in Audi’s photo album.    I wasn’t quite sure how else to post it.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Choices...

S Kauffmann
 

I'm looking at some hay analyses and trying to make a choice. I haven't actually seen either of the hays in person yet, so just looking at the numbers.

One has a low ADF (29.9), average protein (8.5), relatively high sugar for what we typically see around here (8.2) and starch of .8, yet the DE for horses is .88. With those numbers, I would have expected higher DE.

Then there is another hay where the ESC+Starch is better (ESC 6.4, starch .5), but the crude protein is 12.8, and ADF is 35, while DE is also .88. 

I would tend to lean towards the second one, for the lower carbs and greater chew time, but is the protein a concern? I'm feeding three horses, one of whom is a chubby, air-fern mustang that I'm struggling to keep the weight off. Not diagnosed as IR, never had laminitis, but could certainly be IR so I try to feed him as such. The other two are young stock horses who need pretty much double the hay the mustang gets, so they are fed separately. 

So, higher protein vs. higher sugar but the same DE...if we're not factoring in chew time, which would be better? If we are factoring in chew time, am I right to go with the second hay?

Thank you!

Susan K in Reno, NV

Member since 2003


Re: Pergolide Veil

 

Julanne, APF is used in this situation to support them through the transition.  You can discontinue it once you feel she has adapted.  Sorry, I don’t have an exact time frame but I would think a week or two would be plenty.  My decision to stop was based a bit on how much they liked it.  I’m sure others will have additional recommendations, informed by their experiences.  

Prascend is what most vets begin with, agreeing to prescribe compounded under certain circumstances.  The tablet is scored in half so the amount of active ingredient in each half is considered to be the same.  You could break one of those halves as well but those two might be different.  So, you can take half a Prascend and ‘dissolve’ it in maybe 10ml of water and give 5ml of that as a means of obtaining a more accurate 0.25mg.

 As I mentioned before, the taste of the Prascend might be offensive.  Another possibility for dosing is to put the tablet into a gelatin capsule.  I’ve never had to do that but I’m sure someone here will know how to obtain suitable capsules.
--

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: pentosan

Heidi Wright
 

Nancy, wow, that is amazing price.  Could you share what pharmacy you are using?  Thanks  Heidi
--
Heidi Wright
joined Aug 15, 2018
5130 State Route 38
Malta, IL  60150
815-761-2341

https://ecir.groups.io/g/CaseHistory/files/Heidi%20and%20Skyler 

https://ecir.groups.io/g/CaseHistory/album?id=69604


Re: pentosan

Helen Connor
 

Hi Nancy,

I'm sure Dr. Kellon can comment on this as well, but I was researching treatments for arthritis and came across an article that said,

"The ability of any given joint supplement to work depends largely on whether or not the inflammation the horse is experiencing is mediated by the particular set of inflammatory mediators that the supplement targets." 

In other words, of the three major treatments on the market (Legend, Adequan, and pentosan), each targets a different inflammatory "agent" (for lack of a better word in my limited scientific vocabulary. The article calls them "mediators."). If pentosan does not work for your horse, one of the others may. As Dr. K keeps reminding us, each horse is an individual and can react differently. 

In addition, this article warns that these drugs are better used before arthritis becomes a problem (as a preventative) rather than as a treatment after extensive damage has occurred in the joints.

The article is at https://www.equisearch.com/discoverhorses/adequan-legend-pentosan-16151.  Reader beware warning: I can't tell if this was written by one of the companies that make the treatments or not. 

Best wishes for you and Vinnie.

-- 
Helen Connor and Blessing (IR/PPID)
Scappoose, OR
Member since May 2017
Case History:  https://ecir.groups.io/g/CaseHistory/files/Helen%20and%20Blessing
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=6847


Re: pentosan

LJ Friedman
 

100 ml $179.00   which pharmacy? thanks 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Vinnie back on Equioxx

Lorna Cane
 

Arnica Gel, or Cream , gives Voltaren a run for its money, IME.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: Vinnie back on Equioxx

cathyjomitchell
 

Voltaren is the human version of Surpass. Just became available over the counter. I think the price is better as well, but don't quote me on that.  I bought some online from Target. It also has a nice scent. I used it for a shoulder injury for my mare and it helped her in that instance quite a bit.  I believe it has been available OTC in Europe for quite some time.
--
Cathy and Natalie (Morgan)
joined 2008


Re: Pergolide Veil

Julanne Baker
 

Thanks for the info! Would the APF only be used for a short time or would this become a permanent supplement? I am using Prascend, not the compounded Pergolide. 

--
Julanne in Florida 2020


Re: Stress from Move Precipitating PPID/IR/Laminitis??

Kelly Kathleen Daughtry
 

I am certainly not a vet and am generally horse- health ignorant but for "statistical", "case study" purposes, I did want to chime in that I firmly believe that stress played a part (perhaps the most very insignificant part) the times Micah foundered (at least one time for sure). Again, perhaps the smallest component and perhaps the founder would have happened anyway but I will remain convinced that stress had some sort of small effect.  I say this simply for the group that collects information/case studies etc. I'm not commenting on this particular situation. Not that it matters or means anything but I know my horse and I am simply convinced - for whatever that is worth (or not worth). 
Kelly

--
Kelly & Micah, Clayton NC

April 2016

Case History: https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20%20Micah 

Photos: https://ecir.groups.io/g/CaseHistory/album?id=1829  .

 

 

          


Re: Attention Invokana (canagliflozin) Users

Eleanor Kellon, VMD
 

Rita,

The Plus is OK.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Stress from Move Precipitating PPID/IR/Laminitis??

Eleanor Kellon, VMD
 

I completely agree with the two points already highlighted - less exercise and stopping pain meds.

The regular exercise helps greatly in keeping insulin in control, as well as stiffness from arthritis.  The one month time frame for deterioration is typical for an insulin issue. Not ruling out a stress component either - not necessarily from high cortisol worsening insulin but everything hurts more when under stress. Do you have any other horses? Your photos will help tremendously.

Hang in there.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Stress from Move Precipitating PPID/IR/Laminitis??

lindsaykrauland@...
 

Hi Lorna, I don't believe his trim is causing any harm. I was fortunate to find a barefoot trimmer right off the bat who is a member of this group and well versed in the DDT+E protocol.

I do have photos and will be getting an album up ASAP. I simply used up so much time getting his case history together yesterday that I wasn't able to compile a photo album as well. But I'll have some up today.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi


Re: Stress from Move Precipitating PPID/IR/Laminitis??

Lorna Cane
 

Lindsay is his trim part of the problem , by any chance ? Do you have current pix ?

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: Pergolide Veil

 

Welcome, Julanne!

Laura posted you some helpful information on APF and I will provide you with what I might do in your situation.  I will also follow up with our group welcome which should guide you in posting a case history for your mare so we can do a better job of assisting you.

What you are experiencing is not at all unusual.  Some horses are more reactive than others.  WhenI first started my horse on pergolide, a long time ago, I did not know about APF.  My vet warned me that Logo might act a bit weird for a few days (he did) but that passed and I didn’t think another thing about it.  Many years later, when I switched him to a different drug of the same type, he experienced an amazing veil, which I did not expect.

If she is appears to be improving, I would just wait it out for a few more days.  If not, I would go back to the 0.5mg, which she apparently tolerated well, add APF and then wait a few more days before trying to increase again.  You can also make the increases even smaller by using water to dilute the dose, keeping the extra in the fridge until the next day.

Stopping her supplements for a bit isn’t usually problematic except that it’s not a good idea to stop Thyrol L without tapering it down.  I assume she is on that as a weight losing aid as that’s how it’s often prescribed but it’s effectiveness generally diminishes with time.  You may wish to consult with your vet on that.  The other two supplements may not be helping much anyway.  Remission is mainly given to provide magnesium.  Once you have your hay tested, you may find you don’t need to add magnesium but, if you do, that can be done much less expensively.

In terms of administering anything important, I suggest using an oral syringe.  Pergolide can be mixed with water and, while not stable that way for storage, keeps for a few days.  The instructions for doing so vary a bit, depending upon whether you are giving Prascend or compounded pergolide.  If your vet thinks continuing Thyrol L is important, you can give that by syringe as well.  I generally just pop the capsule in the mouth, distract them for a moment until it heads the proper direction and follow with a treat.  Horses don’t seem to find pergolide very tasty so, if you are using Prascend, you could put it into a gel capsule or try compounded powdered pergolide, which should be already encapsulated.

I’ll be looking forward to seeing your case history, especially more details about what prompted an ACTH test.  What follows is lots of good information about the workings of the ECIR group with many links to help you help your mare.

Welcome to the group! 

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. 

 

 

--

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


 
 

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