Date   

Dried Oak Leaves - Donkeys

Philippa
 

Hi

I was wondering if anyone knows if dried oak leaves are safe for donkeys to eat? I know that acorns & green leaves are not good - but am unsure about the autumn leaves. My donkeys seem to Hoover them up when they blow into their paddock. One of my donkeys has Cushings & has had chronic laminitis over the last year which has been under control until a couple of days ago after wind blew more leaves in. I’m trying to source the trigger. But it could be the wormer I drenched them with?

Any advice would be appreciated  

Thanks  

Philippa  



--
Philippa New Zealand 2020
Case History: https://ecir.groups.io/g/CaseHistory/files/Philippa%20&%20Abraham  ;


Re: Thoughts on laminitis episode for Canadian mare

Sherry Morse
 

Hi Pat,

While Willow is very cute there is definitely a bit too much of her to love.  If her current weight is 1200 her ideal is probably closer to 1100 (or less).  Based on that she should be eating no more than 22 pounds TOTAL per day - including hay and concentrates.  You can read the diet section of the website for information on this - https://www.ecirhorse.org/DDT+E-diet.php.

You have her current intake listed as 25 - 30 pounds of hay a day and she appears to still be out on grass for some period of time as well. At this point, until she's lost weight and her feet issues are resolved, the best thing you can do for her is get her into a dry lot or she needs to wear a completely closed muzzle when she is turned out and obviously this should only be for very short periods of time as she'll need to be able to drink which won't be possible with the closed muzzle.  Then her hay needs to be weighed and she needs to be limited to the 22 pounds a day so she can start to safely lose weight.  If the hay isn't tested please follow the information in the emergency diet and make sure it's soaked before being fed to her. 

Information on the bloodwork that you need to request from the vet is in the welcome email Kirsten already provided but I think it's a very good guess that she's IR and getting her diet and trim in order will go a long way to helping her feel better.  Until she's had time to adjust to the new trim I would not be forcing her to do any exercise and there's nothing wrong with leaving her in boots so she's comfortable enough to move around on her own.





Re: WAS: Question for the Canadian folk / NOW: Lecia & Flyte's photo album

Kirsten Rasmussen
 

Great!  Let us know when you have photos uploaded, then we will give you your next assignment (sneak peek: putting all of Flyte's case history information into one folder, and adding that link to your signature).

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


Re: ALCAR questions

Jennifer Murphy
 

Thank you for responding; his dam was a miniature horse. 
He's been pretty sore and slow for a long time, but maybe it was sore muscles.  My vet is coming back in three weeks to do another round of blood work as he's finally eating his meals with the Metformin in them, I'll ask her what she thinks.

--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Re: Current Sinking Founder- 7yr Pony

Kirsten Rasmussen
 

Good to hear!

Ideally you would taper off the NSAIDS so there is no rebound effect, which can increase pain.  The jiaogulan and Devil's Claw can be started anytime, even while on NSAIDS. 
  
From our files:

Start tapering by keeping the current dose the same but stretching out the intervals between doses. E.g.:START: 2 grams bute once a day
DAY 1 through 3 of Taper: 2 grams every 36 hours
DAY 4 through 6 of Taper: 2 grams every 48 hours
DAY 7: 1.5 grams every 48 hours
DAY 8: 1.0 gram every 48 hours 
DAY 9: 0.5 gram once, then stop
 

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


Re: UK bloodwork results help for Red and Kim

Kirsten Rasmussen
 

Hi Kim, thanks for updating it before posting!  There is a place on the first page of the Case History where you can write the date it was updated, too.

The link for your Case History in your signature should be changed to:
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Red

Sounds like he is doing much better so I am happy for you!  That ACTH is high.  The thing with not treating it with pergolide is that PPID is a progressive condition, and has effects other than laminitis, like: compromised immune system, enhanced allergic reactions, muscle loss, increased soft tissue injuries, etc.  I would think it warrants medication even if the insulin isn't elevated because of it, but maybe some of our more experienced volunteers or Dr Kellon can add their input on that, and on why the MIRG suggests IR but the rest of the bloodwork is normal.

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


Re: Current Sinking Founder- 7yr Pony

Victoria
 

Update- this morning she was more alert and evening standing a little better! Which is actually more confusing because I don't think she actually got any meds yesterday. Today I syringed the dissolved metformin, 2g bute paste, 2 gabapentin pills (force fed). This afternoon-still alert and moving around more! Farrier came to lower heels to relieve toe pressure. I noticed she is more curious about the timothy cubes and even had a few bites so it would be amazing if I can get her off of the hay so I know she's will be eating healthier. Still giving her soaked hay for now as well. She ate the thyrozine mixed with chia, ration balancer, 1000IU vit e, salt, turmeric. Then she got her pm dose of metformin. Should I skip the bute paste and gabapentin tonight? Thank you all for your help. Any other suggestions are appreciated!

--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218



Re: Hemp Bedding

celestinefarm
 

It can get stuck if it is too small.  Maybe increase the size of the "peas".. The idea with pea gravel is that Dr. Bowkers studies have shown it increases blood flow and hydraulic flow through the feet and allows the horse to position their feet where they are comfortable.

I believe Dr. Bowker's presentation to the ECIR group on this study is available to download at no charge. I don't have time to find it for you , maybe one of the mods can link.

--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Re: Thoughts on laminitis episode for Canadian mare

Rhonda Turley
 

I too have a wonderful Canadian gelding.  This group was a lifesaver for him. He foundered during the covid shutdown.. Canadians are known as easy keepers.  I have many Canadian owners/breeders on my facebook page if you would like to talk to others.  My gelding is now sound and back in light work.  Follow the directions provided here for best results.
--
Rhonda Turley
Brampton, Ontario
April 2020
Scooter and Rhonda     


Re: Question for the Canadian folk

Rhonda Turley
 

it took me several months to get my horse's case history.  I had to nag, email, phone to get my vets to email me the actual results from testing.  
--
Rhonda Turley
Brampton, Ontario
April 2020
Scooter and Rhonda     


UK bloodwork results help for Red and Kim

Kim Bergin
 

Hi there,

I have just uploaded an updated case history form with blood work results and updated the photo album with xrays (although I'm currently missing RF lateral xray view). Please can someone with experience of UK measurements take a look at the bloodwork results and let me know what your diagnosis is? The EMS calculator says High Insulin responder with MIRG only. What does this mean?

ACTH levels did come back high but because the insulin blood levels were lab normal our vet said not to worry?

He is currently still on 11kg soaked hay per 24 hours but is moving very nicely on both hard and soft surfaces. He is not on any painkillers. He is stabled during the day but at night is out on his own in our 20m X 40m sand arena with freedom to roam between haynets.

Until we understand more about the blood results we are not sure how to progress from here?

--
Kim Bergin UK 2020

Case History URL: https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Red/Kim%20and%20Red  .


Photo album URL: https://ecir.groups.io/g/CaseHistory/album?id=252613


Re: WAS: Question for the Canadian folk / NOW: Lecia & Flyte's photo album

Lecia Martin
 

oh my gosh I think I got it finally!  Woo hoo! Now for the photos etc. It may take me some time to figure out how to go from phone to computer.   Thanks Kirsten and Sherry
--
Lecia Flyte and Flame
Alberta, Canada


Re: General Advice

Carrie Bronner <carrie.espanasilk@...>
 

Thank you so much for all the information! I printed out the emergency diet and will be implementing that immediately. I also have a call in to my vet for the bloodwork. I will fill out my case file as soon as I have all the required information! Thanks again! I believe this site will be indispensable! 
--
Carrie Bronner
Indiana, United States
September 2020


Re: Current Sinking Founder- 7yr Pony

celestinefarm
 

Dr. Kellon,
Metformin in humans can cause non absorption of Vit B12, which is a critical vitamin for various functions of the body, including neurological functions. Vit B12 supplementation is normally Rx along with Metformin.  Is this a possible concern in horses on Metformin?

-- https://www.mayoclinic.org/drugs-supplements/metformin-oral-route/before-using/drg-20067074
See under "other medical problems". I bring this up because my sister in law was on Glucophage for a while and Vit B 12 deficiency became a serious problem for her, manifesting itself in uncontrollable hand shaking even when her blood glucose was in a controlled range. Along with other issues, she had to discontinue it.

Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Re: Thoughts on laminitis episode for Canadian mare

Kirsten Rasmussen
 

Hi Pat,

Welcome to the group! 

Sorry to hear Willow is sore.  She is a beautiful mare!  I read through your Case History and I have a couple comments.  First, the Dr. Reeds (you don't say which one) and the red salt block are high in iron and iron worsens insulin resistance.  I suggest plain white salt (loose or a block) and stopping the Dr. Reeds for now.  I can tell you from personal experience that Dr. Reeds does not add much of value to your supplement program and that a real mineral supplement matched to your hay will be a huge help in healthy hoof growth.  There are details below in your welcome letter with links on testing hay and getting your minerals balanced to your hay so that deficiencies are corrected.  Heiro is not harmful, but it is expensive snake oil...been there, done that, too!  There is no evidence to suggest that it works, regardless of what their website says!  What works are the dietary changes we recommend here and on our website.

Second, if she is sore, do not exercise her.  If she is walking well in her boots (with pads if you have them), then some hand walking is probably fine.  
As for exercise long-term, we recommend waiting until the hoof wall has regrown with a healthy connection at least half way down the hoof wall.  If you can get her laminitis under control now through dietary changes, that will be about 6 months from now.

It sounds to me like your trimmer is on the right track by removing the walls, IF they were flaring and not supporting her weight anyways, but we can't know that or advise on the trim without seeing hoof photos.  When the walls are removed, however, if the horse is tender then boots with soft pads are definitely needed.  It sounds like you are doing that already, but I just want to emphasize that it is important and they should be on 23/7 until she is more comfortable without them.  We have very detailed instructions on taking hoof photos correctly that I recommend you review before you take them and post them (see the link in the Trim section below).  Sometimes, long after shoes are removed, pain can show up in the hoof if there was pathology present when shod for long periods of time, but it doesn't sound like that is your situation and I think you are right that the grass triggered this.

If you can change her diet and management enough to get her insulin under control then her prognosis is good.  Your farrier is right  -  no more grass (this can be revisited later when she has recovered and is back in full work, but it will always be very limited, if at all).  If people are unable to make the changes that are needed for their particular horse (some are more sensitive to dietary sugars than others), laminitis typically recurs over and over, sometimes getting worse each time as the bones in the hoof are damaged over time, and the horse often ends up being more of a pasture ornament or eventually put to sleep if they have a bad founder.  I say that not to scare you but to emphasize that managing diet and exercising a sound horse are the best things you can do to prevent this from happening again, especially as she gets older and IR can get harder to control.  Our first recommendation is to get a diagnosis so you know what you are dealing with (how high is her insulin now, and is her ACTH also abnormally elevated for the time of year), so read through the diagnosis section and consider having your vet come out again for a blood pull.  Otherwise, if you don't know what you are dealing with, making changes can be harder because you'll always wonder if its necessary.  For me, seeing my horse's elevated insulin on a dry paddock with soaked hay made it clear to me that he could no longer go to his summer pasture...before I saw his blood results I thought we could still make it work, after I realized his situation was serious enough that I had to make major changes.

The following is the standard welcome letter all new members get, it is packed with information so read through and click on the links for the things that are relevant to your situation.  
Ask questions if you can't find the answers, we are here to help!


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 and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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: Hemp Bedding

regina bruno
 

Dawn, I use pea gravel and find it stuck around the frog from time to time.  do you have that problem?

--
Regina and Smokey
June 26, 2017
Laurelville,  Ohio

 https://ecir.groups.io/g/CaseHistory/files/Regina%20and%20Smokey  .
https://ecir.groups.io/g/CaseHistory/album?id=8316  .


Re: Aged Pregnant Mare help!!!!

Frances C.
 

Wow! a 25 year mommy mare! How far along is she? If she is carrying more weight then the pain factor may be reduced once she foals. If she is diagnosed with PPID you should take precautions as the hormone imbalance can disrupt the milk supply and also the labor process. PPID can cause a horse to be weak. To ensure the best outcome for the foal I would have a supply of colustrum in the freezer. The vet should be able to locate some. Really watch your mare for signs of labor, which can be false or disrupted and have a "heads up" with your vet for emergency delivery. The foal can be delivered, early, late, viable or not. My 23 year  old PPID mare did not make it but that was many years ago and things have improved. I did have a successful outcome with a DSLD mare who was in a great deal of pain. It stunted the baby's growth in utero. Wishing you all the best and a very happy outcome.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Re: Dx Question

Sherry Morse
 

Hi Suzanne,

So the bloodwork basically confirmed what we already guessed.  As LJ pointed out many vets think that putting a horse on Thyro-L will help with insulin control, but this was found to not be true in studies.  What it will help with is weight loss which Valentino may or may not need (hard to judge without pictures and a current weight vs. ideal weight which is missing from his CH).  

Were he mine I would stop the free choice hay and start feeding him 2% of his ideal weight and I would have the hay tested and then contact a balancer to get him a custom mineral mix to compliment the hay you're feeding.  The Tribute Ration balancer is higher in fat and higher in ESC+starch than we recommend for IR horses and also has added iron which is a big no go for an IR horse.  Until you can test hay and get the minerals balanced to it you can feed him Rinse/Soaked/Rinsed beet pulp and follow the diet in the initial welcome email you received.  I would also take him off grass or limit turnout to only when muzzled out of an abundance of caution as we're in a pretty treacherous time of year for an IR horse.  Fortunately his exercise program is probably helping keep his insulin levels down and you want to do everything you can to keep him healthy.



Thoughts on laminitis episode for Canadian mare

Pat
 

I've had Willow less than two years. She is a very easy keeper. I am still learning how to manage her best. I've had her on full board for all except the first four months. Her feet were good when I got her and former owners only shod her for competitions. So I removed front shoes this July - she had them for a year. She was in pain because of soft sole so I got her some boots, which she wears most of the time. (I remove and clean, etc)

So for two months she has been a bit better then a bit worse then a bit better etc. in terms of soreness. She has only had light exercise - groundwork and walking. Sometimes with boots and sometimes without. She had access to grass during this time. There seemed to be steady improvement as her walls grew in and her sole toughened up.

In late August, she was left out on grass for up to six hours while I was away and was in very bad shape when I got back. Farrier did a trim and then she was terribly sore (would not walk without boots) and four days later she saw the vet. The vet says laminitis but I think she said mild .... (I was in a bit of shock and didn't ask as many questions as I should have.) The individual who told me she was left our for six hours on the grass has now changed her story to 2-3 hours. This person is convinced that the reason Willow is suffering is because I took the shoes off. And that this has caused the laminitis. Even though she has nothing but slow walks and a few trot circles 3 x per week since the shoes came off.

I am moving her to a barn at the end of September where another mare's weight is carefully managed and she is fed 3 flakes over three feedings a day of tested hay (although owner does not have test sheet). I can test the hay when I get there.  I have read info about balancing minerals and will do so once I get her to the new place.

I guess I am trying to figure out 1) how much soreness is from removing the shoes and how much from laminitis, 2) what willow's prognosis may be and 3) how much she should be exercised right now (if at all) and over the next year. I am trying to get a follow-up call from the vet but have been unsuccessful so far. The farrier I have was highly recommended. I think she is trying to build up the heels a bit. But its very difficult to know who is "right" in this industry.

Thanks very much,

--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Re: General Advice

Kirsten Rasmussen
 

Hello Carrie,

Welcome to the group! 

Its great that you are being proactive and joined the group before a laminitis event!  Most people arrive here in crisis or at the tail end of it.  So well done!  Please do take the time to fill out a Case History so that we can find all your mare's information in one place, as well as any details missing in your post.

Yes, is sounds very much like she is IR, however, we really do recommend having the bloodwork to base the diagnosis on.  Until then, definitely treat her as IR.  At this time of year, the TFH Stimulation test is not done.  Instead, you can do a baseline ACTH, insulin, and glucose test from a single blood pull, although your vet will have to process the sample by centrifuge and separate various components for the different tests.  Leptin is optional, it can be a bit expensive and is not critical for diagnosis.  Non-fasting means the horse has had access to her usual forage (in your case you can test her while on the soaked grass hay as she will still likely have abnormal insulin given the signs you've described) before the blood pull, and for at least 4 hours in the morning if she ran out of forage overnight.  Make sure the blood is kept on ice or refrigerated until your vet can process it, and then frozen before shipping with ice packs.  We generally recommend Cornell for bloodwork, which has discounted shipping labels your vet can download from their website.  Do not test her after trailering or exercise or any other kind of "stress" as this can falsely elevate insulin and ACTH.

Because of all her body signs of IR, I would stop feeding everything  -  including the limited grass  -  but the soaked hay right now (as well as the other items in our emergency diet, see the "Diet" section below).  Yes you could feed her minerals on a small amount of rinsed-soaked-rinsed beet pulp but its high in calories so only feed the amount of beet pulp she needs to eat her minerals.  However, the Tribute Essential K is high in iron, and has a soy-alfalfa-wheat base as well as added molasses, all of which are problematic for IR horses so I personally would stop that as well and replace it with a custom mineral supplement that matches the deficiencies in your hay.  To do that, you will need a hay analysis with major and trace elements, as well as ESC and starch (done by wet chemistry methods).  If you cannot test your hay because you buy it from a dealer as you need it, there are other mineral mixes like California Trace that are free of iron and added sugars, and will help probably about as much as the Tribute Essential K without the added harm from the iron etc.

What follows is our standard welcome letter.  Take some time to read through it, clicking on the links that are relevant to you for more information as needed.  And let us know if you have any more questions.


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 and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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   

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