Date   

Re: Lame on fronts - what do I do next?

 

Hello Stephanie,
You came to the right place to learn what you can do for your horse, diet changes, blood tests, etc. My first advice to you is to go to our website for an excellent overview of Equine Metabolic Syndrome, Laminitis, Cushings. Additional sections cover Diagnosis, Diet, Treatment, Trim and Exercise. You will find a synopsis of this information below. Links to the ECIR website and other specific sections and files are in blue and are "clickable".

I found the ECIR group thru a wonderful barefoot trimmer after my overweight/under exercised 1/2 Arab developed laminitis. I then learned that there are breeds known to be prone to EMS. Arabians, Morgans, Gaited breeds, and easy keeper type horses, ponies and donkeys. Disappointing to read! But most laminitis cases are recoverable. Please begin reading the information below. Diagnosis is the first section. This will explain blood testing to you. Be sure you have read this section carefully as many of us have just turned our horses over to our vet for testing before we know the WHAT/WHY/HOW of blood tests. Sometimes you have to get adamant with your vet to get the tests you want and how you want and where you want the lab work done at. 

Meanwhile do read about the emergency diet in the diet section. It will remove all feeds and supplements from your horses diet that may be the cause of the laminitis or possibly be contributing to it.

When your horse's feet hurt you want to help stop the pain. But drugs do not help. The best thing to help your horse become more comfortable is to put his affected feet into "Therapy" type boots with thick, cushioning insert pads. The Easy Care Clouds is one example. I used those boots for my horse. They stay on well and last a long time. There are also less expensive "slipper" type boots for short term use. What is important is a thick compressible foam pad in the boots. This site https://happyhoofpads.com/ has a huge selections of pads and slippers. You can even buy the pads and tape them to the hoof with duct tape. Shoes typically don't help as most shoes do not support the sole and frog an internal structures.

Please begin reading below. Don't let it over whelm you. Begin at the top and continue downward. Do download the case history form and join our Case History sub-group. A good idea is to download the document below so you can refer back to it when you need to. I HIGHLY recommend using our WIKI files for how-to information. It will explain all the workings of our files.

You can do this!
Bonnie Snodgrass


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 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. 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: urgent Test results back for Rio and says not IR

hdavis
 

Checking in to see if anyone has had experience with insulin results being so low after using Invokana that according to the IR calculator you horse registers as not IR?

I am concerned perhaps that Rio’s and Storm’s bloods got mixed up somehow as Storm’s result are high for insulin and Rio’s are so low the calculator says she isn’t IR.  I would be happy if they are correct.. well I think I would if there isn’t any other consequences of her insulin being that low.


My vet happened to be in my area today and I managed to get he to pull more blood on both mares and was wondering what the group thought about my results and if I should retest storm and Rio.  Thoughts please as I need to know and let my vet know about the bloods ASAP.


--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


Storm

Case History



photos

 
 

 




Re: Lame on fronts - what do I do next?

Sherry Morse
 

Hi Stephanie,

You'll get a full welcome letter shortly but for us to assist you we'll need to see pictures of the trim and also x-rays if you have them.  You'll also be asked to complete a case history which will give us a better overview of what's going with your guy.

If you haven't already had x-rays or blood work having both done would be my next move if this were my horse.  Complete metabolic panel (glucose, insulin and ACTH) and x-rays to see what's going on internally.  Instructions on how to make sure you get useful x-rays are in the Wiki: https://ecir.groups.io/g/main/wiki/1571.  I also would not be riding until you know what's going with your boy and wouldn't put anything on his feet other than boots that he's comfortable in until you know what the problem is.  Once you have a diagnosis you can come up with a treatment plan, but without that you're just guessing at possible causes.



Re: Astaxanthin - antioxidant

Sherry Morse
 

Shalom Anat,

I can't speak to the Astaxanthin and whether or not it can help or is at least ok to try Pip on.  We've recently discussed using a flea medication called Vectra CD Red for sweet itch (https://ecir.groups.io/g/main/topic/76544411#254180) and you can read a bit more about some treatments here: https://ecir.groups.io/g/main/message/215687?p=,,,20,0,0,0::Created,,skin%2Bitch,20,2,0,7627969 and here: https://ecir.groups.io/g/main/message/222065?p=,,,20,0,0,0::Created,,sweet%2Bitch,20,2,0,20479806

Is Pip still on Metformin?  Have you been able to have his insulin numbers checked recently?  It could just be the heat setting him off but with these IR horses we always want to make sure the diet and everything else is controlled as possible to avoid issues like this.




Lame on fronts - what do I do next?

Stephanie Sweeny
 

I was instructed to ask for the opinion of this fine group :

I have a 17yo TWH. I got him 10 years ago when he was 7yo. We lived in Fl so all the trails were sand. He had shoes when I got him but I had him barefoot. Little did I know that a barefoot trim is different that what regular farriers do so I dont think he had great trims for 6 years. Always solid, no abscesses or lameness. Probably had low heels, thrush in frog, and toe landing most of this time. Diet was Seminole Sport and 24/7 orchard hay, not much grass. Never needed boots.
 
Moved to Tennessee 4 years ago. Began having lots of soreness immediately. The trails are so rocky here. Let a farrier put on hot shoes for 1 year. It helped for a few months but his hoof walls literally fell apart and shoes would come off in 2 weeks. It was terrible. I learned a lot. Diet was a lot of mixed pasture grass and I had continued the Seminole Sport. Also started having abscesses in the rears, persumably from stone bruises even w steel shoes on all 4.
 
Had enough of the shoes and went back to barefoot 2 years ago. I have an excellent trimmer now who specializes in barefoot trims. Will not put a nail in. Period. Taught me about diet. Changed diet to a ration balancer and California trace. Lots of good changes seen in hoof. Thrush gone, heels higher, nice frogs (I think), finally heel landing. Diet: Still getting lots of great Pasture grass I think mostly fescue. Mixed grass Hay in winter. I did analysis 2 winters ago and it seemed spot on w the California trace. Have not got analysis from the grass this year. Sending sample for hay this week. Using Easy care epics. Finally got the right size. Was on all 4 but was able to ride in fronts only for past year.
 
Since this July he has been sore in fronts on and off. Last 3 weeks, lame on both fronts. Refuses to load, refuses to walk on any rocks... from microscopic to driveway gravel. He always has wanted to avoid gravel but never downright refused. Usually he is a fire breathing dragon on the trail... 8-10mph and loves every second, waiting at the gate to load and go. I took him out Saturday because I needed to figure out what was going on. Sometimes he limps sometimes we ride in the pasture and he is completely fine. So this weekend I padded his boots and booted all 4. He literally walked slower that I thought possible. There were places without gravel and if it was hard surface he was hesitant and tried to avoid. The trail had some areas of fine crushed stone (like sand) that was softer and he flew over that and was happy. He was landing heel first throughout the ride. Seemed sore on all 4 but definitely both fronts equally even w pads in the boots. 
 
What is my next move? Xrays? Bloodwork? He is definitely different and getting worse. I am thinking about glue on Duplos or Eponas. I may need a nail or two to keep them on. Will loose my trimmer if I go that route. What am I missing? I want to know why not just put on a bandaid.
 
--
Stephanie S. Nashville TN Oct 2020


Re: How Long Does the Veil Last?

gypsylassie
 

Teresa, I'm not sure if anyone mentioned this, but you may be able to get the individual adaptogens in APF from your health food store, or at least a couple.  You wouldn't know the quantity, but you could mix up what you can get, and give a little.  The dose of APF is around 6 mls per 1000 lb horse and it's listed as a water-alcohol extract.   Not sure how that would translate to home made.   I think someone here once tried their own mix of the ingredients, but haven't seen anything about it for a while.
Laura K Chappie & Beau over the bridge
2011 N IL


Re: "Emme" Seasonal Cushings

 

Barbara,
I don't want to sound negative about our equine vets, but IMO there seems to be quite a lack of current information about Insulin Resistance and EMS amongst our equine vets and especially with regards to treating laminitis and helping horses recover from laminitis. I've known some really good equine vets and in hind sight I think they were all long time horse owners, riders and often breeders. If you can find an endurance riding equine vet give them a try! Just a personal view point.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: New Bloodwork & question on feed while exercising

 

Virginia,
My deceased horse Mouse was IR and PPID. I used to do endurance with him and after we both "retired" from endurance we continued to ride the trails 3xweek. I carried low esc/starch hay while trail riding in a simple nylon drawstring bag. I think these simple bags are used for work out shoes/clothes. Anyway I put it over one shoulder and my head so the bag hung beneath the other arm. I could easily pull handfuls of hay out to feed him as we went down the trails. Did I let him have some grass while riding, yes, but we never stopped long anywhere with grass. I found that keeping hay going into him on the constant trickle system (his hay was always given in 1" hay nets) and riding him regularly allowed him to have constant hay while at home.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: TRH Stimulation Results

emma@...
 

Hi

His latest radiographs were 2020-06-09.  They are uploaded in his album https://ecir.groups.io/g/CaseHistory/album?id=249458

Could a major mineral imbalance lead to laminitis, or at least a failure to improve?  To test for mineral imbalances, I guess I need to have his hay tested (not currently at grass)?

-- 
Emma M in East Sussex, UK 2020
Case History for Tom: https://ecir.groups.io/g/CaseHistory/files/Emma and Tom
Photo Album for Tom: https://ecir.groups.io/g/CaseHistory/album?id=249458


Re: How Long Does the Veil Last?

 

I haven’t been following this closely so I may be late to the game but I think Frankincense is also known as Boswellia.  

Also, I’m not sure how to do this but it seems like this thread might be better broken off with a different subject heading?
--

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


 
 


APF in Canada

Lorna Cane
 

Hi All,

Here is response from Auburn , wrt APF up here...

 

"Unfortunately right now we do not have a distributor in Canada that carries the product. However we will ship to you from here at your expense. If you would like to send me over you shipping address I can get you an exact quote on shipping."

 

Savanah Gulden

Auburn Laboratories, Inc. 

There are shops in the US which carry it, so it might be worthwhile comparing shipping charges.
Also, if a couple of people went together to buy several bottles,and split the various extra charges, there might be a savings.

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


Re: supplements from uckele

renee lefthand
 


--
Renee SD 2020


Re: Emme

bshellrvt@...
 

I can't thank this group and Dr Kellon enough for your help and the review of Emme's X-rays. Hoof photos coming soon. In view of your groups responses and the lack of labwork to support Cushings or IR, At this point I feel I should take Emme off medications. However I am hesitant, when I last spoke with my vet she did not recommend it.

--
Barbara Shell in Ohio 9/2020

Emme Case history  https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Emme

Emme Xrays   https://ecir.groups.io/g/CaseHistory/album?id=254651


Astaxanthin - antioxidant

Anat Shalev
 

hello all.

i probably should update my files, i haven't been here for a year or so but this is due to Pipo's good overall health ;-)
And i credit this to all the Wonderfull and important advise i got here. so thank you again.


these past month Pip isnt showing any sign of pain, he is happily moving about but has gone back to being very much scratched... i think it is the worse he has been.



i am sure this is all connected to his insulin and feed. and to make things more hard we also had the hotest september ever here in israel and the humitiy was high too so i just couldnt use any fly sheet, i just started cuple of days ago to put him back in his Boet fly sheet - and this already mad a big change

i give him the flex seeds & spirollina but haven't given vitamin E for a while and just got for him some today

we also stopped quite some time ago the Giagulan - so maybe  i should get back on that too

i finally changed my vet and i am discussing with him and hoping to try Pentosan injection as Dr kellon advised us several times before (but i didn't get my old vet to participate with me on that) .

hopfully these changes and the effort to keep balanced diet will help.

but i was wondering about another antioxidant addetive that i came across - if any of you know if that can benefit him as well -

i have a dog that had a loooong history with severe eye issues that was very much helped (to the amazment of vets and us) with the daily addition of Astaxanthin to his feed. it is another potent antioxidant and i spent time researching about it and i was wondering if any of you come across it in connection to IR horses or allergic skin reaction in horses… as i read it has benefits to skin too, so was wondering if this can help with Pip sweet itch.

--
Anat Shalev,
May 2015, Pardes Hanna, Israel
https://ecir.groups.io/g/CaseHistory/files/Anat%20and%20Pipo 
https://ecir.groups.io/g/CaseHistory/album?id=76190


Attn New Member : Shirley J. in Michigan

 

Welcome Shirley,
When new ECIR members submit their first post/message they get our "Welcome New Member" post. Since your first post was within a chain of responses to another member's post I have started a new message directed specifically to you. I hope you see this welcome message.

It doesn't appear that you have a horse in a current crisis but your horse is definitely diagnosed as PPID (Cushings) and is being treated with with Prascend (Pergolide). I know that you've read a lot of messages by now about how common the "Veil" is when starting a horse on Pergolide.

Your post:
I am interested in what others say about this because I've had a similar experience.  My boy started Prascend on 9/12 after the TRH test indicated PPID. He also started at 1/2 tablet for 5 days and seemed fine overall.  After moving to a whole tablet he just seems to be "out of sorts."  He's typically pretty laid back, but lately he's been on and off his grain.  He eats his hay okay and always looks for treats but hasn't been finishing his breakfast or dinner.  Behavior wise, he seems more distracted than usual, and this past week especially he will have moments where he seems tired and uninterested, and then moments where he tears around like a mad man. After yesterday's shenanigans (which luckily didn't result in any injury to him or anyone else) I texted my vet who recommended discontinuing the Prascend for a week and then restarting, again at 1/2 tab for a week, then up to a whole tab. Before we started the rx, the vet said he has very good results stopping and restarting meds so....fingers crossed!   

My experience with the "Veil":

My deceased gelding was diagnosed with PPID and I followed guidelines suggested by the ECIR group. First, before starting Pergolide I started him on APF, an adaptogen. 
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf
After one week of APF I started him on a 1/4 tablet per day of pergolide. I did this for 4 days, then he was titrated up to 1/2 tablet per day for 4 days then finally to a full tablet. My horse never experienced the veil at all . However, PPID horses do eventually need an increase in pergolide and/or Prascend. If their dose of pergolide isn't increased they may slip back into the visual symptoms of the veil, like loss of appetite, grumpiness, etc. They also may begin to lose weight. ACTH levels will begin to rise in early summer increase before tapering downward into the fall. 

I had learned about this rise of ACTH and asked my vet for a new prescription so he got 1.5 mg per day. His attitude and appetite improved. He remained on the increased dose for the following year. This is a common scenario with PPID horses. Most of them will gradually need increasing medication over the years. I chose to use generic pergolide instead of Prascend because the cost was so much lower. 

Well here is the document for new members that we ask you to read. If you have any questions or need help we ask that you start a NEW MESSAGE and put a few words in the subject line that will get the attention of people who can help you. For instance if you are having trouble with uploading your case history FIRST try using our Main Group WIKI. The Wiki has all the ECIR HOW TO DO just about everything that members need. Then if you are still struggling you can use our SEARCH box that is at the top of all pages. If you are in the messages area your search will search thru previous messages for a match. If you are in the FILES area then the search will be within the Files documents.

Please: Always remember to not HIJACK another members message/post. In other words it is fine to contribute to another person's message as long as you are on topic and not starting another subject. You may have a question for the original poster or a suggestion, but please don't make their post about you.

Welcome to the ECIR Group:

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. 

 

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. 






P.S. - I'm not trying to be ambiguous; I haven't been able to figure out how to load our case history yet. I will try again though! 
--
Shirley J. in Michigan
Joined 2020 (because what else could go wrong?)
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: How Long Does the Veil Last?

Lorna Cane
 

Allison,we need to do our homework,as with everything else. I don't believe all Frankincense is created equal.
Suss out the company involved,to be sure it is the pure essential oil.

https://www.amazon.ca/s?k=frankincense&dc&ref=a9_sc_1

--

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


Re: Emme

Eleanor Kellon, VMD
 

I agree with your vet that the diagnosis is very uncertain. No clear evidence of laminitis in the radiographs, ACTH within range for the time of year; insulin at very worst may be in a grey zone but much too low to be causing this pain.  She also has no elevated pulse and is lame in only one foot. Logical next step is to get more complete hoof radiographs to evaluate the navicular and also project out the coffin bone.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Emme

Sherry Morse
 

Hi Barbara,

Could you please add the photo link to your signature?  https://ecir.groups.io/g/CaseHistory/album?id=254651

If you need instructions on how to do that just let us know.  Looks like she has a good amount of sole based on the xrays but I see some minor points that can probably be tightened up in her trim - getting actual hoof pictures can help us with that.




Re: How Long Does the Veil Last?

Allison
 

Really Lorna?? Is all Frankincense created equal?? I do have a good local Health Foods store here also. Maybe I should talk to them, I'm sure they sell it. They might be able to offer advice re: whether or not to dilute it in a carrier oil.
--
Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=254641


Re: How Long Does the Veil Last?

Allison
 

Hey Sherry,

I'm surprised that she applies it directly to the area, since I've read that it should be mixed with a carrier oil! I'm nervous...I don't want to make it hurt even worse poor baby. 

The vet yesterday came up with an idea that sounds awfully barbaric, and I don't know that my local vet would be on board with it...but he suggested tying it off with a catheter inserted to ensure urination could continue. Like castrating with a band. Travelling vet wouldn't do it because he can't be around to monitor the progress. OMG it makes me sick with anxiety to think about trying it. But travelling vet said he would send me some articles about it to present to my local vet.
--
Allison in Ontario 2020

Case History: https://ecir.groups.io/g/CaseHistory/files/Allison%20and%20Sonseeahray
Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=254641

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