Date   

Re: Diana labs

LJ Friedman
 

thinking thats a fine enough acth number in beginning of october???  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: from cabergoline back to CP

LJ Friedman
 

Thanks for the reply. I am fed up with the injection site displeasures, as well as veil not eating for a very short time,  and $415 per month.  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: from cabergoline back to CP

 

I would follow Dr. Kellon's recommendations and not make changes until December ...
 

--
Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History 


Diana labs

 

I've updated Diana's case history. I just got lab results after switching form Prascend 1mg to Pergolide (compounded) 3mg:

Glucose 100 mg/dl, ACTH 38.4 pg/ml, insulin 11.92 uiu/ml & leptin 10.84 ng/ml. G:I ratio 8.39 compensated IR, RISQI 0.29 compensated IR, MIRG 5.2. 

Should I increase Diana's Pergolide now & retest or should I wait until after the seasonal rise is over to adjust it & retest? She's stilll slightly off on both fronts but she is dropping weight (which she needed to do). Thanks in advance!
--
Beth & Flame & Diana

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  




Falki's Recent Blood Work - Request Feedback

Connie Proceviat
 

Hi Dr. Kellon and All,

I received Falki's recent blood work and would appreciate your thoughts.

He does well during the warmer spring/summer/fall months and is currently doing well. However, he was lame last winter during the coldest months similar to how he has been in previous winters.

I recently updated his case history so information should be very close to current. Hopefully I didn't forget anything.

Thank you in advance,
--
Connie Proceviat
2013 Manitoba, Canada
Case History: https://ecir.groups.io/g/CaseHistory/files/Connie%20and%20Falki/Falki%20Case%20History.doc.pdf


Re: Update on founder case and question on how to proceed

 

Yes, rising ACTH can cause rising Insulin levels which of course can lead to laminitis. I had to learn that it just makes sense to test Insulin, ACTH and Glucose every time. I think that some vets may not know that Insulin levels can rise during the seasonal rise of ACTH. 

Mara, do you have the barn hay analyzed? I know this can be hard at many boarding stables because they get multiple loads of hay during a given year. 
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Soaking Hay in the Winter

 

Kim, what question do you have about hay soaking? Are you doing it now? Wondering how to do it in freezing weather? https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together/Hay%20Soaking%20Tips.pdf

Has your hay been tested? https://ecir.groups.io/g/main/files/9d%20Country%20Specific%20Information/Australia/Hay%20Testing


Here is a link to an area of our files where you can find info about what is safe to feed: https://ecir.groups.io/g/main/files/5%20Core%20Diet

Here is more about safe feeds for IR horses: https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds

Horses will eat wet and frozen hay. 
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Flame labs & balancer question

 

Kirsten- I reread your message. You answered my question about the manganese- low amounts (<2mg). Thanks!
--
Beth & Flame & Diana

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  




Re: Flame labs & balancer question

 

Hi Kirsten thank you for your response. I did mean manganese. I’m looking at the ECIR website & specifically the “List of acceptable ration balancers”. It mentions that manganese & selenium might need to be added depending on the area the hay is coming from. I know this won’t be exact like a hay analysis would be but I’m trying to do my best for Flame. You’ve already addressed my question about selenium but I’m not sure if I should add manganese or not. I used to feed Flame California Trace Plus but he got to where he wouldn’t eat it anymore which lead me down this worm hole of deciding to test one batch of hay each year, having it balanced, getting a custom mix made for him & then feeding it until the next year. I know that’s definitely not fool proof but it seemed the closest I could get at the time. I was getting ready to do the same thing again & the feed store manager mentioned that this batch would’ve gone within 2 weeks & it made me realize how useless it was. So now I’m back to finding a ration balancer that the group recommends & seeing if I should add manganese & selenium like the “List of acceptable ration balancers” suggest. 

It also sounds like his Metformin has stopped working so I’ll discontinue it. I read up on Invokana from this group over the weekend & I don’t believe I can afford it. Where are group members buying it from & how much is everyone paying? I’m seeing 30 300mg tabs for $500+ on the Internet. I would love to buy it for Flame but I can’t afford that. 
--
Beth & Flame & Diana

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  




Re: Soaking Hay in the Winter

 

Hello Kim,
I want to welcome you to the ECIR Main IO group. First I want to ask you a couple of questions:

1. Has your mule had blood testing done to verify that he is definitely IR? If he is then you need to stop giving him grain of any type. It is a trigger for laminitis. 
2. Have you had your hay tested for content sugar and starch content? Was it tested and you know it needs to be soaked?
3. Has your mule already developed laminitis or "sore" feet?

Below you will find our Primary Response document which is sent to every new member who has an IR or Cushings horse. It is long, I suggest you save this document. It has many clickable links (in blue) which will lead you more information and files. If you save this document to a PC or tablet he links should still work as long as you are online. 

Use the [ SEARCH] buttons found within a box at the top of every page.
Use our Files (see column to the left). When you open the Files area you will find a search box at the top of the page.
Use our Wiki, (
see column to the left) where HOW TO DO AND USE this web site is explained.

Just below there is a link to the ECIRHorse.org web site. I often refer back to the web site when talking to other horse owners whose horse's need help. There is an excellent area that explains how to talk to your vet about tests, diet, treatment. It helps a lot to gather your facts and knowledge here before questioning your vet.

One suggestion for you, you can change your signature to be a bit more specific about your location. Often we find other members who live in our general area that can recommend feed/hay sources, trimmers, vets, etc. I suggest you put your county and state into your signature in place of "Mid-West".

You'll be getting advice soon from our moderators and experienced members.

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


Update on founder case and question on how to proceed

Mara
 

Hi, everyone. My guy foundered at the end of June. He is outwardly doing great. Feet look awesome, happy with the last set of x-rays a few weeks ago, and moving well. We hand walk 20 minutes, and trot in-hand 10 minutes every day. He can only go in a 12x24 pen, as that is the extent of the dry lot situation. The issue is, his last bloodwork came back high insulin, again. I had tried him on Metformin, but he stopped eating it and the risk of oral ulcers concerns me. I need barn staff to give it.

Looking for help with the following:
- Does normal seasonal rise in ACTH cause increased insulin? I tested at the end of September. I only tested glucose and insulin. His ACTH was fine in June. Should I have tested ACTH? 
- Might ALCAR help him be more insulin sensitive?
- How long should he stay on J-herb? He started when he was in pain, but he has been pain free for a few months.
- Hard to get him to lose weight. Does he just need more time? Would a course of Thyro-L help kickstart the weight loss? Cons to that?

Thank you for your input.
--
Mara
NJ
2020
https://ecir.groups.io/g/CaseHistory/files/Mara%20and%20Enzo/?ord=dirname&d=asc


testing a symptom free ppid horse

LJ Friedman
 

Is it correct to say that if the funds permit, a PPO the horse should be tested for ACTH on January and July each year? Are those the correct months? Thanks
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Soaking Hay in the Winter

Knyoung2008@...
 

I have an IR boy (Mule) and looking for advice on soaking hay this winter. I would also like help in how much to feed him. He's about 950 lbs and you can see his ribs. Vet seems to think he is fine.  He's on Insulin Wise, Thylo-L and a hoof supplement and on a dry lot.  Four cups of grain (2 am and 2 pm of Purina Enriched) each day. We just had to put him in shoes this week. 
--
Thank you and take care
Kim Young

Midwest USA
Joined Oct 2020


Re: from cabergoline back to CP

LJ Friedman
 

jesses monthly cost on cabergoline at 2.5 ml every 10 days is $412.50 per month.   too much to spend in this covid economy.  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Trimmer coming on Wednesday

 

Judy,
I looked at Bugsy's case history folder. I saw a hay test for hay from last year. Do you have a hay test you can post for this year? Just curious, I like to look at members hay tests.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Trimmer coming on Wednesday

Judy and Bugsy
 

Bugsy continues to do very well.  We have switched to this year's new hay (no more soaking!) and new custom mineral blend.  I have uploaded Bugsy's pre-trim pictures and am hoping Lavinia has a chance to do mark ups. 
--

 

Judy and Bugsy

Regina, Saskatchewan, Canada

Feb. 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Judy%20and%20Bugsy
https://ecir.groups.io/g/CaseHistory/album?id=243358

 




Re: rechecking ACTH during seasonal rise- Dolly symptomatic

Trisha DePietro
 

yes- I stopped the smartpak  this past year....I will update her history. Thanks. Trish
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories https://ecir.groups.io/g/CaseHistory/files/Trisha%20and%20Dolly%20-%20Hope
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: rechecking ACTH during seasonal rise- Dolly symptomatic

 

Do the blood tests for sure. I didn't see any blood test results for 2020 in Dolly's case history. The seasonal rise does increase ACTH levels and it typically insulin levels rise along with the ACTH rise. Do you have current hay test results that you can add to Dolly's case history folder? It would be helpful for our moderators and members if you could get Dolly's case history updated. 

I used to use a SmartPak supplement in the past and found it had small amounts of alfalfa in it. I learned that my IR/PPID gelding was sensitive to alfalfa in even small amounts.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Is there a link between analgesics and elevated glucose or ACTH levels?

Mary Ann
 

Thank you for the info Lorna Cane. I will definitely look into this.

--
Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020
https://ecir.groups.io/g/CaseHistory/album?id=252134
https://ecir.groups.io/g/CaseHistory/files/Mary%20Ann%20and%20Rosie


rechecking ACTH during seasonal rise- Dolly symptomatic

Trisha DePietro
 

So, Dolly has been managing herself well these past few months. In July, I increased her prascend from 1.5 tablets to 2.0, thinking that she might need a little additional coverage during the seasonal rise. She did fine with the increase up until Saturday when I noticed she was a little stiff and appeared to be rocking back slightly on her hinds, no bounding pulses, left foot slightly warmer compared to right, hinds equal and normal temps.... So, I started soaking her hay right away. I have a call out to the vet to run bloodwork, specifically ACTH, insulin, glucose. She seems  more comfortable after soaking all of her hay for 2 days.  Should I be checking any other bloodwork at this time? Thanks.

--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories https://ecir.groups.io/g/CaseHistory/files/Trisha%20and%20Dolly%20-%20Hope
Dolly's Photos 
Hope's Photos 
Primary Responder

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