Date   

Re: Insulin still over 200

Eleanor Kellon, VMD
 

Velagliflozin isn't available.

Could you post some current photos of her feet and body?

You can wait to draw the blood.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Favorite boots for starting work

Cheryl Oickle
 

I used cavallo treks for rehab post founder with pads and after Jewel was once again worked, I just took the pads out.  They are awesome boots and I have only had her come out of them ONCE in two years. Even though she seems 100 percent recovered, our terrain is grossly rocky so I ride her in boots always.
 

--
Cheryl and Jewel
Oct 2018
Port Alberni BC Canada
https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel
https://ecir.groups.io/g/CaseHistory/album?id=81063


Welcome Letter for Mary Marshall Re: ACTH off the charts

Cindy Q
 

Hello Mary
 
Welcome to the group! Thank you for getting your signature in place. Although you currently have not posted any question, I am setting out below our standard welcome letter for you. You may be familiar with some of it but as it is so comprehensive, it is worthy for a dedicated read I think. It's also a good post to bookmark for future reference.

Non crisis time is actually a good time to get started on a case history without additional stress factors so something to consider if you have some time :) Please feel free to ask if there are any questions. Here we go:

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 etiquette, what 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.
 
EXERCISE: The 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. 
--
Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response





Re: Updated Case History, please help

Tamara Gonsor
 

Oh ok thank you Sherry, I was reading the directions and was recommended to hyperlink words in case history because uploading all blood work gets messy in the file and lack of space. I will go back and read again, I may have misunderstood. 

--
Tamara G. in Arizona 2020
Case History: https://ecir.groups.io/g/CaseHistory/files/Tamara%20and%20Malik
Malik Photos: https://ecir.groups.io/g/CaseHistory/album?id=252564


Re: Insulin still over 200

Nancy C
 

Hi Jennifer

Would be great if we could see the blood work results. 

As Lavinia said, you have plenty of potassium in your hay. I would not look to feed more. If we can see exactly what the results were, Dr Kellon can give a read out on what -- if anything -- may be going on. Or at least where to look further.

If you are still using the salt block, make sure he is consuming at least one ounce per day. You need to determine the weight of the block, and how long it takes him to consume it. It might be better to add loose table salt, 1-2 ounce per day, to his meals. Start on the lower end b/c he may need to get used to it.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA


Re: ACTH off the charts

Mary Marshall
 

I have been able to pop the Prascend pill into a peanut shell and just add it to his breakfast.
I just puncture the outside of the shell a little bit and pop the pill in.


--
Mary Marshall
Aiken SC
Joined-10/17/2020


Re: Insulin still over 200

Maria Duran
 

Is there a possibility that his diet is low in sodium and his kidneys are keeping it to maintain blood sodium levels while getting rid of potassium to compensate? 

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album
_._,_._,_


Re: APF Pro 1x or 2x per day?

Nancy & Vinnie & Summer
 

LJ you are so lucky..we had a little difficulty adjusting.  But hopefully we can start weaning off too soon ;)
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: APF Pro 1x or 2x per day?

LJ Friedman
 

i  used the 10 ML dose for a Jesse five days before and six days during switching back to pergolide. Everything is quite fine. I think I’m  day 3,off t he APF
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: APF Pro 1x or 2x per day?

Nancy & Vinnie & Summer
 

Update : Knock wood after switching to 10ml of APF Pro one time per day for each horse with the.0.50 dose of prascend at night before bed time, this seems to be working perfectly. I even have Vinnie on his full dose of prascend now. 

Thanks everyone for the ideas!

Nancy
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: Updated Case History, please help

Sherry Morse
 

Hi Tamara,

Lavinia has already addressed most of your questions, but I wanted to mention that you should absolutely leave your bloodwork results in your CH folder.  Not sure where you got the idea that it wasn't allowed.




Re: ACTH off the charts

anneefrancis@...
 

Thank you Lavinia.

I've updated my case history and read my way through a good chunk of very informative information :)

Will give Pergolide a go.  

Anne and Tricana
May 2016
https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana


Favorite boots for starting work

Nancy & Vinnie & Summer
 

Hi all,

We.have Vinnie in the easy boot rx on the left front and we plan to keep him barefoot in that foot until his hoof wall grows down to hold a nail. We plan to put him in a sneaker long term.  The easy boot rx is really only for light turn out.

I want to get a boot that graduates from the rx to something we can start doing light trot work etc.

What are your favorite kinds of boots for this purpose?

Thanks! Nancy 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: Insulin still over 200

Lavinia Fiscaletti
 

Hi Jennifer,

Need Dr. Kellon to chime in on this one.

Do you have a copy of the actual blood work results? If so, would you please upload it to your case history folder. If not, could you get a copy from your vet?

Generally, there is more than enough potassium in hay alone to meet daily requirements.

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


Re: Prascend Dosage during Fall Rise

Angie
 

Thank you for all your suggestions.  I did give Jacob APF in the beginning. I will put him back on it to see if that helps. At this point I think I will wait a few more weeks before retesting.  Timing has been my enemy.
His TRH test was done August 12.  Our plan was to do that test in July but it took forever to obtain the supplies due to Covid. Then fires and evacuations and before we knew it, we were into August and the rest is history.  I now know we should have switched gears and done the ACTH test instead.  But I did learn he was definitely PPID and we were able to get started on the meds.  I have to remember that and stop kicking myself.  We'll get this dialed in.  I so appreciate this helpful group and the immense amount of knowledge available. Thank you again,
Angie
October 2020, Mendocino County, CA

Case History: https://ecir.groups.io/g/CaseHistory/files/Angie%20and%20Jacob
Jacob's Photo Album:

 


Re: Insulin still over 200

Frances C.
 

Burdock root, black seed (nigella sativa) ceylon cinnamon fenugreek seed are good sources of potassium, bananas too
--
- 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: Updated Case History, please help

Lavinia Fiscaletti
 

You'll need to discuss this with your vet but if this was one of my horses, I would definitely be starting him on pergolide as soon as possible.

Generally, 1mg is a common starting dose. As the rise has peaked, ACTH levels will be declining in normal horse now but that may or may not be the case in one with PPID. The good thing is that Twister's ACTH is likely not going to climb any  more this year, so you have a good chance of getting it controlled fairly quickly now.

Generally, it is recommended to retest after 3 weeks at the targeted dose to see where things stand. Titrating up the the prescribed dose,is also recommended to help prevent a possible "pergolide veil" effect from developing. You cna also administer the adaptogen APF when starting the meds to help combat any veil effects. How a horse reacts to the meds is very individual.

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


Riosa trim guidelines

Lavinia Fiscaletti
 

Hi Heather,

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

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

The trim had improved greatly from where you started - good job. The excessive overall amount of hoof capsule is gone, front toes have come back enormously, heels are starting to move back under her and it looks like there may be some concavity starting to develop. The trim needs to get a bit more targeted now to address the things that still need help, rather than everything needing adjustments. Continue to monitor the collateral groove depths to maintain medio-lateral balance and to help with adjusting the heel position. Keep the bevels on the bottoms of the walls until all the detached material has grown out. Also keep a bevel on the toes to keep the breakover set back.

LF dorsal: This is the only foot that still shows obvious flaring all around. The bevel you have on the bottoms are keeping all of that out of ground contact, so it's a matter of just getting it rasped inward and removed as it grows down. The green lines show where the tightly attached wall would be. Blue Xs are that flared wall that can be rasped away from the top, in the bottom 1/3 of the hoof capsule. The darker colored hoof material above the visible crack running horizontally across the toe is that bulbous chunk of remaining lamellar wedge material.

LF lateral: The green outline is there to give you an idea of where the hoof capsule eventually will be. You can see where the coronary band bulges above it, pulling down and inside as it reaches the heels The lamellar wedge in the toe region bulges out beyond it and the heels are run inward from the heel line. The yellow lines follow some of the horn tubules from top to bottom, while the pink lines show how those tubules should be aligned. You can't trim the hoof capsule into the final shape but you can set it up so that is has a template to follow so that all the distrotions are able to grow out.

LF lateral sole plane: Green line shows where the new growth wants to be. Blue area is the wedge material that can be rasped away.

LF sole: Blue solid lines in the heels are where the wall should end - hashed areas need to be rasped away. Blue solid line at the toe is where to start the bevel on the bottom, into the are where the blue dots are.

RF lateral: Same as the LF. Blue area is the bulbous wedge that cane be removed.

RF lateral sole plane: Blue area corresponds to the blue on the lateral view. Green line follows the healthier new growth at the top all the way to the ground. Blue half-circle line is where to start the bevel on the bottom of the toe.

RF sole: Same discussion as the LF. SOlid blue liens are where the perimeter of the hoof be, hashed areas need to be removed. Light blue dots are in the bevel at the toe.

LH lateral: Blue is the toe that needs to be backed up.

LH lateral sole plane: Blue is toe to back up. Green line follows the healthier new growth coming in under the coronary band to the ground.

LH sole: Blue solid line is where the perimeter of the hoof should be, hashed areas are where to remove/bevel out of ground contact.

RH lateral: Blue is where to back the toe.

RH lateral sole plane: Same as the other three.

RH sole: Same idea as the LH. The lime hashes are along the leading edge of the lateral bar that can be tidied up a bit, but only along that edge, nothing closer to the frog.

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


Re: Updated Case History, please help

Tamara Gonsor
 

Ok Lavinia, thank you for confirming. Is this the time to start him on pergolide and if so what dose do I start him at?
I have been reading all day on this group. The doses seem to very per horse. It also seems that I would start him and then test again in 3-4 weeks?


--
Tamara G. in Arizona 2020
Case History: https://ecir.groups.io/g/CaseHistory/files/Tamara%20and%20Malik
Malik Photos: https://ecir.groups.io/g/CaseHistory/album?id=252564


Re: Updated Case History, please help

Lavinia Fiscaletti
 

Hi Tamara,

You are correct that those blood test results are not good as the insulin is over 200uIU/ml and the ACTH is 134pg/ml. He is definitely positive for both PPID and IR. No point in redoing the glucose unless you test insulin at the same time as the point is to see the relationship between the two, not only the raw number itself.

Not walking well may indicate he is starting to suffer from laminitis, so he needs to have the PPID treated as soon as possible.

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

24901 - 24920 of 278175