Date   

Re: Bloodwork, PPID, EMS Invokana and Pergolide

 

Nancy, I'd give what you need to see an effect, up to roughly double the labeled dose. Maybe 6 ml twice a day, or 10 once and a second dose of 4-6 ml. My experience with APF was that double the labeled dose really helped when one horse experienced a serious pergolide veil (non-PPID horse ate the PPID horse's full 5 mg pergolide dose). I'm not being cavalier with herbal dosing, but my experience is that starting doses are fairly conservative. While starting doses may work for some herbals for some horses, especially with Cayuse, failures with strong and effective herbals  (CTB, J-Herb, Devil's Claw, Canadian Ginseng, Spirulina, Mov-Ease) have all been cured by increasing dose and doing it fairly quickly after I notice a failure of effectiveness. 

Also, I'll just put this out there again (forgive me for repeating myself-it's my age) as a possibility. Failure to eat a mash isn't something I'd initially blame on the pergolide veil. Does he seem spacey and distracted? You know Vinnie the best, and I take your word for it when you say you think it's from the veil. Just remember that the veil rarely lasts for weeks. Refusal to eat the usual bucket meal can be a result of pain, an early warning when your horse still wants to eat hay. I get serious fast about the pergolide veil (and about pain!) when my horse won't eat hay. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Bloodwork drawn once yearly?

 

My vet prescribes pergolide based on symptoms.  She says, by looking the horses in the eye to see if they look like they do not feel well.  Thus far, her diagnoses have been predictive of elevated ACTH. 

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


Re: TC Safe Starch Forage

Maxine McArthur
 

Hi Sara
Lavinia has answered your question about the Safe Starch. What follows below is our standard welcome letter for all new members, chock-full of useful information and clickable links. It also has links to the directions on creating a case history for your horse, so that when you ask a question, we can check on the horse's details and give you a more individually targeted answer. 
Let us know if you have further questions after reading it. 
Quick question from me--what is a Savvy box? I found a "Savvy feeder" online, which is a box with holes in the front for the horse to pull out hay--is it similar to this? 

Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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 EMS/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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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. 

 

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Re: New Hay - results. Does his current diet align to this new hay well enough?

ferne fedeli
 

I mentioned using a spreadsheet recently and may have given people the wrong idea.  I actually use the spreadsheet as something to look at while I am calculating (it would also help me to catch something I have calculated by hand that is WAY off) and then when I have everything completed, I plug all my final figures into the spreadsheet to document what I have done & so I can easily see what I need to order when I contact Horsetech for my actual mineral order.

Ferne Fedeli  Magic & Jack   2007

No. California
Case History

 

 


Re: Purina Outlast

Bonnie Eddy
 

Dr Kellon
Regarding giving U Gard instead of Outlast, it says to give Outlast 3-4 times a day up to 6 doses, the U gard 2x.
The Outlast doesn't give the exact amounts of calcium and magnesium in each serving. If it only works just a short time, could the U Gard be as effective?
Thanks, 

--
Bonnie with Racham (over the rainbow) from Southern California, Nov/2016

Case History
Racham's Photos 
Ω 

 


Re: Dewi - latest blood test results - high resting insulin - what to do next?

Kirsten Rasmussen
 

Almost certainly 7.9% ESC+starch is too high for Dewey unsoaked.  Maybe after starting pergolide and invokana you will find he can manage that hay without soaking, but definitely for now keep soaking it and don't stop until you have bloodwork proving his insulin has normalized.

I'm glad you are building a more local support team because that is critical, but yes we are all here for you, too!  :)

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


Re: Bloodwork drawn once yearly?

Kirsten Rasmussen
 

I would push the ACTH testing to late July-early August personally, if I had a PPID horse and a choice of when to test.  Summer solstice (Jun 20th, 2021) is technically the start of the seasonal rise but I would not expect to see much of an increase in ACTH until it's a little more closer to the fall equinox in late September (Sep 22/2021).  It's a balance between testing too early and not seeing if ACTH is rising abnormally fast, or testing too late and not being able to increase the pergolide dose in time to be effective on the full ACTH rise.  It's hard if you can only test 1x a year but that is the reality for many people.  My vet only visits our area 2x a year (spring and fall) and I don't get to chose the dates, so I just get the tests done when I can even if the timing is not ideal.

Other members with large herds of PPID horses have said that they based pergolide dose increases based on tracking signs/symptoms rather than bloodwork because of the cost, and that is a reasonable strategy if you are willing to do a weekly assessment of PPID signs in each of your horses, document your observations, then watch for trends/changes.

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


Re: Bloodwork, PPID, EMS Invokana and Pergolide

Nancy & Vinnie & Summer
 

I thought I should also note Vinnie is slightly improved from yday so we are making progress ever it be small.  I was expecting more soreness today too so that was a nice gift.. 

I think prascend is working.. knock wood.  Next time follow gut.. that nagging feeling is probably right. 
--
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: Bloodwork, PPID, EMS Invokana and Pergolide

Nancy & Vinnie & Summer
 

Cass, would you do 10ml twice per day?  I am doing 1 time rn and did increase jherb too as gums are a little less pink. 

Kirsten, I too got soooo much out of that podcast. And then I went in to listen to the two others Alicia noted in the beginning of the podcast.  So enlightening and inspiring and of course daunting.  But, it is so relieving to know we are not alone.  I think the comrades here and the support provided is what keeps me going.
--
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: Bloodwork, PPID, EMS Invokana and Pergolide

Kirsten Rasmussen
 

Thanks Nancy K for sharing your experience and that podcast post...I had listened to it last summer and really got a lot out of it, but had forgotten her story about that one horse...  This helped me finally decide that I need to do a pergolide trial with Shaku.  No more if, ands, or buts!

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


Re: TC Safe Starch Forage

Lavinia Fiscaletti
 

Hi Sara,

Welcome to the group. You will receiving a formal welcome post later but in the meanwhile, I'll address your current questions.

The ESC + starch of the TC Safe Starch Forage is not a guaranteed analysis for every batch, only and average, so you don't know for sure whether the particular bag you are feeding is actually under 10% combined s/s or not. It also has a higher fat content (min 6%) that has an inverted omega 3 to 6 ratio the we advise due to the added soybean oil and rice bran. It also contains added iron, which no horse needs and is particularly problematic for IR horses as they tend toward iron overload.

I'm assuming you are referring to the the TC Naturals Timothy Balance Cubes (aka Ontario Dehy Timothy Balance Cubes), which have a guaranteed ESC + starch below 10% for every batch. They are mineral balanced to the actual hay analysis for each batch of hay and have no added iron or oil.

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


Re: New blood results not good - advice pls

Kirsten Rasmussen
 

I would not stop the Metformin until you have the Invokana on hand.  There can be an element of pain relief from it and since he is sound despite the high insulin, it could be it is helping.  See the last paragraph in this summary:

https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

Also, Dr Kellon can email some information on Invokana to your vet if you request it.  Use of Invokana in horses is so new so there's not much information out there yet for your vet to read.

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


Re: New Hay - results. Does his current diet align to this new hay well enough?

Kirsten Rasmussen
 

Hi Laura,
I'm wondering if there are people willing to be a tutor
I'd be happy to guide you through the calculations and check your numbers if you are trying to work through it on your own.  I have done the course, passed the competency exam, and balanced a few hays for myself and others.  In the meantime though, you could ask for Dr Kellon to balance with Uckele supplements for now so there's no delay for Ero's minerals when he starts the new hay.

One thing: do this on paper, like how Carol requires it in the course!  It's less overwhelming.  The spreadsheet hides all the background work and makes it hard to see how you've done something (especially if you are coming back to it 6 months later!) and VERY easy for mistakes to be made.  If you do it on paper and 'show your work', you can refer back to it every time you have a new hay to balance and follow the same steps to work through it again with new hay numbers...it only takes 30 or so minutes with a new hay if you have your process laid out in front of you.  I only use a spreadsheet AFTER I've balanced the hay and figured out what I need to add to correct deficiencies and ratios...then, with the spreadsheet I can plug in the numbers for any extras I am already feeding for a carrier (beet pulp/soy hulls/ODTBC/extruded pellets/etc) and for any pre-made mineral mixes (if I'm not doing a custom mix) to see if it fills the gaps and doesn't throw off the mineral ratios.  But I spend so much time checking the spreadsheet for errors that I'm not sure it's any quicker than a pencil and paper!

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


TC Safe Starch Forage

eleison
 

I've been following the thread re. TC Timothy Cubes and wondered if the TC Safe Starch Forage is an option for horse with Cushings/IR?  The profile of the forage on the TC website is within the acceptable range (ESC +Starch below 10% and starch below 4%) but it is not included on your list of safe feeds.  Is there something I am missing about the Safe Starch Forage, which if I decide to use, would go into a Savvy box with small openings in the grate. If it is ok to use it, do you feed it on 1:1 ratio with regular hay or do you alter it as with the Timothy cubes?  Thank you.  
--
Sara D in NC 2021


Re: Bloodwork, PPID, EMS Invokana and Pergolide

 

I’d give maximum dose APF twice a day whenever possible. If it’s not possible every day, do it when you can. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


IR and ulcer treatment along with other health challenges

vicky monen
 

Hi,

Need to pick your brains here for some information regarding Samson and ulcers.  We have had alot of health issues ongoing for some time now. 
He was diagnosed Insulin resistant/Cushings/EPM, allergies.  

Most recently he was dealing with low grade fever and unidentified reasons for such.  I have updated my case history with details listed and CBS-Chem panel.

Basically, I believe he has been dealing with undiagnosed ulcers for a very long time., with the most recent bout the last two weeks.  I have just started him on omeprozole at the treatment dose.  He significantly showed signs of improvement after a few days of this treatment.  I will be adding the sulcrafate once I get it in.  My question is,  I understand that giving alfalfa during ulcer treatment is helpful.  Is there a safe amount I could give him, through alfalfa pellets?  Also, do you have any other suggestion for feeding and supplementation during ulcer treatment?   What about light exercise, or do they need to be off completely from any light work?  

My other questions are,  do hind gut ulcers cause low back pain and can it manifest into other mechanical issues? 
Can ulcers affect Insulin levels due to stress from pain? 
I have recently increased his prascend to 2mg per day, because I was struggled to get his insulin back down.  Also he is constantly lame, which was thought to be possibly due to chronic laminitis. Can the increased prascend affect his gut or exacerbate ulcers?  He continues to be put on Decoquinate powder for preventative & relapses of EPM and would this contribute to ulcers?  As well as he is now on a permanent low dose of aspirin for the chronic laminitis. How do any of these drugs affect his gut and or ulcers?  Vet also believes he has polynuritis but the treatment conflicts with the IR, as it requires levimisole with DEX for several months.  Is there any other thing that can be given in place of DEX to go with the levimisole for polynuritis treatment?

He is a complicated case with many variables. 

Thank you so much for any suggestions in regards to our ongoing challenges. 
--
Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson


Re: Appetitie aid

Eleanor Kellon, VMD
 

You would need to know if there is sugar in the base. The licorice is not safe unless deglycyrrhized. It has ulcer soothing ingredients similar to GUT https://uckele.com/g-u-t-2lbs.html .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Testing for high Iron

Eleanor Kellon, VMD
 

As far as blood letting (aka venisection, phlebotomy), which I know sounds positively medieval, it is an established therapy in both humans and animals with iron overload https://pubmed.ncbi.nlm.nih.gov/19601742/. It is effective more quickly than mineral balancing but still takes quite a few sessions, 7 to 14  days apart, to make progress.  PCV and hemoglobin have to monitored to make sure you don't get too low. It takes around 1 gallon per blood draw to make any headway in a horse and would probably have to be repeated.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Testing for high Iron

Eleanor Kellon, VMD
 

 Nancy and Cass gave you good links to start reading. Here is a link to our latest paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971364/ . Also see https://www.horsetalk.co.nz/2019/10/24/iron-overload-horses-insulin/ .

The bottom line is that iron is a risk factor for IR but iron overload alone won't cause it, and correcting iron overload won't cure it. IR is genetic. It's a physiological body chemistry type. Many things can affect that physiology and it's looking like iron overload is one of them.

Ferritin is the part of the iron screen that only KSU can do.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Dewi - latest blood test results - high resting insulin - what to do next?

Eleanor Kellon, VMD
 

This new study from AU has some good information on seasonal TRH results (table 2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848300/ . I would  start him on Prascend but he clearly had EMS long before this.

If you can already easily feel his ribs I wouldn't recommend further weight loss. Definitely retest your hay for ESC and DE. DE can lower substantially so you need to feed more.

I don't think you need any further insulin testing.

As far as I know, Invokana is available in UK. If you want to try metformin again first, Begin with a short trial and retest in 6 days. If it's not doing a good job then it never will. However, after reading your last experience with it I would probably go directly to Invokana. I will need to send directly to your vet so please send me his e-mail at drkellon @ gmail.com.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

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