Date   

Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

LJ,

Sending medication like that is both illegal and dangerous.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

Lorna Cane
 

Hi Jenny,

Would you be able to take a video of his walking ?

Hang in. Keep breathing.

--

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


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

LJ,

I can't recommend that approach. Invokana is a new medication, incompletely studied in horses (and horses are not people, very different metabolism). It must be used only under the direction and supervision of a veterinarian who understands the metabolism, can set up appropriate testing schedules and monitor the horse. If the veterinarian is reluctant even with signed informed consent forms, try to find another that is not.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

LJ Friedman
 

If I didn’t mail out the invokana , I wasn’t using it for another member, I would gladly mail you 30 tablets if I had them. Perhaps a member in the US can mail you 30 tablets.???
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: NEW MEMBER NEEDING HELP WITH DIET

Eleanor Kellon, VMD
 

Balancing correctly requires analyzing your hay and working from there. More hay is your first line source for fiber and energy but if you need a more concentrated source consider Maxisoy.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

LJ Friedman
 

following this thread, you can’t completely fault your vet for not prescribing Invokana as he did speak to a specialist and they didn’t give “a move forward answer.”answer. Additionally, to think about putting your horse to sleep because you can’t get the Invokana would be awful. What I did, and what I suggest you do, is just get Invokana anyway you can. And then after testing, show the results to your vet and I’m sure he will prescribe it. 
is there no one in UK that can loan you 30 tablets? 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: New Test Results for Bella & Destiny - Dr. Kellon, asking for input about possibly starting Invokana?

Eleanor Kellon, VMD
 

Hi Lynn,

Difficult call! As a rule of thumb, any horse with insulin over 80 to 100 is at increased risk of acute laminitis but even lower levels are causing damage to the laminae. Regular exercise is the best method to control insulin but obviously not possible when they're lamintic.

You can NOT use heat and pulses alone to indicate laminitis. Too many other things can change them. Pain and reluctance to move also have to be present.

Since she is comfortable now, or at least still improving, whether to change depends on your treatment goals. If you treat by signs/symptoms, it would be reasonable to continue with metformin for now. If you want to treat for the best possible numbers, you would switch. You might want to split the difference and get her Chemistry screen and triglycerides checked now so you would be ready to go if you decide to switch to Invokana.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Do the Vitamin C and NAC dosage amounts from Dr. Kellon scale with weight?

Eleanor Kellon, VMD
 

Spirulina dose for lung issues is 20 grams twice a day. If using powders, pair it with Jiaogulan. Chondroitin is for skin problems.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Pergolide and Diarrhea- Not sure what to do

Eleanor Kellon, VMD
 

There is no set dose on the CTB because the strength of sources varies. Are you using an extract or whole powdered berries?

Any improvement with Equi-Winner Patches is pure coincidence.

When your vet is there, be sure to get his urinary tract checked out  with exam of penis and sheath, rectal exam of bladder, urinalysis. That behavior suggests either obstruction or urinary tract infection.

You can feed psyllium indefinitely.The short course then stop is for sand removal. When you feed it  continually the hind gut will break it down and ferment it. No problems with minerals either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Help interpret Bloodwork Results

Nancy C
 
Edited

Hi Michelle

Your understanding of "lab normal" may be getting clearer, but JIC, and for others who are just starting their journey, here is an article as to why not lab reference ranges are not "normal".  It includes a review of the issue with reporting fasting insulin as well.

https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php

The emergency diet is not meant to be used indefinitely.  You may know this too, but again, JIC. The first line of defense and treatment for EMS/IR equines is diet. Dr Kellon goes into in in depth in this 20 minute film.

https://www.ecirhorse.org/video.php

Glycocemic Eq has been described by Dr Kellon this way: "Glycocemic EQ is a "starter" mineral supplement with the minerals most frequently deficient...".  Lost more in the message archives.

The best approach is still through understanding what is in your hay.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


Re: Active abscess and testing for Cushings

Trisha DePietro
 

So, I just want to make sure I get this- Be in the group ie  Main group as an example, then I should highlight messages, then type into the search box? When would I search the files or the wiki? I guess I need a remedial training on searching better!!! :) 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

No, it's not licensed but neither was pergolide until a few years ago. It's perfectly legal to prescribed a drug being used in humans if there is no veterinary alternative. Invokana is approved for human use in the UK. You are supposed to be informed of risks and to sign a consent form.

BTW, metformin isn't  licensed for horses either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Help interpret Bloodwork Results

 

Hi Kirsten ...I thought because his numbers were within the normal range that he’s considered not IR/EMS...I’m partly wondering if his results were what they were due to having a heaves flare?? I was wondering if Uckeles Glycocemic Eq would be beneficial as I think I remember Dr Kellon recommending to others before? Good news is Oskar is in full work and exercised regularly. 
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016


Re: Is anyone in the UK using Invokana

Caroline
 

Sorry, I'm not using it but there are uk studies on it's use in people.  https://www.diabetes.co.uk/diabetes-medication/invokana-canagliflozin.html might help.  Vets can prescribe unlicensed medicines.  Some species literally do not have any licenced meds, and it's up to the vet to bridge that gap.  The cascade stops them prescribing human drugs where there is a species licensed version, but that's not the case here.  Have you spoken to any other vets that might be more willing to work with you?  
--
Caroline
Spalding, Lincolnshire, UK
September 2019
https://ecir.groups.io/g/CaseHistory/files/Caroline%20and%20Evan
https://ecir.groups.io/g/CaseHistory/album?id=231916


Re: Is anyone in the UK using Invokana

jenny.comish@...
 

I’m just bumping this up in case there is anyone in the UK using Invokana that has missed it. However my vet is saying ‘no’ to using it as it’s not licensed. He spoke with a vet at Liphook Equine hospital about it and that was their conclusion. Unless I can find a UK case study I can’t see how I will persuade him. The result of this might end up being Dewi is put to sleep as he just isn’t getting much better - he is on Metformin at the moment and has been for 2 and a half weeks. I would say he looks perkier (he was actually bucking in the arena the other day!) but when he walks he is crippled and has been for months now. 
--
Jenny Comish
England, UK
Dewi Case History: https://ecir.groups.io/g/CaseHistory/files/Jenny%20Dewi
Dewi Photos: https://ecir.groups.io/g/CaseHistory/album?id=257833


Re: Devil's Claw dose -- divided or once daily?

jenny.comish@...
 

My pony is on a liquid Devil’s Claw from a UK company called Hilton Herbs, but there are other ingredients in it too. No idea if it’s helping him! He has it twice daily. Here is a file on pain relief alternatives https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives 

--
Jenny Comish
England, UK
Dewi Case History: https://ecir.groups.io/g/CaseHistory/files/Jenny%20Dewi
Dewi Photos: https://ecir.groups.io/g/CaseHistory/album?id=257833


Re: Pergolide and Diarrhea- Not sure what to do

Jennifer Boydstun
 

Dr. Kellon-

Vet is coming next weekend for Clinic and I am going to run a metabolic profile blood test to see where we are at. last year I followed symptoms and the rise and fall of the ACTH schedule i downloaded and T-Bird did well...this year struggling a bit more, seeing more symptoms; heavy, heavy coat growth and heat/cold intolerance. I like the idea of increasing Chaste Berry.

How much Chaste berry can i safely give? Currently on 1tablespoon in the am bucket. This horse does not sweat in the summer any longer we are in an area that gets 110 +, ugh and last year started to sweat at night in the winter; shaving his arm pits seemed to help, double ugh. I placed the Equi-winner patches on him in May, he didn't sweat much better ( had to hose him down daily) but after the treatment he tolerated the heat better, much better energy and drank much, much better. I did the patches again in the winter hoping it would support better drinking and peeing as this horse tends to pee tiny pees and not drink great...did not seem to work this time. Still seeing tiny pees. Also noticed the sores between his front legs is flaring up again since I started him on the pergolide again. the clumsy; weak kneed episodes seemed to have stopped as of today.  As of today walking comfortable on gravel and hard ground.

I did order pure Psyllium husk, just came in today. How long can i keep him on this product. It says only 7 days and he has been on for weeks off and on. I also heard it takes the minerals along with it? T-Bird is on a custom mineral mix given twice per day. 


Thank you so much for your time. This site has saved T-Birds life.

T-Bird: IR/Cushings Foundered March 2019  

Thank you- Jennifer

--
Jennifer Boydstun
Folsom, Ca.
For T-Birds Windrunner- Tennessee Walker
8-5-18
https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20T-Birds%20Case%20History

https://ecir.groups.io/g/CaseHistory/album?id=89742


Re: Where to go from here?

crista
 

Ok.  I'll work on getting those.  Thanks
--
Crista
2021, Ohio

Mocha's Case history:  https://ecir.groups.io/g/CaseHistory/files/Crista%20and%20Mocha
Mocha's photos: https://ecir.groups.io/g/CaseHistory/album?id=262003


Re: Polson Montana

Karen Warne
 

Thanks, but there is no one listed for Montana!  
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Re: NEW MEMBER NEEDING HELP WITH DIET

Maxine McArthur
 

Hi Ashka
Welcome to the group. You're not too far from me, just a lot higher above sea level! Have to say, I don't envy you the cold winters.

This message is to make sure you get the basic information on what the group recommends for the diagnosis, diet, trim and exercise (DDTE) for PPID and IR equids. The long and detailed message follows my initial comments here, so please have a read through as it will probably answer many of your questions.

You didn't mention whether you have had any bloodwork done on your horses to ascertain if they are IR or PPID or both (see diagnosis section below). While Arabians are 'poster children' for IR, if they are in work they can usually be kept healthy on a suitable diet. This diet may not include grass, depending on the horse and the grass (more below). We do need a bit more information on your horses in order to give you any meaningful advice, such as the circumstances of their laminitis etc--we ask members to create case histories for their horses (instructions are in the message below). 

To directly answer your question about winter--hay is the absolute best feed to keep them warm. We recommend getting hay that is tested at under 10% simple sugars plus starch (more on this in the diet section below). Usually this is weighed and fed at 1.5 to 2% of bodyweight, but in winter there may be a need to supply more. In Canberra, I use teff, Rhodes and tested grass hays. We don't usually recommend alfalfa (lucerne) as some horses become sore-footed on it. If they don't do well on speedibeet, you can use maxisoy (soyhull pellets) as a carrier for the supplements. I'm wondering if you rinsed the speedibeet when you used it? Speedibeet can be quite high in iron, and rinsing (we suggest a rinse--soak--rinse regime) removes quite a lot of surface iron. Perhaps that could have been the reason for the effect you observed on your horses' feet, especially if you were feeding more than a small amount (like, 100g or so dry).
The Fortify has good levels of copper and zinc, but may not balance your hay or grass, which is why we recommend testing hay and getting a mineral supplement balanced to that hay (more in diet section below). Ditto the mag chloride--it's hard to know if they need extra magnesium without testing the forage. Mag chloride actually has much lower levels of elemental magnesium than magnesium oxide, which we usually recommend here. 
If you feed appropriate quantities of hay, there shouldn't be any need to feed more than a small carrier feed for the supplements, especially if the horses are in light work and holding their weight. The copra and sunflower seeds are higher in fat than we usually recommend for IR horses--linseeds are a better option, especially in winter if you are feeding mostly hay, as linseeds are high in omega-3 fatty acids, which are lost when hay cures. You could also add Vit E (I use human gel capsules) when they don't get fresh grass. 

You can also do a search of the messages to see a number of messages about feeding in winter, as many of our members are from Europe and North America where it snows (unlike the rest of Australia). 

Here is the long welcome message, feel free to ask more questions if they come up after reading 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

 

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