Date   

Testing for PPID

K_8_r@...
 

I am after advice regarding diagnostic testing for PPID. I have a 27yr old Welsh sec D who I highly suspect has PPID. He has had his ACTH levels checked 4 times and they all come back within normal range. The vet suggested that there may be more tests. I was keen to understand what tests I should be asking for and under what conditions they should be done. His coat is fine, but he is having recurrent foot abscesses, has lost his top line and muscle mass and his feet show inflammatory changes. I am desperate to avoid dull blown laminitis and keen to have him on the relevant medication if needed.

Many thanks in advance for your help
Kate
--
Kate R Canterbury England 2021


Re: Acute laminitis mustang seeking input

Nancy C
 

On Sun, Apr 4, 2021 at 01:03 PM, Makendra Silverman wrote:
Question: her hay is giving her 1365mg of Iron daily and the way I was understanding it is that I needed to eliminate additional iron wherever possible. In researching it looks like Morton iodized salt has 45 mcg iodine/g which would be 0.045mg iodine/g and there are about 17g/TBL so 34g in the 2TBL daily recommended iodized salt for 1.53 mg daily added iodine - not as much as I was thinking and would barely change the mineral balance requirements. Is iron in the salt more bioavailable?
HI Makendra

https://nutritiondata.self.com/facts/spices-and-herbs/216/2

The amount of iron in salt is 1 mg per cup of table salt. Once you get beyond the emergency diet, you will  want to increase the amount of iodine, but this will get you started. For a 1000 pound horse you need about 5 mg.

I think Sherry answered the rest of your questions. (Thanks Sherry)

Have a good night.
--
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


VITAMIN E IN EMERGENCY DIET

Sue Ring
 

Hello all,

I have a question regarding Vitamin E required for the Emergency Diet.  My pharmacy has Vitamin E Oil that can be syringed out in the desired amount of 2000 IU per day.  Would that be acceptable/pallatable.  I believe it is sunflower oil that it is immersed in.  The reason I ask is because that type of product seems to eliminate the capsule administration and the E oil can be syringed directly on to their ration, which I mix with a handful of Triple Crown Naturals Timothy Balance cubes and soaked.  Thanks for any input or experience you have had using this product.
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/SUE%20and%20DAKOTA
 


Re: Has anyone used products from Immubiome?

Sherry Morse
 

Hi Laura,

In a nutshell it's a bunch of mushrooms, probiotics and some colostrum.  I don't see anything that would help with tension or nervousness in it.  Have any of the people who suggested using it tried it and had success with it?

Even their "Focus" product has Mg in it (although not a whole lot) in addition to the mushrooms and probiotics.



Re: Acute laminitis mustang seeking input

Sherry Morse
 

Hi Makendra,

Just want to mention that if Arrow is comfortable in the boots - leave them on.  There's no reason she can't be out of the boot on the foot that's being trimmed and then put back in it to trim the other foot.  Besides trimming while laying down if she'll stand on a block of wood you can use that bit of elevation to help with trimming as well.

If she's comfortable in the boots and not prone to run and play she should be ok to go out with her friends but do keep an eye on her and if she shows signs of increasing discomfort then I would restrict her to the stall/paddock area.

Sorry I can't help you with the iron question but Nancy may check back in later and be able to help with that. I'm not following what you mean about iron in the salt because there is no added iron (Fe) in Morton iodized salt.

As far as Equioxx vs. bute - they're both NSAIDs so the recommendation for not maintaining a horse on either is relevant to both.

If this is the first year she's had a spring time crest the increase in udder size could be related just to her IR.  Definitely no grass snacks in addition to no alfalfa as some horses can't handle any grass at all and she may well be one of them.




Re: Ideal weight

Kandace Krause
 

I don't quite understand the CH problem but will look when I can get to PC.
She was still on metformin when Feb blood draw was taken, but has since finished, so I think it important to get that retested, to see if it has gone back up since drug stopped.  The draw was apprx four hours past start of a.m. feed.  It was first glucose number I had seen as equine vet felt it unnecessary.
She is 15.2, will check my CH reflects that.
I find the BCS 1-9 too easy to bluff myself through.  And is currently too hairy to really be convinced of ribs. This horse has a way more hair than she ever has before!  I saw a British method using a three body section scoring one to five per section and feel it is less subjective under winter coats, anyways.  If I go back to that, I get her to a 3.5/5 , likely a few more pounds to go.

As far as the devices, NANRICS go, I too cannot fully explain how they work but was told that since we had started down this road, we should continue with it.  When I find another vet, I will be leaving the Specialized farrier to explain to vet and hopefully to me.  When I was told about them I googled Ultimate boot and came up with a riding boot, there wasn't ever any mention of NANRIC at the time, and I wasn't aware of the rocker on the bottom until it was already done, the dumbed down version seemed to be taking tension off the deep digital flexor.  My anatomy is not great and I never claimed to be an expert but I have been prescribed drugs and procedures and ideas by "experts" for my own health that haven't worked so I do question "what about" - everything.  The inventor Rick Redding, is a farrier turned vet and has been doing this for some time, but more than that I do not claim to know. 

Thanks again, Kirsten.




--Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Help! Rising ACTH and Insulin

Suzy Berkowitz
 

Hi Kirsten, I will up Scout’s prascend by .5mg and retest in 3 weeks. Thanks


--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos: https://ecir.groups.io/g/CaseHistory/album?id=260915


Has anyone used products from Immubiome?

Laura and Pabatsa in CA
 

Hi Dr. Kellon/Group,

It's been suggested that I use a product from Immubiome called "Spine and Nerve" for tension. https://www.immubiome.com/pages/horse-conditions

Has anyone ever used it or know about the product this company sells? I'm not trying anything people say is right for my horses without hearing it from here first.

Thanks a lot and Happy Easter!
--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )


Re: Help! Rising ACTH and Insulin

Suzy Berkowitz
 

Hi Lavinia, the Feb x-rays were taken by the podiatrist who trimmed Scout’s feet and made the clogs for his front feet that day. He has taken over from my regular farrier. I will get some hoof pix. Thanks


--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos: https://ecir.groups.io/g/CaseHistory/album?id=260915


Re: Ideal weight

Kirsten Rasmussen
 

Hi Kandice, 

I don't see a CH for K posted at your link.  It looks like it was uploaded into the folder ("Files") area, but it needs to be moved in to your actual folder.  It is here, just a few down from the top if this list of the most recently loaded files:
https://ecir.groups.io/g/CaseHistory/files?p=updated,,,20,2,0,0

If she was taken off Metformin and her insulin went up, then it may be it was helping so you could put her back on it. She started it on Jan 5 but her Jan 14 bloodwork does not show an improvement.  Her February bloodwork is better (see below) so was she still on it?  Metformin typically loses its effectiveness with time and eventually they are taken off of it because it's not helping.  Some horses don't seem to benefit from it at all.  It can be useful to get horses that respond to it through periods where insulin is high and laminitis is occurring though.  I think the goal for you is to get K sound so she can be back in work.  Then with regular exercise she might not need any more help keeping her insulin down other than some care with her diet.

Her latest insulin from Antech is not bad though.  If you divide 226 pmol/L by 6, you get 37.7 uIU/mL.  Of course results from different labs cannot be compared directly, but it gives you a rough idea of how she is now, compared to before.   Her glucose at Antech was abnormally high though.  Was her blood pulled more than 4 hrs after her morning meal?

Ideal weight is what she weighs when her BCS is 4.5-5 / 9.  For a 15H Arab-AT, I would guess 900 lbs is closer to ideal.   But you can judge that yourself based on her body condition score.

As far as the NANRIC shoes and her trim, I'll leave that to someone more experienced, other than to say I personally can't see how they are helping as they seem to be encouraging her to stand with her weight on her toes, if the recent rads are representative of her stance.  I think the idea is to allow them to rock back on their heels more easily to relieve toe pressure?  But they look so unstable and hard to walk on that I can't visualize in my mind how they are helping.  Her trim looks pretty good though and she does have sole depth.  But you need someone more knowledgeable to comment on this.

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


Re: Help! Rising ACTH and Insulin

Kirsten Rasmussen
 

Hi Suzy,

I'm sure it's been mentioned before but your description of the paddock being a mix of weeds and grasses is a red flag when insulin is so high.  Even if it's not lush and green, stressed grasses and some weeds can have much higher sugar content.  It can take so little to trigger laminitis.  Can you make a smaller area next to the shelter completely grass/weed-free and see if that helps Scout?  I have my pole barn divided in 2 with panels and I keep my insulin resistant horse on the side where I scrupulously kill grass, and my non-IR boarder/companion horse on the other side where I don't fuss about killing grass.  The non-IR horse is also eating a different hay that my IR horse cannot tolerate so I have to keep them separate anyways.  They both come and go as they like in their 2 parallel paddocks, and can mutually groom over the steel panels.

I also agree with Sherry that increasing his pergolide is a good idea because 33.9 is high for March.  But the insulin going back up so high suggests to me that better dietary control might be needed.

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


Re: Acute laminitis mustang seeking input

Makendra Silverman - NS
 

Wow, thank you Nancy, I know it can't be said enough what a gift it is to have people help you help your horse - especially in this sort of situation. I so appreciate your time. 
Arrow seems MUCH better this morning (even brighter, muscles feel normal whereas last night she was tight in hind/lumbar region, udder is as low as it ever gets as well, no milk or tenderness, she is able to "release" and chew and enjoy a good long groom and massage- I am so happy). Still sore on front feet in terms of lifting one up but I think that may be a little more fear of pain than actual pain. Will evaluate without boots later to try and move forward with trimming at least a little.  Thank you, it is hopeful to know trimming could be that missing piece.
I am hoping I can safely trailer her to professional/rehab trimmer this coming week if she seems stable. I have looked for a while to find a trimmer who understands biomechanics and can help me look at the whole horse and not just shape a nice foot. 

-Question: should I continue restricting movement even though she is comfortable walking in boots? She is in 15x15 stall with 10x10 mini temporary paddock attached. I have a 30' sand base round pen and/or a 100x100' dry lot with pony and burro friends available outside her small enclosure. She is not stressed to be in current situation but also is not one to run around in the larger paddock and I know movement is generally crucial. 

-Will test iron via KSU, thank you for the details!

-Question: her hay is giving her 1365mg of Iron daily and the way I was understanding it is that I needed to eliminate additional iron wherever possible. In researching it looks like Morton iodized salt has 45 mcg iodine/g which would be 0.045mg iodine/g and there are about 17g/TBL so 34g in the 2TBL daily recommended iodized salt for 1.53 mg daily added iodine - not as much as I was thinking and would barely change the mineral balance requirements. Is iron in the salt more bioavailable?

-Thank you, only did the 1g of bute the first night and then delved into reading more about NSAIDs and avoiding them for laminitis. Her future trimmer recommended Equioxx over the bute. I will taper off the equioxx as recommended but hoping a few days will be helpful to her and not damaging. I found a lot of different ECIR posts about using NSAIDs but it seemed 3-5 days was a good idea or at least not harmful. I will follow up trim with jiaogulan or PhytoQuench as needed - excellent to learn about those as options.

-I luckily read a post about nitrates in hay on ECIR prior to buying and did have nitrates tested, came back at 0.5 which as I understand is very low. I think it is the few stems of alfalfa perhaps that caused the protein level but there really is not more than one stem per flake. No added alfalfa for sure with Arrow. I used to use alfalfa timothy pellets (1 cup) as a base for her supplements but changed to timothy only a few months ago after hearing a Humble Hoof podcast where a guest mentioned even a small amount of alfalfa can throw them off and impact hooves.

-I have never tested her hormones, would that be helpful in this IR journey to health? I don't have particular concerns, just am not very aware of when she is cycling. This spring-time crest is not a normal annual event (at least in past years).  Thank you for link to Dr. Kellon's lectures - I am loving learning and will read these next. I did have Arrow checked for ovarian tumors/cysts in January to see if that was the cause of sacroiliac junction pain but all looked great according to vets. 

Thank you for the kind words and I am breathing now :) Lots of hugging and grooming happening too. 
Thanks for helping me help Arrow!



On Sun, Apr 4, 2021 at 08:27 AM, Nancy C wrote:
Hi Makendra

Thanks for getting your CH in order. It makes a very big difference.  There is a steep learning curve, but you will get there.  Keep breathing and hug your horse.

I will leave the foot comments to Lavinia or Dr Kellon, but wanted to share my experience that, once the trigger for hyperinsulinemia is reduced or removed, getting the trim in order makes all the difference for pain and pulses.  Standing on anti-fatigue mats can help with your trim reluctance. If it’s really bad, some of us have trimmed while they were lying down.

If you want to test for iron overload, make sure you test via KSU.  You need serum iron. TIBC and Ferritin.  Serum iron alone (as on a Chemistry Panel) will not diagnose iron overload. http://www.ksvdl.org/laboratories/comparative-hematology/

About salt: We have no info that salt is an issue with EMS/IR horses. Please feed iodized table salt, unless you are giving an iodine source with known/guaranteed amounts of iodine (Source or Uckele Ocean K are examples)

Red flags I see:
Free choice minerals are not recommended. Glad you pulled her off them.

Please begin to taper off the NSAIDS, if you have not already. This is done by giving at subsequently longer periods of time until you stop completely. It does not help with laminitis pain and interferes with healing.  See this file for guidance on how to taper off. How to Taper Off NSAIDs.pdf https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf

You can use jiaogulan or Uckele PhytoQuench for foot pain, but again, you will not see big improvements until you can concentrate on the trim. Glad she is happy in boots. That is a big plus.

This is very good >>> Bright eyed, eager, hungry, interactive (doing tricks to see if she can get a treat etc).  Take heart in this engagement with her.

Regarding your protein question >>> higher protein can make EMS/IR worse in some equines.  We do not know why but we may be beginning to understsand.

https://ecir.groups.io/g/main/topic/80294425#260884

You might wish to check nitrates on that hay. Many here with protein in the 15% range would recommend that.

I would drop the alfalfa altogether for now.

I wonder about her spring time crest and noted in your CH you had concerns about cycling.  You indicated testing was done. Wondering if you had tested hormones, specifically progesterone, LH, and FSH, preferably two sets 10 days apart.

Your tests don’t show super high insulin that usually accompanies mares with hormonal issues — a good thing. Wanted to just point you to this info in case it is needed.
Here’s the link to Dr Kellon’s 2015 lecture. Scroll down to Ovarian Abnormalities…… https://www.ecirhorse.org/proceedings-2015.php

Let me add one more lecture from Dr Kellon the you may find helpful as a reference which outlines the why behind a lot of the recs here: Tiered Management Approach to EMS and PPID https://www.ecirhorse.org/proceedings-2017.php

I think I given you enough for now!  Hang in there. Keep breathing.  It gets easier. Just take it a step at a time and hug your mare a lot.

 
--
Makendra and Arrow
Denver Colorado, 2021
Arrow's Case History: https://ecir.groups.io/g/CaseHistory/files/Makendra%20and%20Arrow
Arrow's  Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=262625


Re: Compounded Pergolide

Lavinia Fiscaletti
 

If you are starting pergolide for the first time, titrating up to the prescribed dose is recommended, whether you are using the Prascend or compounded version of the drug.

If you are switching from one to the other, and the dose is remaining the same, there is no need to titrate.

If you are switching to the compounded from Prascend and are raising the dose as well, then start at the current equivalent dose and titrate up the new, higher dose.

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


Re: Compounded Pergolide

Lavinia Fiscaletti
 

We recommend getting compounded pergolide in capsule form, rather than the liquid. Cost of capsules is usually much better than that of the liquid.If you need to syringe, just dissolve the contents of a capsule in a couple of mls of water - don't need much - and syringe that in.
--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Re: Help! Rising ACTH and Insulin

Lavinia Fiscaletti
 

Hi Suzy,

Were there any changes made to the trim after those Feb rads were taken?
Was he wearing clogs at the time of those rads or were they added after the rads were done?
Would you please get some hoof pix posted.

Thanks.

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


Re: Uckele Pro Air Pellets Vs. Lung Eq

Nancy C
 

Hi Michelle

Issues with both Vitamin C and MSM have been discussed here often.  MSM was discussed just within the last ten days or so.  Have a look in the message archives.

Vitamin C is not a good idea as it can increase iron absorption if you have a known iron overload horse or are worried about iron, it may be best to stay away from it. Also lots of discussion in the archives.

I would agree jiaogulan and spirulina are a safer bet.

--
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: Acute laminitis mustang seeking input

Nancy C
 
Edited

Hi Makendra

Thanks for getting your CH in order. It makes a very big difference.  There is a steep learning curve, but you will get there.  Keep breathing and hug your horse.

I will leave the foot comments to Lavinia or Dr Kellon, but wanted to share my experience that, once the trigger for hyperinsulinemia is reduced or removed, getting the trim in order makes all the difference for pain and pulses.  Standing on anti-fatigue mats can help with your trim reluctance. If it’s really bad, some of us have trimmed while they were lying down.

If you want to test for iron overload, make sure you test via KSU.  You need serum iron. TIBC and Ferritin.  Serum iron alone (as on a Chemistry Panel) will not diagnose iron overload. http://www.ksvdl.org/laboratories/comparative-hematology/

About salt: We have no info that salt is an issue with EMS/IR horses. Please feed iodized table salt, unless you are giving an iodine source with known/guaranteed amounts of iodine (Source or Uckele Ocean K are examples)

Red flags I see:
Free choice minerals are not recommended. Glad you pulled her off them.

Please begin to taper off the NSAIDS, if you have not already. This is done by giving at subsequently longer periods of time until you stop completely. It does not help with laminitis pain and interferes with healing.  See this file for guidance on how to taper off. How to Taper Off NSAIDs.pdf https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf

You can use jiaogulan or Uckele PhytoQuench for foot pain, but again, you will not see big improvements until you can concentrate on the trim. Glad she is happy in boots. That is a big plus.

This is very good >>> Bright eyed, eager, hungry, interactive (doing tricks to see if she can get a treat etc).  Take heart in this engagement with her.

Regarding your protein question >>> higher protein can make EMS/IR worse in some equines.  We do not know why but we may be beginning to understsand.

https://ecir.groups.io/g/main/topic/80294425#260884

You might wish to check nitrates on that hay. Many here with protein in the 15% range would recommend that.

I would drop the alfalfa altogether for now.

I wonder about her spring time crest and noted in your CH you had concerns about cycling.  You indicated testing was done. Wondering if you had tested hormones, specifically progesterone, LH, and FSH, preferably two sets 10 days apart.

Your tests don’t show super high insulin that usually accompanies mares with hormonal issues — a good thing. Wanted to just point you to this info in case it is needed.
Here’s the link to Dr Kellon’s 2015 lecture. Scroll down to Ovarian Abnormalities…… https://www.ecirhorse.org/proceedings-2015.php

Let me add one more lecture from Dr Kellon the you may find helpful as a reference which outlines the why behind a lot of the recs here: Tiered Management Approach to EMS and PPID https://www.ecirhorse.org/proceedings-2017.php

I think I given you enough for now!  Hang in there. Keep breathing.  It gets easier. Just take it a step at a time and hug your mare a lot.
--
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: Compounded Pergolide

Trisha DePietro
 

I use the compounded pergolide in the almond oil from Wedgewood. Ask them to send you the skinny syringes as it is easier to get more precise when you are increasing in increments for 1 mg. The almond oil and pergolide is more stable than the liquids mixed with pergolide. Yes, to starting slowly and gradually working up. I did 5 days before I switch to the next level. And when they refuse the new level, go back to the previous measurement and wait a few days and try to increase again. Usually, that works....:)
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Compounded Pergolide

Kandace Krause
 

Lavina, I was thinking of doing same, getting compounded pergolide, as I am currently at 2 Prascend tabs and not 100% sure this is even enough.  I read somewhere, maybe here, that buy only one months worth at a time and, like you say, shake well before use.  This is because of dosing now must be syringed and hoping to bring cost down a bit.

--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Uckele Pro Air Pellets Vs. Lung Eq

Michele Goldberg <ladipus@...>
 

Hi Sherry...it looks like both Pro Air Pellets and Lung Eq contain msm & vitamin c ...I wasn’t aware that either one of those ingriedients were problematic for IR horses ?? I was under the impression  that Lung Eq was safe and recommended over SmartBreathe Ultra pellets...it’s sounding like just Jiagulon & Spirulina might be a safer bet ??im wondering how important the rest of the ingriedients are in helping respiratory issues like heaves and allergies ??
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016

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