Date   

Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Sherry, Cornell did not provide the pre-test numbers. Sorry.
--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: Vermont Blend

Sandy
 

Okay thank you - I'll continue using the gelcaps I was using.  I need easy! 
--
Sandy Kemp
Northeast Pennsylvania
Crystal Blue PPID/IR
Tiffany PPID
2021
https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Tiffany 
https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Crystal%20Blue


Hay Analysis & custom mineral/vitamin blend help

Michele Goldberg <ladipus@...>
 

I’m considering switching to a custom blend for my low sugar Timothy hay analysis ...my question is ..if I choose Horsetech for instance or even Uckele..do I just show them my hay analysis and they create the blend? Or does someone else need to look at the hay analysis and decide what needs balancing and they recommend what should be in the blend and with that you take the “prescription” so to speak to the custom blenders ??

I switched all of my metabolic issue horses to the emergency diet last June ..then modified it a bit and have had them on Vermont Blend carried with ODTBC/flax/vitamin e ans some Stabul 1..they’re all doing fairly well and they all have lost considerable amount of weight ..however recent bloodwork shows insulin & glucose within normal limits of the Cornell range-but close to the higher end of normal and the G/I ratio says they are IR and high laminitis risk so I’m thinking the hay might need to be custom balanced??
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016


Now what

Daune Gatenby
 

Now that my horse is not laminitic. How should i feed him. I know to soak the hay and i know low to no sugar balancer, but how much? Still 1 to 2 % of his weight in hay but how much balancer. No grass fields. But how much of everything.


--
Daune and Monty
Southeastern Massachusetts
2021


Re: Acute laminitis

Maxine McArthur
 

Hi Jessi-ra
This message is our welcome message for new members, that contains much important information, and links to further information. Please read it through carefully, and ask questions if anything is unclear. 

If your horse's laminitis is continuing, it means the cause has not yet been found and removed. Laminitis is a symptom, not a disease. So, this group works on a philosophy called DDT/E: Diagnosis, Diet, Trim and Exercise (when the horse is able). The reason Diagnosis comes first, is that until you know what the problem is, you can't treat it effectively. 
You mention that your horse has been put on thyroid medication. Was any bloodwork done to diagnose hypothyroidism? Was any other bloodwork done? There is more on the blood tests we recommend in the message below. High insulin can lead to laminitis, and there are other medications that can be used if a tight diet does not bring insulin down. If the horse is PPID with high ACTH levels, this can raise insulin and worsen laminitis also. We thus recommend testing insulin, glucose, and ACTH. 

You will have received instructions on how to create a case history for your horse, as we need more information in order to offer any suggestions for you. Based on the initial information in your post above, though, I can make the following comments: 
Bute is not recommended for horses with endocrine-related laminitis (as opposed to sepsis-related laminitis or supporting limb laminitis), as this kind of laminitis is not an inflammatory condition. There are some safer pain relief options in the message below, but removing the cause of the laminitis is the only way to bring relief. 
Without knowing your horse's weight (please put this in your case history), it's impossible to say if 18 pounds of hay is appropriate or not. We recommend feeding 2% of a horse's ideal body weight or 1.5% of current weight, whichever is greater, if the horse needs to lose weight. Soaking the hay is a good idea, but what kind of hay is it? We don't recommend alfalfa as it can make some horses footsore. Much more on diet below. 
The Wellsolve feed does not list a value for simple sugars or starch, so we don't recommend feeding it. Rinsed, soaked and rinsed beet pulp is safe, as is soaked soyhull pellets. 
The Soft Ride boots are a good idea, but some horses don't like the raised frog section on the pads, so you could experiment with removing this or using a different pad, to see if it helps his comfort. You can also create a folder in the Photos section of the Case History group and post hoof photos and copies of radiographs for our hoof experts to comment on. 

So, here is the welcome message, chock-full of information. Let us know if anything is unclear. If you get stuck at all navigating around the group, check the "Wiki" (at the bottom of the left-hand menu) for instructions on pretty much everything. 

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: Free feeding tested hay

 

Hi, Pat. 

I have an ulcer-prone horse. My vet said he could spot it when he came to scope her. I wish I’d skipped the scoping and followed this excellent suggestion: “ Another option mentioned in previous posts is to try a few days of GastroGuard or Ulcerguard to see if her condition improves; if yes, then she likely does have ulcers that would benefit from the full treatment.”

I saw results and improvements that were NOT just wishful thinking within 4 days of starting treatment.
My ulcer-prone horse has had a second episode. I skipped the scope and treated her.

Thought I’d mention the trial treatment option. I can’t give my horse meds by syringe, but I found an oral omelrazole option that worked for us. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Sherry Morse
 

Hi Julanne,

Do you have the actual test results?  It would be helpful to know what the pre-test numbers as well as the post-test numbers are.  Also, the TRH stim test is not recommended to be done during the fall as there is no adjusted reference range during the rise.  Dr. Kellon explains that in this message: https://ecir.groups.io/g/main/message/257556.  So having the pre-test numbers particularly for November would be very helpful.



Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Both tests were ACTH PostTRH1 tests, sorry, did not know there were different kinds. My first rodeo with these labs.
--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Thanks, I thought that’s what you meant. Good to know you had to go lower. These air ferns are tough!

--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Think it was a different test:ACTH Post TRH 1 for both April and November.
--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Apparently a stim test: ACTH Post TRH 1
sorry, unfamiliar with the different ACTH tests. Before beginning Prascend, first test results for ACTh Post TRH 1 was 177.

--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: Update: Relevante Goes Rodeo

Lynn
 

Hi Sherry! Thanks for saying that ...I feel better... He has never done anything like that before. I know it's not the saddle because the chiropractor carefully checked everything, the saddle pad was custom made for him and we're using a girth recommended by the chiropractor and of course...no bit since we are using the training halter.  I'm shocked I stayed on but now that it happened and we were able to work through it I have more confidence...especially hearing that this can be part of the rehab journey.
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Re: Update: Relevante Goes Rodeo

Sherry Morse
 

Hi Lynn,

Glad to hear Relevante is feeling so good and hopefully neither of you are sore tomorrow!  I've often found there can be some bucks to work through when you start doing rehab so glad you were able to ride them out.




Re: Free feeding tested hay

Pat
 

She has never been this grumpy in all the time I have had her - she is a very friendly and willing mare - so I don't think it is insulin related or cycling or it would have come up before.
I will be asking for a scoping for sure, have a vet appt coming up.  I will talk to the barn about feeding and see if I can convince them to at least drop down to 1" hay bags and add some more.
--
Pat
August 2020
Metro Vancouver BC Canada
Case: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Willow
Photos: https://ecir.groups.io/g/CaseHistory/album?id=253325


Re: Free feeding tested hay

Kirsten Rasmussen
 

Hi Pat,

I'm glad to hear Willow is doing well and that she has lost so much weight!  That's great that her bloodwork is showing her insulin is well-controlled, but that was back in October.  If her insulin is creeping up at all, that could coincide with a grumpy attitude and a dislike of being touched or worked though so would you consider having her bloodwork checked again?  Biting could also be due to discomfort from cycling, or saddle fit changing after all her weight loss, etc.  If you suspect ulcers, I would have a veterinarian out and have her scoped if you can, to get an actual diagnosis.  Another option mentioned in previous posts is to try a few days of GastroGuard or Ulcerguard to see if her condition improves; if yes, then she likely does have ulcers that would benefit from the full treatment.

Because she is unlikely to ever learn to regulate her hay intake, I would not consider go the route of free-feeding hay.  I think she will balloon up so fast that all your hard work will be undone.  Currently she seems to be eating about 1.8% of her lower body weight estimate.  If you are happy with her current weight, and if she is back in work, you could try increasing her hay intake to 2% of her ideal body weight (assuming 1100 lbs is ideal, that would be 22 lbs of hay).  Also, the hay really should be weighed because estimating hay by flake size is very inaccurate.  Maybe she is getting less than you think and has good reason to be starving all the time?  One suggestion is for you to weigh out a day's worth of hay for 7 days and put it into separate garbage bags, then ask the barn to feed 1 garbage bag a day, divided in to the 3 feedings.  And, maybe on days you exercise her a minimum of 30 min trotting, she can have a small 0.5-1lb meal of hay afterwards that you give her?  Those are just my thoughts.  I know its hard and its a constant battle slowing my horse's hay consumption down, too.

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


Acute laminitis

Jessica Gunderson
 

I have a horse with acute laminitis going on 9 days now. Responded well to 2 grams bute twice a day, 1 gram bute does not seem adequate to manage discomfort. Also put on thyroid medicine. Being fed 18 pounds soaked hay in 1.25 hole net bag split between multiple meals. Also eats 1 scoop loose himalayan salt and 1 cup wellsolve w/c with thyroid medicine. On matted stall rest with soft rides containing laminitic gel. So far no movement of coffin bone based on radiology but concerned horse is still experiencing discomfort after 9 days. Likely brought on by hock injury that resulted in a month off from exercise and other feed changes that sent this easykeeper over the edge. Most comcerned at this point with mitigating the acute laminitis. All advice is appreciated. Thank you.

--
Jessi-ra_Dakotas_2021


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Kirsten Rasmussen
 

I corrected what I wrote in my first post above...I have a bad habit of leaving out the decimal point when saying what percentage of BW in hay a horse is getting!  You are right and she is getting 1.9% (not 19%!) of her current weight.  I found I had to drop my boy down to 1.5% of his current weight to get the last 100 lbs off, and then start soaking that amount of hay to get the last 30lbs to go.

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


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Kirsten Rasmussen
 
Edited

Hi Julanne,

The April reference ranges are 9-35.  That's because ACTH goes up naturally in the fall so the November reference range goes higher.  Its a minor detail but you could correct the April reference range you gave in your Case History if you like.

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


Update: Relevante Goes Rodeo

Lynn
 

Dr. K's April 9 blog post on "Conditioning The Older Horse" was excellent and timely for me and the boy.  Last May radiographs showed severe broken HPAs in Relevante's hind feet. So much so, that Dr. K and Lavinia said to stop exercise and riding. We set about to biomechanically correct the problem with the right trim [from Lavinia of course...we need t-shirts that say "Feet By Lavinia"] and in October 2020 he was weaned out of his Easyboot Clouds (with wedges) and I started walking him and building up the time. [you can see his hoof evolution in his photo album] Last Saturday we were cleared to ride. [I had been building up weight starting with walking him saddled]. I rode him for the first time since this happened at a walk for 15 minutes. It was hard to hold him back because he wanted to GO, but I finally got him to walk on a loose rein. Today was his third medical massage in row [we did a series] and then I took him out to the arena for a walk/ride. [I'm using a knotted training halter with reins because I'll need it when he's ready to gait to help him balance and get his groove back. So I wanted to get him used to it.]
Well...today I became a star  - if I'd know I would have worn a flashy shirt with fringe. He was calling out to the other horses in the barn and as we neared the back of the arena in a flash he spun, threw his head down and started to full out buck. After I recovered from my initial shock - I stopped it by pulling one rein to my knee/foot. The gal who did the massage was watching him to see if she could detect any soreness anywhere and when she started to step outside the gate that's when he threw his little tantrum, one of THREE!!!!! I am proud to say that I did not come off once during this little drama. I am surmising [since he can't talk] that he didn't want to be in the arena alone - and to be fair - he knew his lunch hay was in his stall. I do try to avoid meals time at the barn but sometimes you can't.  I finally got him to be calm and just walk - if I saw him start to get anxious I immediately turned him back to the gate but I wouldn't let him stop there - I kept him moving....and we ended the ride on a positive note with me still aboard. We will continue to adhere to Dr. K's "long and slow" advice per her blog but I share this because despite his long road to recovery [which we are still traveling]- after his shenanigans today - he can't be hurting that much [and here I was afraid I was going to "break" him because I'm no expert at rehab] but secretly - though I would never tell him this - I am glad to see him be able to kick up his feet - just preferably not with me on him the next time.
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Lavinia Fiscaletti
 

Hi Julanne,

Was the testing just a plain ACTH (one draw) or a TRH stim test? The reference ranges for the stim test are 9-110pg/ml.

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

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