Dr Kellon,

Daily diet
Stabul1 - 190g/day - ¼ each AM/PM herbal supplements carrier + ½ cup with mineral supplements
ODTBC - 250g - 200g as mineral carrier for afternoon feed, handful (50g) mixed with BP at night feed to make soupy mash
15 lb of hay is fed dry, not soaked, over 5 daily nets. (Links to these hays show both dry and soaked analyses)
Hay 1, 3.5 lb   7.8% ESC 0.3% Starch   Best balanced, most digestible and cleanest of my hays fed in AM. Only 6-8 bales left
Hay 2, 6 lb      5%   ESC  0.5% Starch    Mature late season/third cut hay.
Hay 3, 5.5 lb   7.6%ESC  0.4% Starch    Mature second cut hay. Like Hay 2, not great major minerals.
1000 g RSR (wet weight) BP fed at night as soupy mash
125g ground flax

She has enough excess energy to gallop to the barn for lunch and to put on a rodeo when it's dinner time. She acts 8 years younger but she's fat. Current body condition mid-body clip: https://ecir.groups.io/g/CaseHistory/photo/7296/3210808?p=Created,,,50,2,0,0 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

If you have a medical emergency and need to use an NSAID you should do it. Use of any medication comes with a risk vs benefit scenario. The gut will heal after short term use. Glutamine can help.

My point for posting that wasn't to never use these drugs, but always think first.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Jane,

Drop me an e-mail privately with your vet's e-mail and I'll send some information. Stop the InsulinWise (and don't forget to get your money back).  Do you know the metformin dose? Is it once a day?

The only thing that's going to help her pain is getting the insulin down.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Dr Kellon, not yet. I was too scared because he is doing so well. And with the low dose I am scared that he will get foot sore :) we just increased walking to 7 mins :)
--
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

Have you tested his urine when at least 4 days off medication?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Rebecca,

From this large study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251896/

"However, unlike the situation in humans where an allergic component is recognised and ongoing medical therapy may be required in the management of EGID to suppress abnormal immune response, it is rare for IFEE lesions to recur in affected horses (hospital unpublished data) nor is ongoing dietary restriction or corticosteroid therapy required to prevent recurrence of signs of abdominal pain."

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

At 2% of body weight, the cubes provide at least 27% above maintenance protein requirements. If you want some amino acid insurance, add Tri-Amino. Add flax, salt and vitamin E.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Cass,

How much of everything are you feeding her?

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thanks Anat, this does help. Couple more questions:

Are you aiming for a 3.75mg dose from the dissolved liquid?
Do you store the remaining liquid in the fridge?

We did get reduced insulin after only 5 days. I am cutting the (300mg) pill 8 ways to 37.5mg . But I worry about the stability of the dissolved medicine. It seems like canagliflozin may not be terribly stable since it isn't a scored pill either??
--
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

i'm not sure this will help you but i can share my personal experience

i live in israel and we dont have here Invokana, after consulting with Dr Kellon we started Pipo (my pony) on Steglatro, it's in the same class of drugs.

This made a huge diference for my pony that was showing signs of laminitis, but on the first blood test after almost 3 weeks of Steglatro Pip’s triglycerides went from 58 (before Steglatro) to 362. we reduced the dose and in order to get an exact amount - i dissolved the pill (a tiny triangular pill in our case) in 4ml of water to take 1ml of the mixed liquid until i finished the box of pills with the higher dose (Steglatro comes in either 15 mg or 5 mg).

i wish i could have some test results with insulin to back up the feeling this is working for us, but from some reason Pip’s insulin test (when still giving a half of pill not dissolved) didn’t show any improvement in insulin. But Pip looks great and in Urine samples on both the half pill (with high dose) and the dissolved pill (the reduced dose) i got the highest possible amount of glucose leaving the body.

we just took new blood test 3 weeks with the reduced dose (dissolved in water) and i was just informed last night that triglycerides went down to 107 and even AST is looking a bit better.

Pipo is still cantering happily so thats another input that let me think that for us this is working - even with dissolved med.

i hope you get more feedback, as i'm not sure it is the same, but wanted to share our experiance in the hopes that this might add more insight, i really appreciate all that you have done with sharing the data and your experiance from Vinnie’s story, so thank you for that.

All the best to you and your horses.

--

Anat Shalev & Pipo the miniature pony

May 2015, Pardes Hanna, Israel

https://ecir.groups.io/g/CaseHistory/files/Anat%20and%20Pipo 
https://ecir.groups.io/g/CaseHistory/album?id=76190

I got the results from the 4/8/2021 bloodwork from Cornell, and have updated my case history.

The ACTH pre & post numbers are both within the normal ranges, which is very good.
Pre: 15.1 pg/mL vs the range of 9 - 35;
Post: 76.7 pg/mL vs the range of 9 - 110.

However, the insulin is now off the charts with a result of >200 ulU/mL vs the reference interval of 10-40. My vet said that the test only goes up to 200 and she is somewhere over that. Her prior reading from 2 months earlier was 159.91 -- so it is much, much worse. Glucose currently tested at 117 mg/dL vs the range of 71-122, an increase versus the reading from 2 months ago of 101 mg/dL.

The IR calculator has the following results:  G:I 0.58; RISQI 0.071; MIRG -68.

To reiterate, her diet is grass hay, usually Bermuda, soaked for 1-2 hours a day. I've been soaking her hay for like 5 years. She also gets the Teff Pellets, plus supplements. I give her the Prascend pills pushed into an end of a celery stalk, so she gets 2 stalks a day for her 2 pills. On occasion she gets the Uckele safe treats after a milestone generally, like not falling on top of the farrier etc. No treats, no sweets, nothing - which has been unchanged for the past 5 years.

Fay has been getting weaker and now I feed her laying down, and after she eats her pellets/supplements and 1/4 of her hay plus a good drink, she has been getting up for a couple of hours, but mostly just lays flat out in her stall. She has an in and out and almost never goes out. I've seen her walk out there only 2 times in the last 2 weeks. The trimmer worked on her feet for a short time, but we had trouble keeping her up, so she is going to come weekly until we can get the feet shaped up properly.

I spoke to my vet about the Metformin dose being low, as well as asking him about Ivokana. He asked me to send along your comments on Metformin dosing and information on Ivokana so he can do some research. He is also going to reach out to Cornell regarding that very high insulin reading. Lastly he wants to keep her on ThyroL for 6 months and re-evaluate. We are also thinking about eliminating the InsulinWise, since it appears to be of no help. Do you have any thoughts about that, especially with her in an insulin crisis.

Any other advice or what I might be missing.

Many thanks and blessings to this group.
Jane and Fay

--
Jane Williams
2018
Prescott, AZ

Fay Case History
Fay Photo Album 

Thanks Lorna, yes his hay was balanced by Kathy who we recently lost I believe. She was very helpful and I know she will be greatly missed. That was well before his colic surgery. If I were to be picky about all of this and I feel I have to be, Dr. Magdesian was aware of the characteristics of the cubes and warned me to restrict them in his diet. i have certainly soaked them and they are very soft after soaking but so is hay after being chewed. What we're trying to deal with is the "scratch" characteristics of the food on the inflammatory colon issues. I confess I don't know how they compare to chewed up hay. I honestly don't know how to determine the risk of the high insulin vs the IFEE. If I get his insulin down only to have a recurrence of the colon obstruction we've lost the battle. I hope you can understand my quandry. 
--
Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

I notice some current additions to Dutch's CH. Very helpful.
I'm still not clear on his nutrition program,but that might be just me.
You indicate that an ECIR balancer has balanced his hay for you,but he doesn't get hay,so this must be from a couple of years ago?
Or is someone helping you currently,wrt what he is able to eat now?

The ODTBC become much smaller than pellets ,when treated as already suggested. They are also(usually) very soft when fed dry.

I think others have said, and you know, that the insulin is a red flag.

--

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

Hi Dr Kellon,  Since I am giving Vinnie such a low dose of invokana, I am wondering if it would be better to dissolve the 300 mg pill in water? I am thinking of dissolving the pill in 8ml of water and then giving one ml per dose, for a dose if 37.5 but wondering if we know anything about the stability of this medication once dissolved?  It would be easier I think than cutting the pill 8 ways as the chips never seem to be the same size.

I am contemplating going up to 50mg and then I would just dissolve the 300mg pill in 6mls of water? Would that be correct? 

Worse case I can order the 100mg tabs and cut in half, but I am trying to save funds as best as I can.

Thanks Nan
--
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

He wanted pellet sized particles. That's pretty small in my mind. He said up to 20% could be the size of the TBC cubes or other chopped forage.
--
Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

Dr. Kellon, is there anything that can be done to help a horse recover from colon damage due to Banamine?  Or does the vet need to use something else in the case of colic?

Thank you,
Joy


--
Joy and Willie (PPID/IR)
Nevada County, CA - 2019

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526

Hello,

I was reading the forum on issues of gastric ulcers. Does anyone recommend a specific supplement that is good to have your horse/pony on? My pony was diagnosed early cushings, ulcers and he has inflammation airway disease. He's anxious by nature so I decided to try him on:

SmartPak Ultra Calm
https://www.smartpakequine.com/ps/smartcalm-ultra-pellets-7477

and SmartBreathe
https://www.smartpakequine.com/ps/smartbreathe-ultra-pellets-15010 

He's only been on them for one month, so I haven't seen too much change. The ulcers were a little bit of a surprise as he's anxious when it comes to certain aspects in the barn which we've been doing a lot of ground work to help build his trust. He didn't have any other typical ulcer signs. I had done acupuncture to help with the asthma and his ulcer points came up. Then I came up one day and he didn't want to eat and I heard a burping type sound. Had the vet come out and they diagnosed ulcers and he 5 days on Sucralfate. He's done with it now but the ulcer paste is still in transit. But his prascend has arrived so he will start taking that on Friday, 4/23.  

My vet recommended Purina Outlast (but this was prior to his cushings test as we ran the test the same day as the ulcer visit). Just curious if there is a better option for ponies with cushings?

Another note: I have the Aservo Equine Inhaler which Clover doesn't like but I read on the forum people were cautious of it being a steroid. My vets had advised with it being an inhaler very little is absorbed systemically so we tried it but my barn did not do it for the full 24 days as per my vets request. Just thought I'd mention it on here because I'm trying to take this all day by day.

--
Jess in New Jersey 2020

Thank you both (Sherry and Kirsten) for the thoughtful response. I'd hate to lose the ground we've made, but really would love for him to get out of the box. 

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album

If you test him again, it would be more informative now for you to know how well Dutch handles his usual meal, assuming he gets all of those feeds mixed together?, or if he doesn't get everything mixed together then the feed that he gets the highest amount of.  So if the TBC are only fed at 20% of his diet and we already know they are guaranteed to be low sugar, then yes you'll get 'better' bloodwork back if that's all he's eaten.  But it won't be accurate because it won't tell you how the feeds that make up the majority of his diet are affecting him every time he eats.  The rule for "forage-only before testing" doesn't really apply to Dutch, IMO, since forage does NOT make up the majority of his diet, and you are not trying to get a diagnosis, you already know he has EMS.

Also, his blood really needs to be pulled at least 4 hrs after he starts eating the first meal of the day because both glucose and insulin rise higher than normal during the first meal after a fast, so that's where you could get falsely elevated results.  But as Lavinia said, Dutch's results would not have been so elevated eating TC Safe Starch if his EMS was controlled, so you know it's going to be high regardless.

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

CH updated with details of urine stick readings, diet. 

I need advice on a plan for weight loss. Cayuse's BCS is 6. Free choice hay doesn't seem to be an option for her.

Also curious if the human DHA/EPA supplement from "algae oil" is a problem and potential dosing. It's expensive. I read an NIH study that mentioned it can reduce triglycerides in humans.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos