Date   

Re: No laminitis but RISQI number 0.18

smtwigg@...
 

Kirsten,
Thank you so much for your quick reply. This all makes sense. This is my second IR prone horse, so I'm better prepared this time.

There is another horse with an IR history who is in an acute laminitic crisis, and we do think the grass under the fence is much more of a problem than we had been aware of, for sure. I think iron is a big factor where we are. I am going to keep tracking my mare's levels, including iron. 

The only issue I have with the recommended feeds is that most carry some minerals, and she's getting all her minerals from the VT Blend. Standlee has a newish Teff pellet that they list as about 8% esc/starch, and low cal. It might be worth a try. The other options aren't sold in this area, and beet pulp--she won't eat it.

I'm really lucky that my boarding barn tests before buying hay to make sure it's low sugar/starch. We do need to exercise more!! I will get reading and start my case study.
--
Sharon T., Front Range, Colorado


Re: New member- advice for endurance competition

Angie Mikkelson <angieorr@...>
 

I forgot to ask, how do you feel about grazing on grass during/after rides, be it training rides or 50 mile competitions? 
--
Angie in ND, 2021
https://ecir.groups.io/g/CaseHistory/files/Angie%20and%20Bear


Re: Cushings Diagnosis

Kirsten Rasmussen
 

Hi Lynn,

When I try to view your Case History, all the words are oriented vertically and it is illegible.  Could you please save it as a pdf and re-upload it?  (keep the .doc copy on your computer for when you need to update it)  That way no one will have trouble reading it.  :)

I was hoping to check on your notes on that glucose test.  Was Teddy fasted then given an oral sugar test?  I think that could also explain the high glucose if he was, but I can't read your CH so I'm just guessing.  Diabetes is rare in horses, usually occurring as a late stage progression of uncontrolled PPID, which seems unlikely for a younger horse with no obvious signs of it.  But lack of energy is a sign of high blood glucose because that means it's not getting in to the cells to be burned for energy.  I definitely agree with Martha and Sherry that insulin and glucose and ACTH should be retested at home, unfasted, and just baseline values (no TRH stim and no oral sugar given).

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


Re: Insulinwise vs ThyroL

Kirsten Rasmussen
 

Hi Lisa, 

In a nutshell, Thyro-L can help with weight loss but it does not affect insulin.  Insulin-Wise was shown to reduce insulin in about 2/3 of the horses in their study, but the drop in insulin is not dramatic.  Neither of these are recommended for uncontrolled PPID.  Also, many of our members have found Insulin-Wise is not effective in their horses, and if that is the case they do have a money back guarantee if you have bloodwork that shows it didn't help.  If you have taken all the dietary measures and are still seeing high insulin, it might be worth trying, but don't expect dramatic results.

The "normal" range for insulin is too high, so unless your mare is at the lowest end of the normal range, you might want to work on reducing it with dietary and exercise measures, too.

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


Re: Hydroxizine?

liisaacson
 

Thanks, all! 
--
Lisa and Haven
Independence, MN
2015

Haven's case history: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Haven 

Haven's photos: https://ecir.groups.io/g/CaseHistory/album?id=261155 


Re: Wonder if I've done something incorrect.

Carrie
 

Thanks for your reply , I certainly dont want to put my donkey on the back foot regarding diagnosis & help.
So before I book another test I just want to clarify questions in my had if thats ok so:
THE ACTH test was borderline according to Liphook & Vet possibly early stage PPID. So Vet advised doing in Autumn where the readings are higher. His thoughts I guess were that it would be a firm result either way. But if it turns out positive & will result in having to have higher medications for longer etc then I don't want that journey if I can do something about it. The results might have been effected by the pain in feet, vet & farrier (double horror for my donkey)  & needles etc, plus waiting time on hard standing before they arrived making them rise a little .  On the other hand the readings may have been inncaurate - I questioned vet about the 7 days between bloods taken & labs testing, even if stored correctly, but he was happy that it wouldnt have made a difference to result-  ( it was a bank holiday weekend)  I made brief notes in Case History comments section. So what are your thoughts on this , does it change thoughts in any way ?

In addition the Glucose Syrup test was insufficient to get diagnosis so vet suggests doing two stage test for Insulin, later at the same time as ACTH test. But if this is the case I would need to book before September to compare the results with collated readings , right?  There is a breif explanation on my Case History notes in comments about the timing of test.

Finally I'm unsure if it would be of value to have an Adipodectin Test which Liphook have restarted again . what are your thoughts please.

Lillie donkey is currently on a measured diet analysed hay & Mineral balancer  (analysed by Forage plus) & Devils Claw , following the ECIR Emergency diet prior to hay analysis. She's off grass, no exercise except the free turnout area. She's having resin attachment to her toe area, next week the farrier is here again  ( 2nd visit) & suggests something similar on the other front foot which she is a little uncomfortable on. If this allows her to be pain free'ish then tests taken in the near future will be improved regarding any concern in the levels rising form pain.
I am keen to follow guidance from ECIR & a barefoot Podiatry trimmer I found near me, she's very holistic in her approach). But for now I need to stick by the vet & farrier working with him in partnership. So far he has managed to relieve pain she was in & I hope to get some of the bone above the hoof capsule long term. I've been able to wean her off Bute & replace with Devils Claw. So heading in the right direction, but have found myself stewing about the testing & the scary amount of money potentially spent, especially if not administered well. 
I'll be interested in your input before I plan the next lot of tests. 
I've just had to send off new hay & straw to be analysed - so will hold on to update the Case History  once those figures are in.
Thanks for support
--
Carrie 
March 2021
UK


Must move barns (asap), is new hay safe?

Laura and Ero
 

Good morning. Due to yet another injury, I have come to the decision that I must move Ero asap. The new barn grows their own hay (mixed grasses) and has the farmer test each cutting. The owner shared the test, but it appears to be missing major minerals (iron, zinc, copper). I'm thinking that the lab/feed company used to test is primarily for cattle. However, the ESC+Starch look to be safe enough to move him (even if I have to continue soaking), and until I can get a sample to test myself. The move is happening fast and I likely won't get my own results back from Equi-Analytical for at least two weeks.

1. Could someone please take a quick look and help me with any "watch-outs" on this hay? I'm not familiar with the format and I can't tell if it's tested via NIR or wet chem. I could call them, but it is what is it for now.  SWF_hayanalysis_July2020  The hay test is also uploaded to my Case History hay folder. 


2. Separately, Ero has outright refused to eat anything with Equi-VM in it including grain, treats, or hay. Uckele even sent me a new batch to try. I've had to remove it completely and am just feeding ground flax and a 1/2 cup Stabul-1 mostly so I can top-dress his 3cc of liquid Vit E. CH is updated. I'm looking to start over with his diet after the move and to balance against the new hay anyway. 

Thank you. 

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: Cushings Diagnosis

Lynnie187@...
 

Thank you so much for your prompt responses!

I decided to test Teddy for Cushings because of a lack of energy.
1.  I will take a picture and upload for you.  He is currently on Red Cell just to ensure he is getting vitamins/minerals.  Should I take him off of it?  
2.  I was hoping I would see a change in energy level.
3.  The 212 for glucose is not a typo.  This test was performed while he was at Cornell during an episode of colic.  Could it be so high from the stress of that?
4.  I will schedule another test for ACTH and glucose/insulin asap.
--
https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Teddy
Lynn K
Upstate N.Y.
2021


Re: Question for Bobbie Day and Desi, or anyone re arthritic knees

lorraine kitral
 


--
Lorrie K 
Illinois Member since 2016
I also have a 30 yr old, very arthritic mare, ringbone, knee, shoulder. I give her hyaluronic acid from my best horse, along with previcox and it has saved her from being put down. Before the hyaluronic acid she was doing poorly. The previcox alone seemed to have stopped working but when I added the HA, she now moves around with barely any lameness. I am seriously impressed at the difference


Re: No laminitis but RISQI number 0.18

Kirsten Rasmussen
 

Hello Sharon,

Welcome to the group!  Actually, I think you are managing your mare very well.  Although an insulin of 32 uIU/ml definitely leaves room for improvement, overall it is well below the threshold where acute laminitis can occur (at ~80 uIU/ml).  Two obvious things that could be driving her insulin up are the excess iron in her environment, and the access to fresh grass under the fence.  The timithy-alfalfa pellets are another unknown and could be higher in ESC than the manufacturer states.  We would suggest using rinsed-soaked-rinsed beet pulp as a carrier for minerals (although we do have several other options if RSR beet pulp will not work for you, which you'll see if you look at our 'safe' feeds list: https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds ).  Whatever you do use as a carrier, feed as little of it as possible as they are more concentrated in calories than hay.  In addition to accounting for these dietary factors, increasing exercise if she is sound is the best way to lower insulin.  Bringing her BSC down to a 4.5 to 5 would also be beneficial. 

It would be great if you could take the time to put together a Case History so we can better advise you on your specific situation and on her diet.  Although you seem to be well aware of how to manage an EMS/IR horse, take a look through our welcome letter below...I know I always learn something when I read it and take the time to follow the hyperlinks.


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. 



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


No laminitis but RISQI number 0.18

smtwigg@...
 

Hello,
My 16 yo mare has no history of laminitis, but is an at-risk breed for IR and an easy keeper. So I had her tested (Cornell) and her numbers are Insulin 32, Leptin 8.4, ACTH 11.9, so a RISQI of 0.18. Her blood was drawn non-fasting.

Last December her iron levels were slightly elevated, her black coat was very red, and she was a bit dopey. She gets NO iron in her feed, but we live in a high iron area. I increased her copper and zinc by switching to a mineral supplement with higher levels of both. Her summer coat is coming in black and her iron levels have decreased as of April.

Her body condition is 5-6. She is trimmed every 6 weeks by a specialist in barefoot, laminitic, and PPID issues. Her diet consists of hay only, under 10% ESC and starch, free fed in haychix nets for roughly 12 out of 24 hours. She lives on a 1/4 mile dirt track with 10 mares. She gets 1/2 cup flax, 1500 E, Vermont Blend without SE,  Smartmare Harmony, 1 T salt daily, delivered in 2 cups of timothy/alfalfa pellets. Prior to the Vermont Blend, she was on CA Trace plus. So...

How can she have a "severe insulin resistance" RISQI number? She does not get any grass normally, but over the last two months she has had the chance to munch what she can reach under the fence, which is minimal. My second question is, what should I do now? 
--
Sharon T., Front Range, Colorado


Re: Request markups for upcoming hoof trim

Kirsten Rasmussen
 

If the low insulin was combined with abnormally high glucose that would indicate her pancreas has been overwhelmed/damaged and can no longer pump out insulin.  This occurs in late stage diabetes (type 2) in horses.  Denny's glucose was perfectly fine, well within normal range.  There is nothing wrong with low blood insulin as long as glucose is normal.

I don't know if Type 1 diabetes has been documented in a horse so I'll leave that for Dr Kellon to comment on.

If you see laminitis signs with diet changes then definitely watch her diet.  Maybe there is something going on with her mineral absorption (since Mg is important in regulating insulin) that worsens the effect of an inappropriate diet.  Or maybe her blood pull us not representative of her usual insulin.  I don't think you need to move to the Hoof forum just yet, and I don't think your request for markups will be affected.

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


Re: Restarting exercise and distinguishing between low energy vs hoof pain

Kirsten Rasmussen
 

OK, thank you.  I will try to do both of those things tomorrow if my diabetic friend is ok with helping us out.

I have also uploaded new hoof photos.   Fronts were trimmed 4 days ago with the toe rolled into the sole a bit, but it looks like the toe roll needs to be refreshed already.  Hinds were trimmed 10 days ago.  I can see I've left toes too long all around, and am leaving the lateral wall on at least 3 hooves a bit longer....it's amazing what becomes apparent when you take photos and look at them on a bigger screen!  Last notable laminitis event was early Nov and that corresponds with the event line that is just about to grow out at the toe.  There are ripples in his hoof wall above this, esp noticeable on his fronts, but no obvious laminitic events occurred since early Nov.

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


Re: Request markups for upcoming hoof trim

Diane Pingrey <dianehorsevol@...>
 

Just curious. Since Denny has low blood insulin, is that considered Type I diabetes?  Is ECIR able to advise on the low blood insulin condition?  She becomes laminitic with too much sugar from fresh pasture grass or from feeds high in sugar and starch.

Thanks!


--
Diane P and Denny in Lincoln, CA 2021

Denny Case History:  https://ecir.groups.io/g/CaseHistory/files/Diane%20and%20Denny
Denny Photos:  https://ecir.groups.io/g/CaseHistory/album?id=263875


Re: Request markups for upcoming hoof trim

Diane Pingrey <dianehorsevol@...>
 

Thanks Kirsten.  When Denny was fed Purina Equine Senior feed, she became extremely laminitic with the front legs out in front to relieve pressure off of the toes and her hind legs under her with her weight leaning back onto the hind legs.  I moved her to a boarding facility closer to my home so that I could control what she was fed and the quantity. At that point, I phased out her feed and introduced the ECIR recommended feeds.  In two weeks, the laminitis has subsided; there may be some of it, but nothing like before.

After xrays, she does have founder with a ski tip on the left coffin bone and that probably started when she lived on an irrigated grass pasture in 2017-2020.  I suspect her big problem is due to her high blood calcium level which is blocking much of the absorption of magnesium and phosphorus throwing that ratio out of balance, and contributing to IR-like symptoms, thus she  behaves like an IR horse. I suspect she needs a calcium to magnesium to phosphorus ratio of 1.1-1-1 up to 2-1-1.  So far, only vitamin A reduces the blood calcium on mineral blood tests, but the magnesium and phosphorus are stuck low, in spite of supplementing for those 2.  I'm slowly increasing her Uckele vitamin A dose to further reduce the blood calcium.  Her other problem is that right arthritic knee further causing her to bear more weight on the left front hoof (the more foundered side) compounding things.

Based on ECIR's criteria that you mentioned, if Denny is not PPID and not IR, that is a good thing!  

Will I still be able to get markups on Denny's upcoming trim on 5/22/21?  

Or do I need to move to the hoof side of the house, and if so, how do I move to the other side of the house?

I found out about Denny needing vitamin A to reduce her blood calcium through an alternative practitioner because prior to ECIR I was not able to get results through any other avenue, and I may have to go the alternative route again to get to the bottom of Denny's IR-like issues as I'm feeling kind of like Denny might be falling through the cracks here.  ECIR has so much great information, I was hoping that ECIR would have already paved that path with other horses that might have been in the same or similar situations as Denny.   

Thanks to everyone for all of the information provided so far.


--
Diane P and Denny in Lincoln, CA 2021

Denny Case History:  https://ecir.groups.io/g/CaseHistory/files/Diane%20and%20Denny
Denny Photos:  https://ecir.groups.io/g/CaseHistory/album?id=263875


Re: Insulinwise vs ThyroL

Candice Piraino
 

Hi Lisa!

We will need a completed case history to provide more precise advice for you- which is explained further down in this welcome letter.

Sometimes ThyroL doesn't help some horses and sometimes it does. It is just a short term option though to help kick start weight loss. Diet and movement are key to help insulin. For PPID equines, they will need pergolide- which I am glad to see she is tarted on. 


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. 

--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Insulinwise vs ThyroL

Lglpn12@...
 

Hello. I have an 18yr old appy mare PPID that is slightly over weight. No cresty neck but minimal fat pads and currently dealing with a reoccurring sub clinical mastitis that vet feels is related to uncontrollable PPID. Her last ACTH in oct 2020 was 40 and is currently on Prescend 1mg daily. She will be retested  next week. Her insulin has remained within normal range. Vet has recommended ThyroL which I had tried for my mini (IR/PPID) with no effects so I had been told about Insulinwise. Is there any preference over the 2. Thank you.
--
Lisa Swale, Massachusetts 2019


Re: Request markups for upcoming hoof trim

Kirsten Rasmussen
 

Hi Diane,

Denny's latest insulin of 2.5 uIU/ml is the lowest I've seen in this group so far.  Even allowing for a difference in the Loomis assays, their upper range for normal is 20; Denny's is low enough below that that I'd be very surprised if she was IR.  Combined with a glucose of 100, her G:I = 40.  We consider a G:I>10 to be non-IR.  Considering she was not fasted (lowers insulin) and the sample shows no signs of degradation (glucose value is normal for hay only), she would not be considered IR or EMS by our criteria.  That said, if she appears to react to diet then feeding her as an IR horse is not going to hurt, and might be of benefit.

Her ACTH is also normal for this time of year, although in rare situations horses with normal ACTH can have early PPID.  A TRH stim rest would help you rule out early PPID if you think that could be a factor.

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


Re: ECIR Group 2021 NO Laminitis! Conference -- Registration is Open!!

 

Good.For.You. It’s so much work! I can’t thank you and everyone on the team enough.

Cass

On May 18, 2021, at 7:32 AM, Nancy C <threecatfarm@...> wrote:

I know you can't see me, but I am dancing...

Bridging Research and Real Life

Across the World
When: The weekend of August 13 - 15, 2021.

Where: ECIR Virtual Conference Room at the location of your choice.

Speakers:


  • Eleanor M. Kellon, VMD
  • Robert M. Bowker, VMD, PhD
  • Kathleen Gustafson, PhD
  • Elaine Norton,  DVM, MS, PhD, DACVIM-LA       
  • Shannon Pratt-Phillips, MS, PhD, PAS
  • Paige Poss, APF, Anatomy of the Equine, LLC
  • Pete Ramey, PHCP Practitioner/Clinician

Attendees:     Any professional or owner who has one or more horses in their care.

Ticket Pricing:

  • Full Lecture Admission $280           
  • Early-bird (Registration prior to 07.30.21) $250
  • Virtual Group Early Bird (2+ at one dedicated Zoom link) $500
  • Veterinary Professional Early Bird $250
  • Qualified Veterinary students $175
Conference Topics: 
  
  • EMS – What It's Not.
  • Protein and Iron — Their Affect in EMS and PPID Horses.
  • Pros and Cons of Forage Analysis and Targeted Supplementation.
  • The Effect of Exercise on Glucose Metabolism and Insulin Sensitivity in the Horse.
  • Strategies for Using Exercise as Part of Dietary Management for Overweight and/or Insulin Resistant Horses.
  • Common EMS and PPID Pharmaceuticals.
  • Emerging EMS and PPID Pharmaceuticals.
  • The Genetics of EMS.
  • The Impact of Genetics on Height and Insulin Dysregulation in Welsh Ponies.
  • Take it with a Grain of Salt – Navigating Nutritional Fact and Fiction.
  • Reading the Foot – Thinking Vertically.
  • Reversing Hoof Capsule Rotation and Distal Descent.
  • Looking Internally at Distal Descent and Rotation in the Hoof.
  • Estimating Palmar Angle when Looking at the Hoof.
  • What is a Normal Foot? Questions Need to be Asked.
  • Trimming Practices Can Encourage Decline in Overall Foot Health.
  • Winter Laminitis: Why the normal trim can make an episode worse.
  • How Trimming Can Improve Foot Structure and Function.
Recordings will be available to all attendees for six months post conference at a private Zoom Link.

For those of you encouraging your veterinary and hoof care professionals to attend:
This program has been approved for 18 hours of Veterinary continuing education credit in jurisdictions that recognize RACE approval. https://www.aavsb.org/


This event has been approved for 20.5 International Association of Professional Farriers (IAPF) Continuing Education Credits. For more information visit their website - www.ProfessionalFarriers.com


Progressive Hoof Care Practitioners (PHCP) has approved 20 Elective or CE credits for members attending the 2021 NO Laminitis! Conference. https://progressivehoofcare.org/

Please note: This is a live event that will require attendance for CE credits.

We are very happy to announce our growing list of Benefactors, who strongly support the needs of the ECIR Group members. Many of these folks will be available in break out sessions on Friday and Saturday afternoons. You can access their links and see them listed anytime on our two websites.  https://www.nolaminitis.org/benefactors.php

DIAMOND BENEFACTORS
California Trace
Soft-Ride Equine Comfort Boots
Auburn Laboratories, Inc. - APF
ForagePlus
Uckele
Mad Barn
Custom Equine Nutrition - VT Blend
HorseTech

PLATINUM BENEFACTORS
Black Horse Spirit, LLC
Progressive Hoof Care Practitioners

GOLD BENEFACTORS
Anderson Feed - NuZu Feed
Omega Fields
Equi-Analytical
My Best Horse
Hay Chix
Island Pharmacy
Beet-E-Bites
Triple Crown
Pure Sole

SILVER BENEFACTORS
Sox for Horses

BRONZE BENEFACTORS
New England Equine Balance
Yank Gulch Equine
Great Plains Forage Balance
Ration Plus

Lots more work to do and only 87 days to go!!!  (Breathing deeply. Trying not to hyperventilate. Still dancing.)


On behalf of your hosts,
Cindy McGinley and Sherry Morse,
and
the 2021 NO Laminitis! Conference Committee.

--
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


--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Vitex/Chasteberry study #Vitex_CHB_Chasteberry

 
Edited

Hi, Sue. 
After you learn all the subtle and not-so-subtle signs of uncontrolled PPID, you can decide to check ACTH, insulin and glucose based on your observations.

The best time to test, assuming Shifty is comfortable and doing well on his current dose, is before the seasonal rise really gets going, in late June or very early July. That's early enough to check that his ACTH and insulin levels are within normal ranges and, if not, quickly make adjustments to his pergolide dose before the seasonal rise really ramps up. The collective experience here is that increasing pergolide dose before the seasonal rise works much better than chasing out-of-control PPID in September or October. Learning to monitor the symptoms of uncontrolled PPID will help you through this.

Read about the seasonal rise and its annual effect on ACTH here: https://www.ecirhorse.org/seasonal-rise.php If you like to read charts, you can see the how the seasonal rise increases  ACTH week by week: https://www.thelaminitissite.org/ppid-faq/acth-interpretation 

With a newly diagnosed PPID horses, it's a learning experience to manage pergolide dosage during the seasonal rise. It's common for horses to need an additional 1-1 ½ mg of pergolide (or more!) to keep ACTH from an exaggerated increase August through November. If you see signs that PPID is not well controlled during the rise (or any time of year!), increased urination, lethargy, depression, muscle loss, more of a pot belly, and especially if Shifty becomes tender footed, it's wise to check ACTH, insulin and glucose.  And even if PPID seemed well controlled, I've seen bruising at the toe during trims in early January or hoof abscesses, indicating uncontrolled insulin some time within the previous few month. We become really alert to the subtle signs of uncontrolled PPID. 

Some members can slowly reduce the pergolide dose after the seasonal rise, in late December or early January, assuming you see no signs of poorly controlled PPID. Other members have not such luck.  

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

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