Date   

Re: Need help interpreting bloodwork and hay tests #file-notice

Eleanor Kellon, VMD
 

Laura,

Your horse is borderline for IR and insulin not high enough to cause problems. There is no evidence of laminitis. His major obvious issues are obesity and flat palmar angles with poor ground clearance.  That may also mean he has DDFT strain but either way the solution is to grow more foot and higher heels. Muscle definition comes with work and  getting rid of all the fat on top of it that hides it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Laminitis and Mare Hormonal Relationship?

 

Hi Lisa,
Thanks for the great tip!  I’ve posted a formal welcome to the ECIR group here.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: welcome to Lisa in NY (was Laminitis and Mare Hormonal Relationship?)

 

Hi Lisa,
I know you’ve been a member for a few years but this appears to be your first post, which automatically generates a welcome from the ECIR group.  I’m not sure where you are in terms of needing help with horse care so please let us know if you need help.  In the meantime the welcome below will give you lots of reading material which may answer some of any questions you have.

We’ll be looking forward to hear more from you!

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. 

 

--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Laminitis and Mare Hormonal Relationship?

lisamurf@...
 

When my horse wouldn’t finish his food, I started using Uckele Equi-sweet. I use the peppermint flavor and he licks his bowl clean every time. There’s no sugar in it and it comes in peppermint or banana/apple flavor. Look it up. Great stuff.
--
Lisa Murphy
Prattsville, NY
5/25/18


J-Herb on Vancouver Island

Helen Connor
 

Hi Kirsten,

I'm trying to find a business on Vancouver Island that offers Jiaogulan (J-herb) for sale for cash. Can you help me? I'm in the US and am asking for a horse owner in the island that several of us are trying to help. Lavinia suggested I check with you. 

Thanks,
Helen 


--
Helen Connor and Blessing (IR/PPID)
Scappoose, OR
Member since May 2017
Case History:  https://ecir.groups.io/g/CaseHistory/files/Helen%20and%20Blessing
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=6847


Re: Need help interpreting bloodwork and hay tests #file-notice

 

Hi, Laura. I'd choose the first hay, SWF- MIXED CLOVER & GRASS- JULY 2020. 
That's based on the assumption there's clover in both and that you want to limit soaking (we all want that!).
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Need help interpreting bloodwork and hay tests #file-notice

 
Edited

Take heart, Laura.  At 7, he should just be getting started.  Can he be ridden at the moment?  Are you comfortable taking him out on a trail ride?  Walking up and down hills would be good for his hind end.

I would also agree that, if you feel he has lost weight on your program, you should continue that.  He looks like he’s carrying more extra weight than would be comfortable for him.  Go through your hay weights again to make sure he’s not getting extra.  The idea of the emergency diet is to give you a safe place to start while getting organized.  I test my hay and soak it when I am concerned it might pushing the 10% limit.  I’m trying to avoid an emergency by doing so.  Otherwise, I just balance the tested hay with mineral supplements and the recommended vitamin E, flax oil and salt.

I agree with your decision to move to a quieter barn.  Dressage riders tend to be competitive people (I know as I am one.) and full of advice (yup!), some of it more appropriate than others.  No one else is riding your horse, feeling what you feel and progressing with your skills and temperament.  We all pretty much need to follow our own paths, reaching out to others as we see fit.  In my mind, the dressage journey should not be about racking up scores and ribbons but rather, using the skills you’ve developed to ride the horse forward, straight and through.  The feel of the horse under me when all is good is better to me than a show score.  An Olympic dressage rider once told me that, now that she was done with the Olympics, she was going to learn to ride her horse through.  Her horse was considerably older than seven.

--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Laminitis and Mare Hormonal Relationship?

Eleanor Kellon, VMD
 

Jackie,

I am sending a longer mail to you and your veterinarian but long story short for those who are wondering the high estrone is also seen in human PCOS. Progesterone not changing is also suspicious.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Relevante trim mark-ups

Lavinia Fiscaletti
 

Likely a combination of factors, Lynn.

If there have been weather changes - dry vs.wet - that can play a role. It also looks like there is more wall length than there has been, which will crumble away, esp. when the wall isn't as well attached as it could be. More exercise increases blood flow and can speed hoof wall growth as well.

Bottom line is, you  trim what is in front of you.

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


Re: Need help interpreting bloodwork and hay tests #file-notice

Sherry Morse
 

Ah ok.  I think that probably what you're seeing is an overall lack of muscle from not being in regular work due to all the other issues.  However, don't give up on the dressage dreams quite yet.  If you can get the various issues sorted out he's certainly young enough to do well now that you're moving in a positive direction and you know what you're dealing with. 



Re: Need help interpreting bloodwork and hay tests #file-notice

Laura and Ero
 

@Cass - I was trying to learn more about clover and will look into the links you've provided. Given that and if I have the option extended to me, which of these two hays would be a better choice to go forward with?

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: Need help interpreting bloodwork and hay tests #file-notice

Laura and Ero
 

Sorry, I meant his hindquarters are guant and his general appearance is less-muscled. Yes, the vet puts him at a 6 or higher on the BCS, but I feel like I've done a good job on getting him dialed in with his feet and diet, since getting some pretty harsh feedback last fall. I dove in to learn as much as I could and fast as I could for him. He has a much reduced crest and has lost weight. I've found a barefoot trimmer and switched barns. Regardless, my vet's response is always the same. She also doesn't think he's EMS/IR and recommends a lot of Purina products, so I take their feedback with some hesitation. As for dressage - I've pretty much given up on ever getting through this. Competing is a lost dream. I just want him safe and comfortable. I can honestly say, I am doing my best. This journey has been hell and at 7, my expectations for his life are grim. 

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: Need help interpreting bloodwork and hay tests #file-notice

 

Hi, Laura.
As Sherry mentioned, the combined ESC+Starch in both these hays bears watching. Mixed feedback on soaking is a result of mixed effects of ESC+Starch on different equines. Some equines are extremely sensitive to ESC and require ESC+Starch that is low within the usual acceptable range. Just be aware that both hays are at the high end of the scale, with one slightly over the 10% safe cutoff. Conservative management would be to soak these hays. That is NOT mixed feedback. It's based on experience with sensitive equines. Ero may not require it, especially if he is in work and not tender footed.

There is the possibility of a second issue with these hays, and again, it may not be a problem with all equines and all clovers. I see you've fed mixed legume hay in the past.  But clover can, in some equines, cause them to become footsore.  You can search messages for more information on different clovers in hay, Red Clover being the most obviously problematic. Some recent examples: 
https://ecir.groups.io/g/main/topic/30446088#233263 
https://ecir.groups.io/g/main/message/243720 
https://ecir.groups.io/g/main/message/247865 
I emphasize this is based on the reactions of different equines. Some are more sensitive than others.

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


Re: Need help interpreting bloodwork and hay tests #file-notice

Sherry Morse
 

Hi Laura,

Based on the picture from May he is hardly gaunt.  It may help to remember that a normal horse should be about 4.5 - 5 on the Henneke scale and I would rate Ero as a 6+ based on the pictures you've posted.  You noted in your CH update that the vet also rated him as a 6 and he still has fat behind his withers.  Fat IMO does not equal regal, it's equal to 'getting close to a disaster' so just something to keep in mind.  We have 2 PREs at my current barn and both are fat even though they are in regular work so there's a breed predisposition to that shape for sure and it's not helped by many dressage people wanting their horses to be on the chunky side. 




Re: Need help interpreting bloodwork and hay tests #file-notice

Laura and Ero
 

https://ecir.groups.io/g/CaseHistory/files/Ero%20and%20Laura/Ero%20Bloodwork/EroMetabolicReults_June2021.pdf

The hyperlink to bloodwork was going to a wrong location (sorry). Correct link here (numbers also in CH). 
--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: Need help interpreting bloodwork and hay tests #file-notice

Laura and Ero
 

Both hay tests are wet chem (trainer packages 603). I continue to get mixed feedback on soaking hay. Several say it's intended for emergency only and if he's stable, should NOT be soaking if starch is below 4 and overall hay is below 10. Others say if he's risky (which he has been, especially given low work levels due to endless injuries) .. then continue soaking. I've really tried to dial in his diet and weight since January, but he looks gaunt to me whereas he used to look much more regal. 

As for NPA, oofff! I feel we've made progress on his fronts. But the hinds have always been a challenge. Coupled with SI issues -- no one is sure which is the cause and which is the effect. But working more is hard if he's physically not comfortable. Our focus is correct movement (not extension) and relaxation. He was previously pushed too hard/fast by a dressage trainer. Learning the hard way. :(

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: Need help interpreting bloodwork and hay tests #file-notice

Sherry Morse
 

Hi Laura,

Glad to hear you were able to get Ero moved.  I'd be happy with those bloodwork results as well, but I would also still be treating Ero as possibly EMS because of his breed and because he does seem to need tight management in terms of diet to avoid issues. 

With that being said - since his work schedule has been erratic I would be less interested in adding protein to his diet to help with topline and muscle and instead look to increasing exercise (as possible) to help with both of those issues.  As far as the hay tests - do you know what test (NIR or wet chem) was done on it?  At 8.9 ESC+starch for the 2020 hay and 10.3 ESC+starch for the new hay I would still be soaking rather than taking a chance on setting Ero off on another foot event.

I'll leave the trim comments to Lavinia, but if you've been reading any of Lynn and Relevante's hoof mark up commentary you know that NPA on the hinds can be a long journey to fix. 





Re: TSF Metabolic Support, Bunch Grass, and Palmer Angle questions

Sherry Morse
 

Hi Shera,

I would suggest posting an email with Lavinia's name on it so she can make trim suggestions for the new farrier (assuming you want those to help guide the trimming).  From what I see it looks like there's a bit of bulge on the LF from the new material growing in at the top and the lower 2/3 of the hoof which suggests the toe may be too long still.  The RF looks to be the better of the 2 right now.

As far as the Haystack product - this is where things become very individual.  Yes it's on the list of safe feeds, but if you look at https://ecir.groups.io/g/main/files/9c%20Analyses%20of%20Various%20Feeds/Haystack%20Farm%20and%20Feeds/Low%20Carb:Low%20Fat%20Horse%20Feed%202018-03-07.pdf you'll see that in at least this test it was not the same as what's outlined on the bag, which to me means other bags will probably test higher/lower than what's listed in the analysis.  For a horse that's not at least compensated IR I'd err on the side of caution and replace this with something that you know to be lower in ESC+starch just in case that's one of the things pushing her insulin levels up. 

If you switch to something else and her crest becomes softer or starts to go down you'll know that the Haystack may have been contributing to that.  I'm not saying it definitely will change, but just something to think about.  She looks to be at a better weight now than she was in the pictures from so that's a positive.  Just out of curiosity, have you weight taped her recently to see what her weight is now?  I suspect her ideal is less than the 1000lbs you have listed since you also graded her as a 6 when she was 1000lbs and she looks closer to a 5 now to me which is closer to where we'd like to see an IR horse ideally.




Need help interpreting bloodwork and hay tests #file-notice

Laura and Ero
 

Ero has moved and our environment is much calmer. I now have his updated metabolic results (including first time TRH Stim) and also have the on-farm hay tests (both last year's and this years). CH is updated. Looking for direction now that I have new data. 

I need help understanding the bloodwork. Glucose and Insulin values are lower, he ate hay only within 4 hours of being tested. I was excited about the lower numbers, but the IR calculator seems to indicate he's worse? Vet has no issues with these results, although says he needs more topline and overall muscle (add protein). Keep doing what I'm doing. She suggested I could stop soaking hay. Last time I received this feedback, ECIR disagreed. 

Hay tests. All hay is grassy mix (no alfalfa), grown on farm and consistently fed: one file, two tests/pages. Last year's hay is still being fed, but will soon be mixed and transitioned to 1st crop of this year. Both of these seem safe in terms of ESC+Starch and iron is okayish? 

Q - Are these hays safe and safe to start feeding unsoaked?
(Ero has been on soaked hay and an emergency diet on/off since January. When he refused the Equi-VM, I kept what I could including mag ox. I've recently been able to add in about at Tablespoon of Vermont Blend Pro, but not up to a full reco of 1/4 C.)
Q - Looking to have his diet re-evaluated. Dr. Kellon did this last time, but Ero no longer will eat Equi-VM. Dr. Kellon, any insights/recommendations?

Last note - Ero's May rads showed no rotation, but still some NPA in hinds. He's more comfortable all around (barefoot) but still unbalanced, and stabby behind. He's started again W/T in very light work. Hind feet were put into FormaHoof on 6/21/21. I'm not sure what MORE I can do for him. 

As always, thank you!

--
Laura and Ero

October 2020 | Colgate, WI USA 

Ero Case History

Ero Photo Album


Re: If alfalfa is cause of foot soreness

Nancy K.
 

Anecdotal works for me. Thanks. I'm buying enough grass hat for a full year, so all other issue should resolve and nothing is more "inconvenient" than laminitis. Loks like I've learned my lesson, too!
--

-Nancy K. with Jalila & Shiraz

March 2021, Blaine county Idaho

Case Histories: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Jalila

Jalila’s Photos: https://ecir.groups.io/g/CaseHistory/album?id=262313
Shiraz's Photos: 
https://ecir.groups.io/g/CaseHistory/album?id=262467 

 

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