Date   

Re: Supplements and conflicting information

Kirsten Rasmussen
 

Hi Kandace, 

I'm not sure if your iodized salt would be stable, and if it is stable whether it contains enough iodine to meet your horse's needs.  Ideally you would also feed a supplement containing some iodine, or feed kelp flakes.   I'm sure you saw all that in your ECIR rabbit hole search though.

I usually come back to this post, which shows why we recommend 2-3 oz ground flaxseed (because 3 oz provides about 19 mg Omega-3 FA, which meets/exceeds what horses on pasture get).
https://ecir.groups.io/g/main/message/226573?p=,,,20,0,0,0::Created,,Flax+seed+to+Flax+Oil+Conversion,20,2,0,25707499
Here is another useful article that recommends 4.5 oz ground flaxseed/day:
https://drkhorsesense.wordpress.com/2021/05/24/flax-to-mimic-pasture/
This one is also interesting and explains why we recommend flax over other O-3 sources:
https://drkhorsesense.wordpress.com/2021/03/08/omega-3-fatty-acids-in-equine-and-canine-nutrition/

Some house-keeping: can you add the year you joined ECIR to your signature please?

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


Re: best time to test acth and insulin

vicky monen
 

HI,

Seasonal rise is considered what months exactly? Aug through Dec? 

and how long after a dose increase should I recheck ACTH?

He is currently showing no symptoms, but obviously I need to test to make sure.  Also he never had high ACTH, only symptoms that suggested early cushings.  I usually have to go by symptoms since ACTH is always normal. Any other suggestions for dosage increase for these early cushings horses that test normal?  Currently the only cushings symptoms he is showing is long guard hairs and his coat grew in thick and fast after clipping in March 2021.  Otherwise he is looking great on the current dosage.  

Thanks so much,
--
Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson


Re: Case History

Eleanor Kellon, VMD
 

Anette,

If you mean LibreOffice you don't need Microsoft. When you save a document click on the drop down arrow on the "save as" line and you will see an option to save as Microsoft Word document.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Case History

Nancy C
 

Hi Deb

I'd like to point you again to the messages you have received to help you get started.  Not clear from previous communication you have seen them. 

https://ecir.groups.io/g/main/topic/83692247#265880

There is a lot of info in the four responses to your first "I need help" post that might help point you to get started. These messages include links to our Wiki and to the Case History subgroup. These are "rooms" off of our main discussion room. Bookmarking the pages helps to find them again if you get lost. You can also find them in the header of each page on the groups.io. so for example, go here to the groups discussion on the web and scroll to the header at the top of the page.  https://ecir.groups.io/g/main/message/266251

Like any software program, Groups.io takes getting used to how it operates, but with the help of ECIR volunteers and individual practice, the vast majority of folks find it can be done. Please let use know by posting here, where you are getting stuck.  Volunteers want to help you. We've not seen any more info form you other than this post and the link above, so please feel free to tell us a bit about your horse. It would be very helpful to know, at least, what device you are on.

Thanks in advance for helping us help you and your horse.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


Re: Lavinia would you advise the new Xrays please

Carrie
 

Apologies all photos in original file now. 
Added label in description box for each photo as couldn't find another way of labelling them this time .. feel so useless !! It's not hard.. but dhh !
Includes LF & RF X-Rays plus lateral photos as requested.
NB. half of the resin remains on RF - from front toe to medial side. The hoof has area where it was trimmed for Seedy toe & smaller holes made for resin to anchor & stay on better.
Thank you Lavinia
--
Carrie 
March 2021
UK


Re: Case History

debost@...
 

No kidding!  I find it impossibly complicated and difficult.  I've given up, at least temporarily.  This website is like a house that has been added to over the years and makes no sense as a unit.  Simplifying the instructions or starting over with the process of posting case studies would help a lot more people and horses.
--
Deborah Ostrofsky
Year of joining: 2021
Location: Northwestern Pa


Re: Jalila almost managed?

Lavinia Fiscaletti
 

Hi Nancy,

The 2021-07-05 photos are from after the trim that was done once you had the radiographs to look at - correct?

Toes are still miles too long on all four and that hole is located in the excess toe length - remove the toe length and that hole will also be gone: it's likely that dark gap you can see at ground level in the toe of the LF lateral radiograph.
Hind heels are severely underrun. Soles are thin, which isn't surprising with the toe length and wall flaring that is also present. Much of the damage that is visible is due to the mechanics that are still aggravating the situation. Trim needs to be tightened up considerably. If she is heel landing at the trot, that is a good thing but being "off" is not. If she isn't sound, she should be wearing padded boots - which will be difficult to fit with the excess toe length. Sand will tend to abrade the soles so she should be booted any time she is moving in sand.

The March blood work results are pretty similar to the latest blood work done on June 27th. The anomaly is the June 25th blood work, where her insulin was >200 and her glucose put her in the diabetic range. Are you sure (meaning vet, Cornell) that there wasn't a mix-up in that sample with some other horse? Not doing the ACTH and T4 had nothing to do with the result, as the insulin and glucose testing would be the same.

Good that she has lost weight. Feeding anywhere from 1.5%-2% of her ideal weight is generally the formula, which will be influenced by the calorie content of the hay as well as the metabolism of the horse eating it. What hay are you feeding - there are four listed in the case history. When do you get the new hay? Yes, you should get a custom supplement to match whatever hay you are feeding, as all of the hays have a serious calcium-phos imbalance, which the CA Trace won't address. This would take iron content into account as well. It would be a good idea to discuss the overall situation with one of the Hay Balancing people listed in the files:

https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf

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


Jalila almost managed?

Nancy K.
 

I redid Jalila's case history document and added detail, while maintaining the integrity of what was previously in the Apple Pages debacle. It's now in the Word/PDF format so it should be readable. I also added a new blood work report, front foot x-rays, and photos of feet and body to our Case History and Photo Album files.
I have some questions and need help understanding where Jalila and I stand in the process of managing this EMS/IR.
X-rays & Feet & Exercise
Jalila's x-rays are not as bad as I expected. My farrier was able to be with us when the vet came to do them and he trimmed her immediately after. It looks like she has good attachment between her bony column and hoof wall to a little over half way down. That's where the changes in the hoof show from post-laminitis and switching to the EVIR Emergency Diet, which added minerals, Vitamin E, and flax. My understanding is that if we keep the flares from leveraging the "good" growth will continue and repair will complete.
On her 2021-07-05 LF Sole shot, there is a little hole/pocket. It showed up post trim. Is that an old abscess pocket or is it showing separation at the toe? She is mobile and sound at the walk. her soles are thin and she is definitely off and heel landing if she trots. Should she be exercising? (Hand walking on level ground in sand arena) In the next three weeks or so, she will be totally off alfalfa, which I understand might contribute to foot soreness. How does iron figure into this? Will a custom mineral balance for my new crop of hay regulate that possible factor?
EMS/IR Calculator & Diet
Could someone please walk me through what those numbers mean? It appears she is a bad case. The March numbers were possible skewed by the fact that she was still laminitic and, likely, abscessing when we drew the blood sample. The blood work report from June 25 showed an extreme insulin level (>200) My vet and the lab at Cornell insist Jalila must have had a carbo load just prior to the draw. That is highly unlikely. I timed her breakfast, 6 lbs. of hay in a nibble net, so she would finish 45 minutes to an hour before the vet arrived and there is nothing else to eat in her dry lot. Whatever, since the June 25 test (blood was drawn on the 21st) was not the same as the March test, and lacked the T4 & ACTH numbers, we reran a test with a blood draw on the 27th (Test result on the 29th).  Do I need to get onto the grass hay, get a custom mineral mix and give her some time before I panic?
She has lost a lot of weight, but her weight loss has slowed and she needs to lose more. I cut a pound of hay from her rations, went from 18 lbs. to 17 lbs., about 3 weeks ago. Should I wait to adjust again until after the grass hay arrives or cut another pound now?
Finally, thanks to everyone for being so supportive and helpful.
--

-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 

 


Re: Case History

Sherry Morse
 

Hi Annette,

Let's start with step 1 - knowing where your current case history is located on your device.  Do you know where the file is? 

If yes - is the information in the file current or does it need to be updated?

If current - make a note of where the file is located and open your case history folder.  Click on the "+NewUpload" button and then click on "Upload file" in the drop down menu.  From there you will need to navigate to the file location on your device and upload.

I suspect from what you've written you do NOT have a current case history file on your device.  If that's the case you need to start from scratch and include both the old information from your case history as well as any updated information.  Once you have all the information entered into the document you need to save it as 'Horse's Name_Case History_Date completed', note where it's saved on your device and then save it as a PDF (either by going to File>Print>Print to PDF) or using an online file converter.

Once that's done you would then follow the steps outlined above to upload the PDF file to your case history folder.  If you run into a problem you need to let us know what stop in the process you are having an issue with.  If you need to download the pages form again you can go here to get it: https://ecir.groups.io/g/main/files/Case%20History%20Tools/Case%20History%20Form.pages




Re: Case History

 

Anette,
Have you opened our Wiki to find and follow the Case History directions? The Wiki is located on the left side of this page, bottom item . Open that then proceed to Case History help.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased


Re: Lavinia would you advise the new Xrays please

Lavinia Fiscaletti
 
Edited

Hi Carrie,

Would you please combine all the pix and rads into the album that is in your signature, rather than having multiple albums. Here's the link to the new album:

https://ecir.groups.io/g/CaseHistory/album?id=265767

Would you be able to get a lateral shot of that RF as well? Is there only a rad of the RF? Could use to see pix of the LF too.

Thanks.

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


Re: thyroid help

 

Kandace, I don’t think there is any reason to delay your test as long as it’s 3-4 weeks since your last dosage increase.  I’m sorry if my post confused you.  You want to test before you get too far into the rise so you can make any adjustments early.  The test you did last February indicated more pergolide was needed.  You’ve increased the dose by 0.5mg since then but have not tested.  If the test indicates still more is needed for control, you want to make that change as soon as possible.  Are you saying you want to test during the rise?   What do you hope to learn from that?
--
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: Seasonal Rise

 
Edited

Kandace,
Are you using prescription medication "Prascend" or using a generic version of pergolide?
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/3.%20Prascend

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased


Case History

Anette
 

I need " How to upload Case History for Dummies"! I have tried several times to upload one, had the info filled out and lost it! Today I even made an account so I could use the Microsoft Office for free thing to fill out the form and it won't or I don't know how to get the document there. I use Libra for other documents I make so Don't have Microsoft on the computer. I have an Ipad and tried doing it from there up to no avail,help please!
--
Anette P and Jaywalker
Boomer, NC
Sep.9 2018
https://ecir.groups.io/g/CaseHistory/files/Anette%20and%20Jaywalker


Re: Seasonal Rise

Maxine McArthur
 

On Tue, Jun 29, 2021 at 06:59 AM, Kandace Krause wrote:
I know I have asked this before, I cannot seem to be able to find all my messages to track the answer down.  I have, in the past, found all my messages by typing my name into search bar.
Hi Kandace
To address this part of your question—below the window with any of your messages, on the right-hand side, you should see the word ‘more’ with three little bars. On my phone it is in blue. If you click on this, it should give you the option ‘see all messages by this member’. 
 
--
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: Seasonal Rise

Trisha DePietro
 

Hi Kandace- it does depend on your results - which your vet will help you increase it...there are many horses here who need more than 3 mgs per day. Not sure where you heard that 3 is maximum tolerable....Did your horse have laminitis? how is the trim? is it resolved? how much new growth? is he lame?
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Supplements and conflicting information

Trisha DePietro
 

Supplements -- Flaxseed, how much to feed.pdf (groups.io)
--Hi Kandace. This is a link for you regarding flax and feeding flax- If you stay in this category and look to the left and click files you can then search for more flax information. Hope this helps. 
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Seasonal Rise

Kandace Krause
 

Hi Sherry,

Just read in another question and it seems my CH a bit out of date.  I am at 2.5 tabs daily.  Where do we go from there?  I believe I heard 3 tabs is maximum tolerable.  Keeping in mind that I cannot keep a horse as a paddock ornament.  My goal is to be able to get this horse back to work, if only a pleasure trail horse.

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


Re: thyroid help

Kandace Krause
 

Hello Martha,
Yes amount has been increased to 2.5 tablets daily (previous was 1.5 one day 2 the next, like 1.75 daily, a small increase), and this is second increase since then.  I thought I had updated case history at least once since then.
She has been on the 2.5 tablets for well over one month now, but do you feel it would be better to wait even a little bit longer for testing than 3 to 4 weeks past solstice?  As I am looking for results for the rise, I can delay a bit longer, it is not a panic more a confirmation that we are finally under control.  My vet is on rodeo circuit and I have to fit in when she is in my area, so I have to look a bit down the road.
We have been slowly improving and I am hoping that we are now controled, but with the shivering and sweating I am wondering about hypothyroid imbalance which causes thermo disregulation in people as well as horses I have read.
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: New to the group

 

Hello Ardyce,
Many of us have had a friend point us to the ECIR group. I was lucky enough to have a friend who pointed me to this group. Below you will find a detailed document that will be your initial guide to all the information we have to offer. You have received an email with directions about your signature (good job!) and information about creating a case history for your horse. We need the background health history for your mare so that safe advice that is applicable to your horse's situation can be offered. Yes, there is a lot of reading for you to do but we need you to understand the basic information so that you can make safe choices for your girl.

I suggest that you first go to the ECIR website where a good synopsis for Diagnosis, Diet, Trim, and Exercise is offered. This is a VERY good place to start reading. The document offered below will lead you to more detailed information. All words in "Blue" type are clickable links. Just click on them and they will open a new link.

I suggest you copy and save the document below to your computer/phone/tablet and refer to it as you need to.

Use the WIKI link. Our WIKI will help you navigate this group and give you "How-to" information. How do I create a folder? or How do I upload test results? ETC. Use that Wiki.

Use the search features. On every page there is a "SEARCH" button within a box, usually at the top of each page. Using search will allow you to find topics, questions, answers that will allow you to find more information on your own.

Please respond to this welcome post and tell us more about what is happening with your horse and ask your first questions here as a reply. You can give us a brief history about your horse's health and ask any immediate questions that you have.

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 (look under the Hay Balancing file if you want professional help balancing). 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. 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

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