Date   

Re: New member, New rescue horse

Sherry Morse
 

Hello Jackie,

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 had bloodwork done on your mare to determine if she is PPID as well as IR?  Loss of muscling can be an indication of PPID so testing for that is indicated, especially given her age. As she's IR, her diet needs a major overhaul.  There is more information on that in the "Diet" section below but to start with the information you've given us:
  • Thryo-L will help with weight reduction but will not help lower insulin.  If you are trying to put weight on this mare it would be best to stop the Thyro-L, HOWEVER it must be weaned down slowly so her thyroid can start functioning again.  To do that we recommend dropping the dose by a 1/2 tsp every two weeks.
  • Insulinwise has been found by the majority of our members who have tried it to have no effect on insulin numbers so it's not a product we recommend.  I do believe they offer a money back guarantee so you may want to look into that.
  • Alfalfa is NOT an appropriate feed for an IR or PPID horse as it makes many of them footsore.
  • Tribute Essential K is also not an appropriate feed for an IR or PPID horse as it is over our recommended 10% ESC+starch limit.
  • Hay should be fed by weight - 2% of ideal weight is our usual recommendation for feed per day (hay plus any concentrates).  We can't comment on the amount being fed without knowing what your mare's current weight is and what her ideal would be.  As with feed, hay should be under 10% ESC+starch
  • Purina Supersport is 17% ESC+starch and therefore not appropriate for an IR or PPID horse.
  • Triple Crown Balancer is also not appropriate for an IR/PPID horse

Some of the issues you are seeing are no doubt related to her diet.  If you can source Triple Crown you can use their Triple Crown Naturals Timothy Balance Cubes as a replacement for the alfalfa pellets.  Please note that the cubes are fed at a 3:4 ratio as a hay replacement so if her total diet is supposed to be 14lbs a day and you are feeding just cubes she would be getting 10.5lbs of them per day.  Since the cubes are balanced by batch you only need to add salt, flax and vitamin E to them (information on this again is in the "Diet" section below).

As far as your hay - do you know if that test was done NIR or wet chem?  If it's NIR you may want to repeat it via wet chem as there can be a 20- 30% variation in results and wet chem is more accurate.  Until you know for sure, I'd recommend soaking the hay to make sure it's safe.  Can you get a copy of the hay analysis?  If you have the full analysis you can contact one of the trained balancers listed here: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf for assistance on balancing your girl's diet appropriately.

When was the last time her insulin/glucose were tested and do you have those results?

With all of that being said, what follows is our official welcome letter which is full of a lot of information.  Please take your time reading it and let us know if you have any questions but again, I would address the diet aspect ASAP as well as the testing for PPID as we are now into the fall rise and we do not want any horses to experience laminitis.

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.






Re: BIG Decisions Needed

Starshine Ranch
 

Anne,  I am so sorry you have to go thru this... I would be devastated.  I have no technical information to give you but Dr Kellon and Sherry have so much knowledge and seem to be indicating that he is likely never to recover.  It also seems he could even develop more issues as his pain could affect so many other areas.  Talk to your friends and those that know you and Nemo and then put your anxiety and fears aside and just think about what is best for Nemo.  You've done so much for him so if you have to let him go, and I truly hope for a miracle that you don't, you know you did your best.  My prayers and love are with you both.
--
Linda in CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara


Re: Question about sinking

Eleanor Kellon, VMD
 

On Fri, Sep 10, 2021 at 11:27 AM, TERRI JENNINGS wrote:
Is it possible to have sinking of the coffin bone without a metabolic cause?  Poor biomechanics and poor confirmation?  
Absolutely. Sinking/distal descent is extremely common from things like shoes and overly long toes.
 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Question about sinking

TERRI JENNINGS
 

Is it possible to have sinking of the coffin bone without a metabolic cause?  Poor biomechanics and poor confirmation?  
--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Re: New member, New rescue horse

Thurstonjs@...
 

Correction, that was supposed to say I was looking at adding volume WITHOUT adding calories.
--
Jackie Thurston
Suffolk, VA 2021


New member, New rescue horse

Thurstonjs@...
 

Hi all, thank you for approving my join up.

I adopted a sweet Icelandic mare and brought her home 7/24 of this year. She was already on Thyro-L and InsulinWise, 2 quarts of alfalfa soaked pellets, and grass hay. She is 17. She had lost muscling and weight. I had my vet come out. Feet were x-rayed. Showed old rotation and separation. My vet recommended Tribute Essential K (1 1/2 cups/day) and 10-14 pounds of hay per day, high end if not grazing.
-- Also, when I asked how best to increase her muscling, vet recommended Purina Super Sport amino acid supplement. 

She has gain weight, ribs can still be felt, and a bit more muscling. That said, her disposition is different now. I know she's anxious because I brought my gelding home from training and is still transitioning. I felt she was getting too much sugar and protein so cut the amino acid supplement out gradually. I think she was used to being served a big meal with the soaked alfalfa pellets and might be missing all the fiber from that. 
So I was looking at Timothy pellets that I could add more volume safely with calories. I know she needs vitamins and minerals but was thinking of switching to TC balancer, it has less sugar/starch, or finding a vit/min supplement without a huge amount of protein. But I also know she needs it for muscle.

I'm very very new with IR horses, her being my first. She is getting good farrier trims too. Just want her to be comfortable. Btw, for some reason when I asked for the sugar/starch from the hay supplier (they run analysis on all their hay), I was given WSC instead of ESC. I just called them back about my current hay. It's a 1st cut Timothy/orchard from the west. ESC 8.1, starch .7, CP 7.6.

Thank you!
--
Jackie Thurston
Suffolk, VA 2021


Re: Saddie new blood work, triglycerides, and iron and magnesium, Dr. Kellon please review

Eleanor Kellon, VMD
 
Edited

I made several suggestions on this thread https://ecir.groups.io/g/main/topic/85381743#268672 . You need to find the cause of the fever and treat it.  The hyperlipidemia is from not eating.

Serum iron only tells you recent intake. To check iron status you need serum ferritin, serum iron and TIBC from http://www.ksvdl.org/laboratories/comparative-hematology/ .ss
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Updated photos - Lavinia can you comments on today’s trim?

Trisha DePietro
 

Rita- your doing a great job- he looks great in his pic update! Crest is much better! Let us know if its soft and squishy or hard and lumpy....:)
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Updated photos - Lavinia can you comments on today’s trim?

Lavinia Fiscaletti
 
Edited

Hi Rita,

You're making progress, for sure, but the toes need to come back quite a bit more - RF more than the LF. Look at the angle of the new growth on the LF as it's coming in under the coronary band - that's the angle that the dorsal wall needs to be at all the way down to the ground.

Make sure to take the walls out of ground contact (RF lateral is the most obvious) until all of the damaged material has had a chance to grow out and get the bevel onto the sole at the toes, rather than leaving the toes flat on the ground.

And as Sherry mentioned, make sure not to touch any of the sole behind the long toes AT ALL.

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


Saddie new blood work, triglycerides, and iron and magnesium, Dr. Kellon please review

dr.kellylear@...
 

Hello, 
I have Saddie’s case worked up by an internist but looking for some more help. I did get her lyme results back and respiratory viral panel back and both her negative. 

Over the last few days Saddies comfort in her feet seem pretty good. However she still occasionally has a low grade fever. She is not eating and acting lethargic. I had them check her triglycerides and cholesterol today and they are elevated so she has hyperlipidemia. She also has some slight elevation for the liver enzyme values but the internist doesn’t think they are significant. I had them check her bile acids and sdh and hopefully those results are back tomorrow. I have posted all these lab results for review. Any suggestions on what could be going on and recommendations to help her? 

I also had them check her serum iron levels. Her iron is high and magnesium is on the low end of normal, I am going to syringe her magnesium oxide but any suggestions on how to get her iron down? I did test her water and the iron is low.
here is the link for all her updated lab work. Please let me know what steps I should take now?

thank you again!

kelly
 https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Saddie

--

 

Kelly Lear in Texas 2021

https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Saddie

https://ecir.groups.io/g/CaseHistory/album?id=267371


Re: Iron in Lupins

 

Just to try to clear this up…
Sherry is right that Hygain isn’t on the safe feeds list, but it could be added. It can be safely used as a carrier according to Dr Kellon. So Cindy is right too. It will require mineral balancing if more than a pound or so is fed. Here’s the thread: https://ecir.groups.io/g/main/message/266326
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Updated photos - Lavinia can you comments on today’s trim?

 
Edited

Hi Rita,
I posted a note to you on another thread and hoped you’d see it but we must have been posting about the same time.  I’m copying it here as this is where it belongs.  

 Here’s a link to my post and here’s what I said -

Hi Rita,I saw that you were posting in your album today and so I took a look.  He looks pretty chipper!  Then I took a look at his case history, which left me with some questions.  Can you explain the large drop in insulin in a month’s time?  Do you think the high reading was provoked by something unusual?  Have you spoken to your vet about trying some pergolide?  His ACTH was above what we consider normal for that time of year.  You could test him now to see how high his fall rise value increases.  That might help for next year.  You could instead do a TRH-stim test next spring.-- 
Martha in Vermont
 -- 
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: Updated photos - Lavinia can you comments on today’s trim?

Sherry Morse
 

Hi Rita,

Is his crest firm or squishy?  He is looking SO much better in the picture you posted today.  His toes are quite long on both front feet but I'll leave it to Lavinia to give you specific trim information.  The one comment I have with regard to that is that if you are trimming sole at all he didn't have any to spare so it should be left alone.




Re: Checking in and with some interesting info to share

 

Hi Rita,
I saw that were posting in your album today and so I took a look.  He looks pretty chipper!  Then I took a look at his case history, which left me with some questions.  Can you explain the large drop in insulin in a month’s time?  Do you think the high reading was provoked by something unusual?  Have you spoken to your vet about trying some pergolide?  His ACTH was above what we consider normal for that time of year.  You could test him now to see how high his fall rise value increases.  That might help for next year.  You could instead do a TRH-stim test next spring.
--
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: Iron in Lupins

Sherry Morse
 

Hi Cindy,

If you're referring to the Safe Feed list (https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/Safe%20Bagged%20Feeds.pdf) - Hygain is not on it.




Re: BIG Decisions Needed

Sherry Morse
 

I found the case history floating in the main files, it's now where it should be: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Nemo.

There are a couple of things I can see in the case history that could be issues, but as Dr. Kellon said the main issue is the bone infection and bone loss in that foot and the resulting tendon contracture.  I'm guessing that's what you're referencing when you say the vet wants to "treat the tendon"?




Updated photos - Lavinia can you comments on today’s trim?

Rita Chavez
 

Hello everyone, 
Today marks 90-days since Stetson’s founder and IR diagnosis. He continues to improve on the diet and seems stabilized as far as weight loss, right at 1005 lbs today. His crest refuses to slim down, though. I doubt I’ll be able to get more off him until he’s cleared for riding again (Feb/Mar 2022). Has anyone had a stubborn crest and did more exercise help? He’s moving freely at all gaits at liberty, no problem making tight turns, and not showing any signs of ouchy feet. Since starting him on Jiaogulan I have noticed a lot of hoof growth. Boy, that stuff works! I’m rasping his feet every week now. But I’m concerned about the bulge on both front soles, the bruised area directly under P3. Oh God help me, but it looks like it wants to break through!

Lavinia, if you have a moment could you please take a look and comment? I’m focused on getting those toes tightened up, but getting closer to that scary bruised bulge.

Thank you! 
--
Rita C. and Stetson (2001 Tennessee Walking Horse/Gelding, diagnosed IR)
Aiken, South Carolina USA
June 2021

https://ecir.groups.io/g/CaseHistory/album?id=265166 

https://ecir.groups.io/g/CaseHistory/files/Rita%20C.%20and%20Stetson


Re: Strawberry new rads :( (Currently in extreme discomfort)

Lavinia Fiscaletti
 

Hi Nicole,

I've added a couple of mark-ups to Strawberry's album:

https://ecir.groups.io/g/CaseHistory/album?id=267559

As I mentioned before, the biggest thing is to get the toes backed up. This will require backing thru what may look like the "white line" at ground level. Need to leave the rest of the sole alone. Frogs and bars also need to be left alone, at least for this round, as the bony column alignment is fine but the sole depth is not. There is capsular rotation, which is the laminar wedge pushing the hoof capsule away from a tight alignment with the bony column. This needs to be addressed thru the trim. There is also sinking, which is contributing to the compromised sole depth. Once the underlying causes of the laminitis are removed (high insulin), then the lamina will stop being assaulted and can start to heal. Setting the trim up to support that mechanically is another important step. Have a read here for more info:

https://www.hoofrehab.com/Breakover.html

https://www.hoofrehab.com/HeelHeight.html

https://www.hoofrehab.com/HorsesSole.html

https://www.hoofrehab.com/FrogTrim.html

RF lateral composite: On the radiograph side, the pink line shows the bony column alignment and stops at ground level where the breakover should be. There should be no hoof capsule touching the ground beyond this point. There is barely adequate sole depth, so not a millimeter to spare. Green line follows the angle of the new growth coming in under the coronary band toward the ground and indicates where the dorsal wall should be, if it was well attached and there was no laminar wedge. This is a visual marker, not a trim line. Blue line at the toe shows where the toe should end, with the blue X being the excess horizontal length at ground level. Red line indicates that NOTHING should be removed from the bottom of the foot behind the blue line. Yellow line #1 runs thru the coronary band, #2 points to the extensor process. The distance between them indicates the amount of sinking.
On the photo side, the green line is the same as the one on the rad. The blue area corresponds to the blue X on the rad. Red line means nothing off the bottom o the foot. Orange line shows where the heels should line up eventually, once they are no longer underrun.

LF lateral radiograph: Same general discussion as the RF except that here, the sole is thin so really need to preserve every millimeter that exists, This means no removal of anything behind the blue line, even if it appears to be exfoliating or appears lumpy.

Strawberry should be in boots and pads at all times until she is comfortable without. Which pads to use depends on what makes her comfortable. If a pad squishes down and conforms to all the crevices;collateral grooves in her foot, leave that pad and just add another one underneath that one to increase the cushioning benefits. You want the pads to support the contours of the foot to be the most effective.

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


Re: slippery elm sugar levels?

 

Yes, Nancy, I believe it’s in a number of ulcer preventatives.
--
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: slippery elm sugar levels?

Nancy & Vinnie & Summer
 

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