Date   

New xrays

nikkibob1994@...
 

Hey all, Darby is struggling, not sure why we are dealing with another bout of laminitis, he's been really good for a couple years now. Just started on Metformin as per Dr. Kellon, but would like someone to take a peek at his xrays in his file and compare them to June's. Yes he needs a trim, but I don't want to do that until he is more comfortable..or is that wrong thinking? Thanks!
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Re: Seasonal Rise and allergies

Sherry Morse
 

Hi Vicky,

Did you give him APF while titrating him up?



Re: Seasonal Rise and allergies

vicky monen
 

Yes, I was switching him from splitting the dose of 1mg am and 1mg pm to one dose of 2 mg per day.   I got him up to 1.5 dose per day and he stopped eating  and was refusing meds.  He gets the veil with any changes at all with the prascend.  I was afraid to just give him the 2 pills all at one time in a single dose as I knew it would have a harsh veil with it. So, I got him to the 1.5 pills and am working him up to the 2 full pills in one dose at this time.  I know its not perfect since the seasonal rise and I should have already gotten him taking the 2 pills at one time by now.  
--
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: Trimmers located in the Dallas/Fort Worth area

agavehurricane@...
 

Thank you!
--
Cristina Brogdon in Texas 2021
Pro trimmer 5 plus years


Re: Trimmers located in the Dallas/Fort Worth area

 

Hi Cristina,
I sent you a Welcome to ECIR message 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


 
 


Welcome to Cristina Brogdon in Texas was Trimmers located in the Dallas/Fort Worth area

 

Hi Cristina,
Welcome to the ECIR group.  Your first post here triggered this welcome.  I know you are not looking for help with a horse but instead trying to help someone else.  Perhaps you will find some interesting reading here as there is much to read about caring for IR/PPID horses.  Thank you for joining us.

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. 

 

--
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: Mare 2 1/2 months pregnant has foundered

Kim Leitch
 

Thank you, Dr. Kellon, that is the information she needs.
--
Kim 10-2014

Clover, SC

Dually: IR; Grits and Bella: PPID, IR; and Eeyore (deceased, but not PPID related)

Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually

Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314

Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978




Re: Trimmers located in the Dallas/Fort Worth area

agavehurricane@...
 

Hi Carol, what town is your friend in specifically in DFW?
--
Cristina Brogdon in Texas 2021
Pro trimmer 5 plus years


Re: Seasonal Rise and allergies

Sherry Morse
 

Hi Vicky,

You'll know once you get your test results back if his PPID/IR is controlled or not but increased itchiness can be a sign that the PPID isn't as controlled as it could be. 

I would not use Cough Ease as it's made in a honey base.

I'm a bit confused as you said in July that you were going to start giving him the 2mg of Prascend once a day instead of splitting the dose (https://ecir.groups.io/g/main/message/266815) did that not happen?





Re: Mare 2 1/2 months pregnant has foundered

Eleanor Kellon, VMD
 

Yes, an ultrasound will show if the pregnancy is normal or not. If it's PPID related, you can treat with pergolide but it likely won't help until after December and has to be stopped at least a month before foaling unless you can get a nurse mare because it will stop lactation.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Seasonal Rise and allergies

 

Hi Vicky,
PPID is associated with an increase in allergies.  With your vet’s cooperation, you could increase his pergolide a bit to see if that helps.  You would have to do that fairly soon or your results will be complicated by the fact that the rise will be at peak next week and beginning to drop off.  

I noticed you were giving him 2 Prascend in January but I didn’t see any mention in your case history of having cut him back.  Did you increase it for the fall rise last year but not this year?

Dr. Kellon addressed the question of antihistamine use for someone else recently.  Have you tried searching the messages?  You will also find lots of help dealing with itchiness there.  It’s a hot topic.


--

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: Coronary Bandy Dystrophy and Cushings

Sherry Morse
 

Hi Rose,

You did enter the bloodwork in the right place. Do you know if the bloodwork was done fasting or not? https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php would be useful reading for you on this point.

If you feed hay cubes they should be Triple Crown Natural Balance Cubes and they are fed at a 3:4 ratio to hay.  Many of us board and we use a commercial balancer because of the hay issue.  There's a list of those in the files: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Acceptable%20commercial%20ration%20balancers

As far as pain relief you can look at using something like Phyto-Quench from Uckele or even just Devil's Claw or HA. 





Re: Coronary Bandy Dystrophy and Cushings

 

Hi Rose,
Warmbloods are not often insulin resistant at baseline but they can become insulin resistant with uncontrolled PPID.  It’s wise to keep track of the insulin readings as you continue your ACTH testing.  It’s the high insulin that brings on laminitis which is what tends to bring people here.  With my own WB, I never needed to make the sorts of diet adjustments we recommend for IR but I kept him on the carefully balanced diet which is good for all horses.  He was able to be turned out and, as I have iR ponies which need hay low in s/s, he ate that as well.  I never soaked his hay if the hay went slightly above 10% s/s.

The idea behind balancing the hay is that you will be adding only what you need to his diet because the hay happened to be lacking there.  If you sample the hay that is used and have that tested, you can get a better idea which pre-mixed mineral supplements will serve your needs best.  As the hay comes from the same general area, continuing with the same supplement will most likely be fine.  If you know how to do this, you can do it yourself or we have people who were trained by Dr. Kellon who can do that for you for a reasonable fee.

For more calories, ideally you would increase his hay.  Beet pulp works well but it is labor intensive as you need to soak and rinse out/off the extra sugar and processing iron.  You can feed cubes, ideally Triple Crown Timothy balanced cubes.  They are made of hay with has been analyzed and supplemented appropriately, bound together with some beet pulp.  I generally add enough water to soften them although I often put dry cubes into a dispensing toy.  Four pounds of these, dry, provide the equivalent in calories of five pounds of hay.

There are other products we tend to use for arthritis.  As he isn’t IR, I’m not sure what the risk is of continuing the Cosequin.  I use Mov-Ease from My Best Horse and Devils Claw containing supplements.

The 0.5mg dose of pergolide you are giving may not be enough to control his PPID.  We usually consider 1 mg as a good starting dose.  Ideally you would retest his ACTH after three weeks of being on a chosen dose and make a decision about how well the dose is controlling his PPID from the results.  If you test right now, you’ll know how well controlled the ACTH is at the peak of he fall rise.  Ideally you will want his results to be in the midpoint of the reporting range during the time of the year not in the rise - the mid teens to the low twenties - with a bit of leeway for the rise.  Generally, we would test just before going into the rise (to be prepared for the rise), mid winter (to see how they fared coming out of the rise) and any other time you have concerns.

By the way, the rise I keep referring to is a normal phenomenon in preparation for winter.  It begins with the summer solstice and ends with the winter solstice but the months of Sept and Oct are generally when it’s the highest.  All horses experience it but PPID can cause it to be exaggerated.  The higher the ACTH gets, the more likely for insulin levels to be an issue.

--
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: Mare 2 1/2 months pregnant has foundered

Kim Leitch
 

Dr. Kellon,
There is no dx, except founder. I’m having her run a Cornell metabolic panel as soon as she can get a vet out. Are there tests the vet can run to tell if there is a uterus/placenta problem? Will an ultrasound show it?
If it is PPID related founder, will medication proper management save them? Can Pergolide be used in a pregnant mare?
--
Kim 10-2014

Clover, SC

Dually: IR; Grits and Bella: PPID, IR; and Eeyore (deceased, but not PPID related)

Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually

Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314

Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978




Re: Vaccines with Sedation

Eleanor Kellon, VMD
 

Claire,

No interaction between vaccines and sedation as far as I know.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Mare 2 1/2 months pregnant has foundered

Eleanor Kellon, VMD
 

Kim,

The answer really depends on why she developed laminitis. At 2.5 months she is early for the hormonal changes induced by pregnancy. If there is a problem with the uterus/placenta behind this, that is probably why they said she needs to abort the pregnancy.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Coronary Bandy Dystrophy and Cushings

Sherry Morse
 

Hi Rose,

You might be interested in reading this article then: https://www.equipodiatry.com/news/articles/how-to-treat-coronary-band-dystrophy

My impression is that if you're having issues with this it's probably more than just the single condition that's a problem.




Re: Sore post trim

Lamourah Perron
 

Thanks so much Lorna!
--
Lamourah Perron 
Queens Bay British Columbia 
Hoof pictures Sept 2021


Re: Sore post trim

Lorna Cane
 

Hi Lamourah,

Go here in our Files
https://ecir.groups.io/g/main/files/6%20Diet%20Balancing

Scroll down to Hay Balancing

People don't have to be in your area (or even in Canada) to balance your hay,if that was a concern for you.

--

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


Seasonal Rise and allergies

vicky monen
 

Hi,

My IR/Cushings boy seems to be having severe itchiness during the seasonal rise.  He deals with sweet itch and possibly neck thread worms. (I do the ivermectim treament every to 3 to 4 weeks starting spring and into summer if needed). He did well during spring and most of the summer, but suddenly  now he is itching again terribly bad.  Is there any correlation with bug allergies during the seasonal rise?  We do have no see ums here in Ga and I know that they bother my guy pretty bad.  He is up to 1.5 mg of pracend 1 x day. 

How does the correct prascend dose affect allergies, or does it?

Can an IR horse have cough ease? 

How much benedryl or zyrtec can be given to a  1000lb IR horse (dosage and brand)? 

I am currently waiting on my lab results from last week to see where his insulin and acth levels are currently at.  I am planning to increase the prascend to the 2pills 1x a day. My understanding is that increasing the prascend during the rise may not be effective compared to before the rise.   FYI, my guys ACTH is always in the low to normal range, as he is early cushings.  Our insulin is usually the issue we are constantly battling.  

Trying to give this guy some comfort from the extreme  itching!  Starting desitin/vicks/zims mix topically.  Trying to figure out what anti-histamine or close to it, is safe for him for these allergies.   
--
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

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