Date   

Vinnie and Invokana update 9/2021

Nancy & Vinnie & Summer
 

Hey all, just wanted to send a quick update.  We have been working very hard getting Vinnie metabolically controlled. He finally came back positive for PPID and seasonal rise made us have to react quickly.

Super positive lab results this week!!! 
Cornell
Acth 20.0
Insulin 29.68
Glucose 97
TG 188 

He is getting 1.8mg CP, 175mg invokana daily.

We are making some dietary adjustments workijg with Dr Kellon to get him to eat more of his beet pulp to get those trygliceridesa little closer to normal.

He is doing fantastic!! We are walking about 20 mins per day, split in 2 sessions and he is offering trot and lots of silliness!  Check out this boy!!!

https://youtu.be/GqSop7RomC0

Loads of special thanks to Dr Kellon.  Vinnie would not be here without your guidance!!

Ps I need to update by CH but there is a comprehensive spreadsheet of the diet plus labs in my CH folder if you want to see that comparison.  

Fondly, Nan
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: Seasonal Rise and allergies

vicky monen
 


Re: Lame

Lavinia Fiscaletti
 

Hi Lamourah,

If she is sore, please don't force her to walk. Just allow her move at her own pace in a safe turnout area.

Her trim looks a lot better than many we see but could use a bit of tightening up. Hard to see exactly without a full set of hood photos, tho:

https://ecir.groups.io/g/main/wiki/1472

Getting lateral views, with her standing squarely, that include the cannon bones would be helpful. Her heels are underrun, so need to leave them alone to gain some vertical height. It appears as tho the breakover may be far enough back but the laminar wedge is still fairly extensive on those toes, so you can remove more of it with each trim adjustment. Frogs looks healthy and solid. Have a read here for a bit more on the soles and heels:

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

See esp. figures 2 and 3.

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

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

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


Re: Lame

Kirsten Rasmussen
 

You could also try soaking her hay for now.  If you see an improvement in pain within 3 days then you'll know it's helping.

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


Re: Hello and lab results question

Lavinia Fiscaletti
 

Hello Ashley,

Welcome to the group! 

Great that you attended the conference and it sounds like you already have many things in place to manage Blondie well. Halflingers are a breed that is on the list for developing issues due to EMS/IR. This is a separate condition from PPID (Cushings), which is what the Prascend (pergolide) is treating (see DIAGNOSIS below). It would be helpful to see any past blood work results as well, so we have a better idea how Blondie has progressed - which is where the case history comes in. Please do fill one out as soon as you are able.

Her insulin levels are very high at this time while her ACTH says that that it is not the primary factor driving these levels. Her leptin is also high, indicating that she is an EMS/IR horse at baseline. It is the elevated insulin that is causing the foot pain so that needs to be addressed as quickly as possible. The human diabetes drug Metformin can be used to lower insulin levels when diet and exercise aren't enough. Dosing is 30mg/kg, twice daily. More info here:

https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

As long as she is sore footed, she should not be formally exercised in any way. Allow her turnout in a safe area where she can wander at will but is not being forced to move. If she chooses to lie down, that's fine as she is resting her compromised feet. NSAIDs should avoided after the first couple of days as they do more harm than good at that point (see EXERCISE below). Her basic diet sounds good, so that's a plus. It would be helpful to know exactly what minerals she is receiving and the amounts of everything she consumes (DIET section below). Seeing pix of her feet and copies of any radiographs that have been done would also be helpful (see TRIM section below).

The rest of this message contains our Official Welcome info. It's an in-depth dive, with extensive info and links, so grab a cup of your favorite beverage and have a read. We recommend saving this somewhere that is easily accessible for future reference. Please let us know when you have any questions so we can help you get Blondie on the path to being healthy and happy.


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.


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


Re: Lame

Eleanor Kellon, VMD
 

You could see if there is an experienced horse owner or a vet tech (e.g. from a small animal practice) that will pull blood for you so it can be taken to a vet willing to process and submit it for you. After that, see if a vet is willing to give you Prascend and metformin.

The Jiaogulan won't help her with Previcox on board.  Try to get some Devil's Claw.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Lame

Lamourah Perron
 

Thank you, she is on low tested sugar and starch hay. Is taking all the advised minerals along with Jiogolan. No pasture at all and us eating from hay nets.
Diet wise I think she is covered. She will be getting blood work in October. We do not have a regular vet in our area unfortunately.
I am giving her previcox for pain and keeping her hoofs trimmed regularly.
Is there anything else l can do?
I will be hand walking her as well.

Thank you,
--
Lamourah Perron 
Queens Bay British Columbia 
Hoof pictures Sept 2021


Re: How to Store Pergolide Once Blister Foil is opened?

Eleanor Kellon, VMD
 

About the fig newtons (or any food) - not a good idea to put medication inside them unless you are immediately feeding it. The chances of the medication breaking down are greatly increased.
 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New member My Mare Chicy diagnosed with Founder 9/15/2021 at just less than 3 months in foal

Eleanor Kellon, VMD
 

Janet,

One thing I would suggest is taking her temperature  twice a day.  Did she abort the fetus yet?


Re: How to Store Pergolide Once Blister Foil is opened?

yodatoto@att.net
 

Addendum: I tried fig newtons! Put them in the little glad plastic containers with the pergolide and Equioxx inside them.   My horse figured out there will pills in the fig newtons after a while, and refused them even as a treat after that.
--
Victoria , Maryland, joined March 2020


Re: Saraphina blood work,help Dr. Kellon

Eleanor Kellon, VMD
 

Just for the record, the low end white cell count and differential wouldn't concern me in an older horse. They are far from dangerously low. On the chemistry screen, triglyceride elevation is from the EMS. Bicarbonate and anion gap data are not reliable unless the sample is freshly tested.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: How to Store Pergolide Once Blister Foil is opened?

yodatoto@att.net
 

Hi,
I have the same issue at a boarding stable.
This is not perfect, but the best I came up with:  I use pergolide capsules. Place that and the Equioxx  tab in a very small mini 4 oz snack size air tight lid plastic containers from Glad , along with other dry supplements.  I add Equine flavor fix for peppermint flavoring.  Sometimes Ive used the powdered greens used in human smoothies, to add flavor.
Not 100% the horse will eat the pills, but most of the time it works. 

Yes, the pill/capsule is exposed to air...but if the boarding stable worker wont do it individually for each horse, this has been the best method for me.
I'm interested to see what others have to say
--
Victoria , Maryland, joined March 2020


Re: Saraphina blood work,help Dr. Kellon

Eleanor Kellon, VMD
 
Edited

Hi Cindi,

First, hind gut ulcers is not a real thing - https://wp.me/p2WBdh-Do .  Unless she is/was on bute or another NSAID, this isn't colonic ulcers. If she was on an NSAID with Gastrogard at the same time she is at even higher risk for colonic ulceration.

Is she still on thyroid supplementation? That will cause weight loss, but not poor appetite.  Oral ulcerations from syringing the metformin are another possibility.

If her pergolide dose is the problem, you would have seen it as soon as you increased her dose.  Did you see that?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: How to Store Pergolide Once Blister Foil is opened?

 

Just an added note.
When the Prascend packaging is opened, the Prascend ‘magically’ turns into the equivalent of compounded pergolide, which many of us use preferentially.  You want to do the best you can to protect it’s activity but the most important part is to get it into the horse all at once.
--
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: Saraphina blood work,help Dr. Kellon

 

Hi Cyndi,

It appears that Saraphina is improving although it might not seem that way with each tube of GastroGard you purchase.  I know we told you earlier about UlcerGard and Abler products which would save you some money.

It would be really helpful if you renamed the documents in your folder of Saraphina’s vet records.  The most recently posted are the ones I expect you would like to have reviewed - the ACTH, which looks super, although it would be nice to know who did the testing, the CBC, which I can’t help with and the equine diagnostic report which is likewise.  If you could rename them to better describe what they are and the date, that would be fantastic.  You can do that by clicking on the box with a pen in it next to the file name in the folder I linked to.  There are some values which are not in the normal range, although not markedly so, and hopefully Dr. Kellon can take a look at them.
--
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: Lame

Eleanor Kellon, VMD
 

Lamourah,

Yes, there is a very good chance this is related to the seasonal ACTH rise which peaks next week. You are the fifth or sixth this week on the group.  See https://drkhorsesense.wordpress.com/2021/09/16/fall-laminitis-risk/ . Check ACTH and insulin, tighten up diet as much as you can.  The ACTH may call for pergolide
but it often is not very effective when started this late.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Hello and lab results question

ashley.symington@...
 

Hi!
By way of a quick intro, my name is Ashley and I live in MA.  I have a 14 year old haflinger mare, Blondie. She is a beautiful spirit, inside and out!  We had our first bout of laminitis in November of 2018.  With vet and trim support, she came through really well and recovered quickly.  We were good until this past late December/early January when another episode occurred.  This one has been a lot harder to get through.  We've made additional dietary adjustments and trimming adjustments.  She is less uncomfortable moving now, so we are slowly working in physical activity.  I just got lab results back yesterday and am looking for any thoughts and suggestions around what course of action to take related to them.  Blondie is currently on a 1mg dose of pergolide, taken in the form of Prascend.  No grain; hay only-diet with minerals supplemented and given in rinsed/soaked beet pulp.  
ACTH: 23.7 pg/mL (reference interval 2-35)
Insulin: 174.07 ulU/mL (reference interval 10-40)
Leptin: 18.67 ng/mL (reference interval 1-10)

I attended the No Laminitis! conference this past summer and have found the resources available through the website very helpful.  I look forward to being able to connect here as well and thanks in advance for your support and insight!
Thanks,
Ashley
--
Ashley S in MA 2021


Re: How to Store Pergolide Once Blister Foil is opened?

Suzanne and Pilgrim
 

Thank you everybody for your ideas and suggestions. Much appreciated.


--
Suzanne and Pilgrim
Joined March 2019
Winnipeg, Manitoba
Canada
https://ecir.groups.io/g/CaseHistory/files/Suzanne%20and%20Pilgrim
https://ecir.groups.io/g/CaseHistory/album?id=90935


Re: How to Store Pergolide Once Blister Foil is opened?

ediefr@...
 

I have been concerned about both light and air getting to the tablets, as I try to figure how how to get my barn manager to continue to hand-feed the meds to my horse without him spewing the tablets onto the floor of his stall, which is what happens when she does it with a bit of grain. She doesn’t pay close attention, and he drops at least one pill every other time, which I later find on the floor if I am the one doing his stall. When I mention it, she gets irked at me. He gets 2 Prascend and 1 Equioxx every morning.  

She says that I have to come up with an easy solution for her that doesn’t involve getting the pills out of the foil or the Equioxx bottle herself & that she can easily turn into a tasty treat for him. I found small black Mylar ziplock bags on Amazon that are lightproof and airtight, so I am going to try those for the pills, with a pill pocket treat or a Fig Newton that she can stick them into and give to him. The bags come in different sizes and are reusable, so if I can load the treats myself ahead of time without having the taste of the pills soak into the treat, I will put the treats fully loaded into the bags ahead of time. 

We’ll see how it goes! 

--
EdieFr
Cape Ann, Massachusetts
Joined March 2021


Re: How to Store Pergolide Once Blister Foil is opened?

Tanna
 

I used to do as above. Now I split my pills and set them up in tiny cosmetic containers. 

I got mine from a local dollar store but they look like these if my description doesn't help..
Bekith Cosmetic Containers with lids


--
Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 

12641 - 12660 of 278139