Date   

Re: Understanding MIRG

jlmccarroll@...
 

Hi Sherry

I assume the blood work was done at UC Davis.  I will be calling tomorrow for a copy of the lab's report.  The normal glucose range reported to me was 80-120 mg/dL, insulin normal range 4.5-20 mL and ACTH 1.0-9.0 pm/L.
--
Jeannette Mc, NorCal 2021


Re: Cushings

Cindy Q
 

Hello Deborah

Welcome to the group! 

I'll be sharing our official welcome letter below. Tons of detail so please take the time to read through it including details on getting ACTH into the middle or low part of the normal range for PPID. Currently in September, since you are in North America, it's pretty much the peak of "seasonal rise" and ACTH would be elevated more than other times of the year. 

To increase pergolide, this should be titrated up to reduce risk of experiencing the "pergolide veil" (which affects some horses). We often recommend increasing gradually by 1/4 tablet after 3 or 4 days until you reach your targetted dose. ACTH can be retested about 3 weeks after you reach your targeted dose.

You can see more information under the Diet section on the need for salt. Salt is about 40% sodium and I find most commercial electrolytes based on memory seem to have only 11 to 20% roughly of sodium. You should add salt to your diet if you have not already been doing so.

Dry-coatedness or anhydrosis can be a symptom of PPID and uncontrolled ACTH. Please see the discussion here: 
https://ecir.groups.io/g/main/topic/84868366

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. 



--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





Re: New Radiographs, Lavinia please review

Lavinia Fiscaletti
 

No, the magic cushion has antiseptic properties and the iodine and turpentine should actually harden it to some degree.

I took a quick look at the latest rads - I don't see any change in the amount of sinking but it's really hard to be precise when none of the rads have the coronary band location marked. The sole depth also doesn't appear to have changed since the 9-16-2021 rads but those earlier rads appear to have been taken with the foot wrapped in some way, with some type of padding or packing under the wrapping: is that correct? The latest rads don't show any of that wrapping/padding/packing on them, so the angle of the entire foot is different. The padding had raised the back half of the foot, so was supporting the coffin bone in a better position but with the padding removed, and the heels too low, that has allowed the back half of the coffin bone to settle down lower, causing a broken back HPA. This means we are trying to compare apples to oranges in some ways. It looks to me like most of the changes between the two sets of rads are due to the presence/absence of the wrapping/padding.

Being suddenly more lame on one foot is a classic sign of an abscess building, which can be more painful than laminitis.

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


Re: Updates

Lavinia Fiscaletti
 

Picture lamina as really strong Velcro that attaches the hoof wall to the coffin bone. When the two sides of the lamina (velcro) get separated, the material that fills the gap is called laminar wedge. The more of it there is, the further the hoof wall will be pushed from being well aligned with the coffin bone.

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


Re: Saraphina blood work,help Dr. Kellon

CYNDI CARLSON
 

Sherry,
thank you for the Cabergoline information. I did get my husband to hold her got a pen light and looked around in her mouth and did not see anything odd, of course with out dental jaws I couldn’t see way in the back.
--
Cyndi Carlson in Colorado 2021


Cushings

Deborah Krauskopf
 

Hi,
My horse Nellie was diagnosed with Cushings last week. I’m guessing she had it for some time. Skin infections and a longer coat were the symptoms. I started her on Prascend right away. 

Two days later she stopped sweating.  My vet said to give her OneAC.  She had already been on it for 2 years and did great.  The vet said to give her electrolytes.
Is it normal for her to stop sweating and will she sweat again when she stabilizes?
Any info would be great.
Thank you.

--
DebK in Jensen Beach FL 2021


Re: New Radiographs, Lavinia please review

dr.kellylear@...
 

They are also applying magic cushion, does that soften the sole? 
--

 

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: Does Tendon EQ have enough JHerb for Ringbone Pain?

Laura and Pabatsa in CA
 

Thanks so much Sherry!

I'm behind the times with all of this because P has been in good health for the most part...now he's not so I need to play catch up. Of the three products you mention, do you have a preference for him?

--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )


Re: Understanding MIRG

Sherry Morse
 

Where was the bloodwork done and what were the reference ranges?  The normal range for glucose is 71 - 122mg/dL if done at Cornell.  A glucose value such as you listed makes me think that the bloodwork wasn't handled properly which means that the other values are also not valid.




Understanding MIRG

jlmccarroll@...
 

Hello All:

 

I recently had my suspect IR  8 yo Friesian cross gelding (non-fasting) tested after 30 days on an either soaked and rinsed sweet meadow grass or tested safe teff hay diet with balanced nutrients. He has lost a little weight and the vet re-evaluated him from a 6 to a 5+.  His blood values were good at:

 

Insulin  7.6 u/mL

Glucose 7.7 mg/dL

ACTH 3.3 pmol/L

 

Using the ECIR calculator, his results are:

 

G:I  10.3

RISQI 0.36

MIRG 5.5

 

I understand that the MIRG indicates the ability of his pancreas to respond to blood glucose; however, I am not able to find any written documentation on what an MIRG of 5.5 means.  BTW one month ago, he had a 4-day period where he was doing a lot of laying down and was a little short strided at liberty in the sand arena.  He had been on free feed through a trickle net on sweet meadow grass with a combined ESC+starch value of  11.5%.  I immediately began soaking/rinsing until I could get some safe tested teff hay and he seemed much more comfortable within days.

Can you help me understand the MIRG?

 

Thank you for all your help - you guys are the best!

--
Jeannette Mc, NorCal 2021


Re: New Radiographs, Lavinia please review

dr.kellylear@...
 

Okay, she is in boots, with deep shavings too. I am really trying to help her. Does she need anything else done? 

--

 

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: Hay question low de

Lecia Martin
 

OK Cass I uploaded my analysis,  it is the 2nd one marked 2nd cut mixed grass.   As for my case history my August update is not there for some reason I will have to figure out what happened to it and get it uploaded.
Thanks.
--
Lecia Flyte and Flame
Alberta, Canada


Re: Lame

Lamourah Perron
 

Thank you, I will not flush anymore. How often and how long(times/days) should I be soaking the hoof? 
--
Lamourah Perron 
Queens Bay British Columbia 
Hoof pictures Sept 2021


Re: Hay question low de

Lecia Martin
 

Hi Cass,  I am asking about this hay for both horses.  Flame is not on Invokana and my last years hay of 4.8 S/S seemed to be ok for both at free choice.   With this new hay the lower de and higher s/s has me a little concerned.  I will post it in my folder.  Thanks
--
Lecia Flyte and Flame
Alberta, Canada


Re: New Radiographs, Lavinia please review

Sherry Morse
 

Hi Kelly,

Obviously every situation is different but we have had horses on the list who have penetrated their soles and managed to live through it.  The biggest issue I see with Saddie is that she has NO sole so if she's not in boots 24/7 she needs to be.




Re: Updates

Deb Walker
 

Can someone please give me an easy to understand definition of what the laminar wedge is? I've googled it, studied pictures, and I still don't really understand it. Thank you.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Re: Saraphina blood work,help Dr. Kellon

Sherry Morse
 

Hi Cyndi,

Cabergoline is very expensive and horses can experience a veil with it just like Prascend.  What is going on with Saraphina does not sound like a veil to me; but could be an issue with her stomach bothering her or an issue with her mouth.




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

Sherry Morse
 

A 2- 3 month old fetus is maybe 3 - 4oz at most so trying to find a trace at this point is going to be difficult, unfortunately.




Re: Does Tendon EQ have enough JHerb for Ringbone Pain?

Sherry Morse
 

Hi Laura,

J-herb is used as an adpatogen and for help with the immune system and can help with increasing the rate of hoof growth.  We've never mentioned using it for pain relief here that I can recall.  That role is filled by Mov-Ease, Phyto-quench and Devil's Claw among others. 




Re: New Radiographs, Lavinia please review

dr.kellylear@...
 

Hi Lavinia, 
Thank you for reviewing the last X-rays. They repeated X-rays again today because Saddie has become non-weight bearing in the left front. They told me she has sunk and rotated more and that she will likely penetrate her pedal bone through her sole. They are recommending euthanasia. This breaks my heart but I was wondering if you could look the X-rays from today and tell me what you think.
One thing I did notice is that her toe is more rounded but her toe has not been touched at all, so I don’t know how this happened. Please let me know what you recommend. 

Thank you again, 
kelly 

 

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


--

 

Kelly Lear in Texas 2021

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

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

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