Date   

Re: new trim pictures

Kirsten Rasmussen
 
Edited

Hi Nikkibob,

It looks like Darby was trimmed after the rads were done?  I think overall you have done a good job and Darby and his hooves look good, but the RF toe looks a bit long still.  I see you already backed it up quite a bit but the lateral view to me looks just a bit too long.

Now for some unsolicited advise.  It looks to me like he's growing out some damaged hoof as it is quite pink and also there is a lamellar wedge indicating stretched lamellae.  Your Case History also notes he is currently laminitic?  His 2021 insulins have been on the high side.  In my limited experience, an insulin of 40 uIU/ml can easily lead to a laminitic flareup, which it seems happens regularly (annually) for Darby.  If you're not already soaking his hay, that would help him a lot.  Is there a reason it's not tested and mineral-balanced?  I can't emphasize enough how important that is for making sure the hay is not the trigger, and that he has the minerals he needs in the correct proportions to grow healthy lamellar connections.  Also, with insulin that high, pasture should be stopped, even in winter unless you know for a fact he is not digging in the snow and eating frozen grass.

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


Re: lab results in

vicky monen
 

Can I add that they vet just suggested Metformin.  Can anyone please share their thoughts on adding this med for Samson?  How did it help and and any experiences with it? 
--
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: DIXIE rescue pony

Sherry Morse
 

Hi Terrie,

As Dixie is both IR and PPID she needs tight diet control, a proper trim and Prascend to get her feeling better.  Bute will not help with metabolic laminitis and there are studies showing giving bute and Omaguard at the same time can be detrimental to the horse (https://thehorse.com/195233/use-caution-when-giving-horses-bute-omeprazole-together/)

Diet - she should be eating no more than 6kg total (2% of her body weight) if 300kg is her ideal weight.  That includes hay and concentrates.  We do not advocate free feeding hay on this group as many IR horses do not have an 'off' button to stop eating and will eat as much as they possibly can.  While the Perfect Mash is one of the better feeds I've seen in terms of the ESC+starch numbers and fat amounts the fact that it has added iron in it would make it a no go for me.  If you need a carrier for supplements we recommend plain beet pulp.  Also no lucerne as it can make many IR/PPID horses foot sore even though it's low ESC+starch.

MSM is also a problem for IR/PPID horses as it may inhibit mineral uptake. Tumeric is also not recommended for IR horses.

As far as the Prascend - it's a medication that is dosed to effect, not by weight.  When did you reduce her dose back to 1mg?  It takes 3 weeks for changes in dosage to show up in bloodwork so if you just recently did this and did bloodwork less than 3 weeks afterwards you will have no clear idea which dose is effective for her.  If her ACTH is still elevated though she will need a dosage increase. 

Pictures and x-rays can go in a photo album on the Case History group (which you should have an email on already).





lab results in

vicky monen
 

Hi,

Samson's pre-cushings/Insulin, recent lab results are in for ACTH/Insulin.  His insulin is up at 69.50 ulU/ml, and ACTA 10.3 pg/mL.  I am still struggling to get his insulin down.  He is being exercised more since his lameness has improved after the May 2021 coffin joint injection and shoe changes.  He is still on a strict diet with measured weighed out hay in ultra slow hay net. In dry lot no access to grass.  Minimal 1cp Stabul 1 with timothy pellets as carrier for sups/vits/mins.  He will be at 2mg prascend 1x day starting this wed. He is currently at 1.75 mg per day now.   Apf for veil at 6ML 1 x a day for Veil with the increase in prascend, as he is super sensitive to any changes. 

He currently is severely itchy on face, neck, mane, tail and rump (yearly issue).  He has mildly loose stool with some water after which is new, as we had this under control for a long time prior. He was just wormed 8-26-21 with ivermectim, as he is normally under the neck threadworm protocol starting spring.  

He was treated for ulcers from Feb to May and is now on maintenance dose of omeprozole/Abler. 
 
He definitely can  use more exercise, as I have only been able to work him 3 days per week.  With him in the dry lot he does not get much movement, as he will just hang out at the hay net or sleep. 

If anyone has any additional suggestions to get his insulin down please let me know. 

His history has been updated. 

Thank you so much, as your input and suggestions really make the difference in this continued walk with IR.  

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: Hay question low de

Kirsten Rasmussen
 
Edited

Hi Lecia,  

Is the hay analysis this one in Flyte's case history folder?  It was uploaded today but the numbers are different than what you noted above.

https://ecir.groups.io/g/CaseHistory/files/Lecia%20Flyte%20and%20Flame/Flyte%20case%20history/Lecia%20Martin%20210824%20%20603&604.pdf

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


Re: New Radiographs, Lavinia please review

dr.kellylear@...
 

Okay, thank you! I will do that. And is there anything I should do for a trim? Drop the heels or bring back the toe? Or just round the hoof walls for now? 
And if she does have an abscess, do you let it work it’s way out of do anything else? 

Kelly 

thank you so much

--

 

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: DIXIE rescue pony

Cindy Q
 

Hello Terrie

Welcome to the group! You can bookmark this post for now to come back to it to add additional replies: https://ecir.groups.io/g/main/topic/dixie_rescue_pony/85740911 

Our recommendation for Prascend is to feed the dose that gets the ACTH into the low to mid part of the normal range. Increase in Prascend should be done gradually, by increasing by 1/4 tablet every 3 to 4 days until you get to your desired dose. ACTH can be retested about 3 weeks after you reach your desired dose. You can read more about this under the "Treatment" heading of our official welcome letter (a little below the heading "Diagnosis"). There are many equines on much higher doses here and doing well - we do not recommend to fix the dose by weight of the horse or pony.

Unless you have a specific recommendation from Carol to take longer, you can probably go straight onto the full emergency diet. You are in good hands with Carol Layton on diet and mineral balancing advice.

I haven't seen your pictures as they do not attach to the post. Under the "Trim" heading, there are links to to tell you how to create an album where you can upload xrays and you should try to get a full set of hoof pictures upas well to provide as much information as possible to get trim input from Lavinia. Please read the wiki on how to get hoof pictures (also linked in the same section). Remember to get your camera/phone way down on the ground so it is on the same level as the hoof when you take the dorsal (front) and lateral (side) views of the hoof. Don't have your camera so close in that the picture gets unfocused. 

Our welcome letter is a big read, but there's ton of information in it so please take the time to read it. Again, you can bookmark this page/post and keep coming back to refer to it. If you have questions, do ask!

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: Seasonal Rise and allergies

Sherry Morse
 

Hi Vicky,

We have people who have dosed up to 10ml but you might get more answers by posting a new topic titled "APF Help" or something like that so people know that's what you have a question on.  You can also search on "APF Dosage" in the messages and this thread might be helpful as well: https://ecir.groups.io/g/main/topic/77422193#256665




Re: New Radiographs, Lavinia please review

Sherry Morse
 

Given the current condition of her hooves I would recommend sticking with boots and pads and avoid anything that involves nails or wouldn't be able to be removed easily as she may need frequent trims as her hoof continues to grow out.




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

Sherry Morse
 

Hi Laura,

My suggestion would be pick one and see if it works for him.  If it does stick with it.  If you don't notice a change within a month (or however long it should be before there's a noticeable change) go on to something else.  Every horse is different and what works for one may not work with another.




DIXIE rescue pony

terrieheining
 

I have recently contacted Carol Layton at the request of my farrier, for dietary help for my laminitic pany,  and Carol suggested that I join your group for help with the many other issues that Dixie arrived with. I have joined the group but have no idea how to post this information within the group, so if that is preferred could you send a link to show me how to do that please.  I have engaged Carol to devise a dietary plan for Dixie, but would greatly appreciate any advice you can provide to set Dixie and myself on the right path to a happy and pain free future. 

I adopted Dixie just over a year ago, she is now 22yo.  She is said to be a welsh mountain pony weighing 300kg. Her backstory is one of neglect by her original owners.  I have been told that she had been having laminitic episodes most of her life, often being left down in the paddock for days on end, unable to rise, until eventually the RSPCA seized her and I adopted her after a year in foster care.  It is unclear what treatment she received prior to her adoption, but she has been footsore since coming to me.  

The first farrier I used trimmed her fortnightly for six months, with no improvement in her comfort.  I was feeding her Hygain Zero with soaked wheaten chaff, and as he suggested, ad lib Teff hay.  She was primarily stabled on soft bedding and wore RX therapy boots at all times when she was out of her stable in the small bare yard attached.  After the six months this farrier suggested euthanasia as her comfort levels had not improved.

I then contacted an Equine Podiatry and Lameness Centre who saw Dixie fortnightly for 2 months, put her in Ultimate slippers with some sort of putty in them for the first 2 weeks, then removed them, she was footsore again, so put them back on, then removed them again,  and after the 2 months advised that there was nothing more they could do for her.

I now have Dixie under the care of another barefoot farrier, and she is still very, very sore.   Current farrier took over on 11th May.  Dixie has been on and off Bute over this time, which was recommended by my vet so long as she was given Omaguard at the same time.   My current farrier asked me to transition Dixie from Hygain Zero to Furneys Perfect Mash, with soaked lucerne chaff and Teff hay ad lib, plus MSM with hyo,clivers, devils claw, white willow, chamomile, Equishure and Belindas Amazing Minerals.  Dixie still wears RX therapy boots, with 20mm thick rehab pads.  I take them off for 2/3 hours per day while she is in her stable, A few months ago I stopped Bute and have been using Bute All which is a herbal mix paste containing guaicum, turmeric, celery, skullcap, passion flower, jamaican dogwood and magnolia bark.

When being treated at the Lameness Centre,  ACTH was 225 pg/mL and Serum Insulin was 84 mU/L. These tests were done 17/3/21.  My vet has today taken blood for a current ACTH reading, which should be available in about 2 weeks.  Original dose of Prascend decided by the Lameness Centre was 1 x 1mg tablet daily.   When this was having no effect, they increased it to 1.5 x 1mg tabs daily, and Dixie was on that dose until recently, as my local vet considered the dose excessive for a 300kg pony.

Since having the ad lib Teff hay in her stable, Dixie began to eat more and more of it, to the point where she was leaving her feed to eat the Teff, so I am now weighing out her daily allowance and she now eats all her feed and additives, plus the appropriate amount of hay.  Since speaking to Carol Layton last week, and as the teff is the only thing that has remained constant throughout this ordeal, I have now started to soak the Teff for an hour, and dry it out before feeding, until we can have it tested to make sure it is as it should be.  I am also 5 days into transitioning Dixie over to your emergency diet.

Also at the request of my current farrier, I sent off a manure sample to Equibiome in the UK in July, and the results came back recently and are horrendous, however as my farrier is more confident in their expertise than I am, I have not acted on the results other than to purchase all of the suggested potions.  As I have been giving Dixie Equishure for months now which I understood was for hind gut health, with no obvious difference, I do not want to subject Dixie to anything further until I am sure.

Dixie has rotation in all four hooves, and xrays are attached that were taken by the Lameness Centre.  These were taken after they had trimmed her a couple of times.
Please let me know if there is anything further I can provide you with.  There is nothing I will not do to try to help this pony, even though,  so far, my efforts have been in vain.  

Kind regards
Terrie Heining
Stroud. NSW. Australia



--
TerrieH in Australia 2021





















Re: lidocaine patches/voltaren for arthritis pain

Joy V
 

Hi Trisha,

I used Voltaren gel on my horse's hocks last winter and it worked well without clipping, although his hocks are not really *that* hairy at any time of year.  I did find that the gel irritated his skin once it got warmer so I discontinued use then.    

  
--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526


Re: New Radiographs, Lavinia please review

dr.kellylear@...
 

Would formahoof, glue on pads with dental
impression, shoes or anything else be a good idea, or just the bandages and soft rides until she grows more sole? 

thank you again for helping me! I really appreciate this! 

kelly 
--

 

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: New Radiographs, Lavinia please review

dr.kellylear@...
 

Thank you again for looking at the new X-rays. Yes, the bet had removed the padding to take the new X-rays to have a better view of possible abscesses. He thinks there is one at the tip of P3. The wraps are back on and she is also in her soft ride boots too with deep bedding. 

the vet did mention that he might try to get the abscess drained at the tip of P3 along with groove the hoof wall where the dark area is. ( he said laminar sepwratuon. I don’t think this is a good idea but I wanted to verify with you? 

and thank you for letting me know about the magic cushion. I will keep applying with bandage changes every couple of days. 

is there anything else I should do for her feet. 

thank you again! 

Kelly 

--

 

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: Seasonal Rise and allergies

vicky monen
 


--Do you  have a suggested dose outside of what's listed on the packaging?  Will 6ml to 8ml 1x day be enough for 1000lbs?

Please let me know if I should increase this to help with the veil.  I am open to any suggestions! 

Thanks! 

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: Understanding MIRG

Eleanor Kellon, VMD
 

I suspect that 7.7 is actually 77. A glucose that low wouldn't be reported in tenths.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


lidocaine patches/voltaren for arthritis pain

Trisha DePietro
 

Hi all. for those of you who used lidocaine patches or voltaren gel for your horses- was it necessary to clip the hairs short so that the medication made skin contact? or did you find it worked without clipping? thanks. Trisha
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


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.

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

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