Hi Cass,

After my epiphany regarding feeding my boy Purina Enrich, I think suspect is the the new normal for me.

Jennifer, glad you’re thinking critically. EquiShure is a great example of the benefits of using ECIR’s Search function. Here’s one post to start with:

Hi Stacy,
Welcome to the ECIR group!  This is the formal welcome promised by Sherry.

How did Buster do with starting pergolide?  Some horses experience some apparent depression when starting it and it sounds like your vet was trying to avoid that with the long intervals between dose increases. We recommend giving an adaptogen (APF) to avoid this veil.  I mention this because it’s quite possible that 1 mg will not be enough to control his PPID.  You’ll want to keep testing and making appropriate dose changes until you get the ACTH into the teens or low twenties.  This may or may not help his hair coat but it should have a positive effect on his allergies - a good reason not to get too involved in treating him for those until his PPID is better controlled.
I want to caution you on giving NSAIDs with omeprazole to act as a stomach protectant.  There’s recent evidence that things don’t work that way and the combination is worse the the NSAIDs alone.  We don’t recommend them either as they have little effect on the pain of metabolic laminitis.

I agree with all of Sherry’s points and see that you’ve followed up on the testing results. Thank you for posting the radiographs and the bloodwork results.  Was the testing done fasting or not?  I am totally not the hoof person here but to me it looks like a trim issue.  I would hesitate to give him J-herb without passing his latest xrays past someone like Lavinia.

And on to the formal welcome with all its reading material.  Let us know as questions arise.

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 etiquette, what 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.

EXERCISE: The 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. 

--

Hi, can you tell me how you insert the capsule into a carrot or apple?   
I'm  interested in hoping to get the stable worker to agree to  place his 2  pills  inside a carrot. Do they have to use a knife? Thanks...

I've only tried soft treats so far...but he figures out pills are in there after a while..
--
Victoria , Maryland, joined March 2020

Hi Deb,
How sensitive was he after previous increases?  Does he show a rise?  That might tell you how you want to go about increasing it.  If you dissolve the contents of one 5 mg capsule into 10ml of water, each 2 ml of fluid would contain 1 mg of pergolide.  You can use 5 ml to start as well but a larger quantity reduces any error.  You’ll need some small oral syringes.  I would probably put the 10 ml of water into a transparent container, anything from test tube to custard cup,  Add the pergolide powder and draw it up into the syringe a few times to mix it.  Then pull-up the 2 ml, or whatever amount you decide on, and squirt it into his mouth.
--

I work with my vet to have a supply of Prascend on hand for dosage adjustments. Once ACTH is in the desired range, I ask for a dosage adjustment of CP. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

I wonder if Equishure is safe for the ones with metabolic issues. I’m so paranoid. 
--
J.Green 
MA, USA
2021
https://ecir.groups.io/g/CaseHistory/files/Fergus%20Case%20History
CaseHistory@ECIR.groups.io | Album

I am now getting myself concerned regarding Lavinia's comments on the Update thread for Scotty. She said if the pergolide dose was not enough to control seasonal rise, he would continue to sink. For us - that means we are done.

My vet cannot do the blood draw until Monday 9/27. Is there a safety or basis for increasing his pergolide now, before I have test and results? I use the capsules...currently 5 mg. Not sure how to increase without actually giving him 2 at a time (10 mg.)

Thoughts??


--
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

she does seem more comfortable in the styrofoam pads taped to her feet, but still not totally comfortable...What would be her trigger if this is laminitis superimposed onto arthritic joints...I feel like I can help the arthritis, but if I don't know the trigger for the laminitic "look" she has...I can't get to the cause of the issue and correct it. Her insulin is the best its ever been and her ACTH  is stable and unchanged since May 2021. She is eating fine, drinking and eliminating just fine. 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder

Thanks Lavinia. I've got that visual firmly in my head. What I don't get is how you physically *see* the laminar wedge when looking at the hoof. What am I looking for to see it...just the longer than normal toe?
--
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

Hello,
I just received my first RX refill from AVRIO (after the switch over from PetHealth).  The capsules are TINY in comparison to what I've been receiving from PetHealth for the past 3-4 years.  I'm worried.  Has anyone else experienced this?  Are they using a different form of the drug or a different process that allows them to fit more inside a capsule?  
Please advise.
Thank you,
~Natalie & Jay in TX

Nov 2002

NRC & NAT 2008

Jay - https://ecir.groups.io/g/CaseHistory/files/Natalie%20and%20Jay

Photos - https://ecir.groups.io/g/CaseHistory/album?id=1902&p=Name,,,20,2,0,0

 

Cass, Dr. Kellon  thanks for your response.   One of the reasons I am retesting is because the iron doesn't jive with the first cut this year and in the previous two years.  It generally has come back with 86- 96ppm.  After listening to Kathleen's presentation I think the first sample I sent in wasnt clean.  At least that's what I am hoping for.    As for the inverted calcium/phosphorus I am aware and I did work with our ag extension office here and treated accordingly because last years hay was also inverted although not as bad.  It apparently didn't work though.  I work with Scott at Mad Barn to balance my hay each year and will do so once I get the second sample back.   Dr. Kellon, as for the beet pulp,  Flyte really doesn't care for large amounts, the most I can get him to eat at once is 1 cup dry weight.  I will increase it slowly and see if he takes to it.  If not, would I use the same amount of soy hull pellets?  He does like those.  And Flame gets the exact same diet as Flyte, minus the Invokana.   Thanks
--
Lecia Flyte and Flame
Alberta, Canada

Hello again, 
sorry about all the questions… I was wondering with my mares current GI issues if it would be safe to still give her laminox and her vitamin supplements. I am worried about messing something else up. 

Thank you, 
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

Hi, Vicky.
My Paint suffers from the veil, too. I give her 3 droppers of APF twice a day. Sorry I don't have the dropper in front of me. I don't stop until she's eating normally. It took her 3 weeks over the course of the latest dosage increase to start eating normally again. I probably went through a small bottle of APF. She also gets Jiaogulan twice a day. She isn't one to get dramatic relief from APF, but at least she kept eating about 80% of her daily hay.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

My mare who is not IR or PPID does have what we call runny butt syndrome AKA Free fecal water. We give her Equishure. It really helps. We started her off at the max dose for about 1-2 weeks and then tapered it back to a dose that maintains her. Might be an option
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396

My PPID 18 year old gelding has had soft stool since June. No diet changes . We tried 6 weeks psyllium with no improvement. Then started him on Absorb All with low dose psyllium. Started slowly over 5 days. He’s getting the full dose now divided into two feedings and his stool is very loose and watery. Took him off it this morning. Anyone else have this problem?
--
Angie
October 2020, Mendocino County, CA

Case History: https://ecir.groups.io/g/CaseHistory/files/Angie%20and%20Jacob
Jacob's Photo Album: