Date   

Re: Tuck

Candice Piraino
 

HI Kim,
Could you please post a case history for us to see a bigger picture? Please complete as much information as possible. You can also post you hay analysis and labs as well.

The sole depth is less than half of what we would consider decent, but some metabolic horses do have an issue growing sole. On the bright side, there are a lot of horses who can grow sole, who are well managed! It is tough to lose good hoof care professionals, but it sounds like you might have a good one to help you!

Need to find the trigger(s) to the founder in order to stop the rotation though. We can try to mitigate that with a case history. Please load it when you can. Thank you.

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


New Therapeutic Boot option

Rita Chavez
 

Just wanted to share this new boot available for lameness issues. Looks easy on/off and you might be able to use a foam cushion inside too. 

https://www.tackoftheday.com/vet-strider-equine-poultice-boot-and-hoof-protection-orange-470648-orange/p
--
Rita C. and Stetson (2001 Tennessee Walking Horse/Gelding, diagnosed IR)
Aiken, South Carolina USA
June 2021

https://ecir.groups.io/g/CaseHistory/album?id=265166 

https://ecir.groups.io/g/CaseHistory/files/Rita%20C.%20and%20Stetson


Re: Euthanasia within 24 hours

Erica Reimers <Ereimers90@...>
 

Hi Amy, 
I'm so very sorry you are having to make that tough decision.  ❤. I would give her banamine and let her enjoy herself. Treats and some nice alfalfa if you have it. Maybe a nice bath before turnout so she will enjoy a good "get dirty" again roll. 
Sending lots of hugs from myself and my gelding, Snap. ❤


On Tue, Oct 12, 2021, 8:03 AM amyscrivanich via groups.io <amyscrivanich=yahoo.com@groups.io> wrote:

I am giving Mater her “final gift” tomorrow (24 hours from right now).   This is an odd request, but I want her to have some pasture and treats before she goes.   Would be bad to give her turnout today or at least tonight?   Euthanasia is planned for 11 am

 

--
Amy Scrivanich
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)
https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Mater%20the%20mini

https://ecir.groups.io/g/CaseHistory/album?id=264439

 


--
Erica H CA 2021


Re: Euthanasia within 24 hours

Qhgirl
 

Hi Amy,
You are being a great mom to Mater. I know this was a tough decision and made with love. I would let her have whatever makes her happy at this time. Let her last hours be enjoyable and let her have pain meds so she does not have pain
i have had to make the same decision for some of mine in the past. Bush her, kiss her, talk to her and tell her what is happening. She will understand. Hugs. 


Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Herbs for Horses - Three Aminoes

Tanna
 

Thank you Lorna

CH now updated. 

--
Tanna 

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

Tula's Case History 


Re: metformin dosage

vicky monen
 

Is this something he will need indefinitely, or until the insulin comes back down? He is super sensitive with any changes in diet, hay, medications, supplements, is there anything else to add with the metformin other than milk of magnesia? How much of milk of magnesia does he need?  He is also currently on omeprozole due to GI upset and diarrhea lately.
--
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


Tuck

Sunkawakan
 

Tuck has EMS as an 11 y/o gray Appy x gelding. 
As directed by Dr Kellon, I sent current hay analyses & the supplements I provide. Other diagnoses include RAO managed well with monthly allergy shots, a probable immune-mediated uveitis which led to a mature cataract in the L eye, sarcoid lesion on R barrel (resolved). First lameness issue 8/2019: severely lame RF with ‘mild’ rotation & 6mm sole.
Ongoing lameness this summer: 6/2021 RF 9 degrees rotation w/approximately 5mm sole LF 5 degrees rotation w/approximately 8mm sole thickness. I lost both dedicated barefoot professionals, one to retirement & the other to vet school. Trying another individual now who is knowledgeable & capable. Despite current dietary measures, oh yeah-low T4 as well...Tuck’s insulin level is at an all-time high, glucose stays elevated, the weight stays on because he cannot exercise. I use boots.
--
Kim F
WI
2021


Re: Chronic Laminitis 8yo rp x welsh

Kirsten Rasmussen
 

Hi Molly,

There is some information here on posting photos and xrays:
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help
Once you've made a Photo Album in the Case History sub-Group, please add the hyperlink for it to your ECIR Signature. 
If Deacon is still foot sore and he's on the Emergency Diet, then it's possible trim is still a problem.  A common issue is thin soles, so make sure no material is being removed from the bottom of his hoof while he is sore.  For more advice on trim, please upload your rads and a full set of hoof photos as instructed in the above link.

Did you have his insulin and glucose tested?  If insulin is high despite being on the Emergency Diet then the pain could be due to ongoing/chronic laminitis.  If that's the case, and you have already minimized dietary sugars by following our protocols exactly, then there are medications you can try as a final measure to bring down insulin.  As Candice said, we need to see his PPID testing results, too. 

Don't worry too much about the past and your learning curve.  We all have to do the best we know at any given time and many of use could have done better, too, but you're here now so we will try and help you get to the bottom of this.

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


Re: Supplement Changes/Sore?

Kirsten Rasmussen
 

 she is still reaching under fence to eat what she can, its not much but could it make a difference enough?
Short answer: yes.  If you can add an electric line to the bottom or a physical barrier, like plywood or snow fencing, so she can't reach through, that is the easiest way to stop this.  I sympathize with you on the battle against grass when it rains...

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


Re: Euthanasia within 24 hours

F Sanford
 

Amy my heart goes out to you and you have done everything you can, it’s never an easy call.  If she were my horse I would let her enjoy her final hours.  I would give her pain meds and turn her out 5-6 hours before the appointment.  I too, don’t know what others would do or say, I just know it’s  what I would do.   It’s what I did 20 years ago with my heart horse and I have never regretted my decision. She loved the freedom,  and I loved seeing her grazing again, we both were happy.  I will be thinking of you during this difficult time.  
--
Florence in upstate NY joined September 2021


Re: Euthanasia within 24 hours

Kirsten Rasmussen
 

Sorry to hear that, Amy, that's a difficult decusion.  I'm not entirely sure how quickly laminitis pain can start after dietary indiscretions, but for hay changes it seems to take my horse at least 2 days.  So I don't think making her last 24 hours a pasture buffet and spoiling her a little will cause any pain before she goes.

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


Re: Supplement Changes/Sore?

Eleanor Kellon, VMD
 

Nitrate is metabolized to nitrite which interferes with oxygen carrying capacity in the blood. There are many reports of it causing or worsening hoof pain.

Protein on a hay analysis is actually a guesstimate made by measuring nitrogen. When protein is unusually high like yours was, there can be nitrate nitrogen contributing to that protein estimate.

If you know the hay analysis was wet chemistry that's all we need to know.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Should I test Monte?

Kirsten Rasmussen
 

Hi Chris, 

Since your last test was in April and he has had a couple(?) dose increases since then, AND we are still in the seasonal rise....if he was mine I would have his ACTH checked now.  It would be very informative to know if his dose is high enough.   I believe checking 2x a year at a minimum is important for managing PPID.  Preferably in late July, then again in late Sept.

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


Re: Supplement Changes/Sore?

Kathleen Rauchle
 

Sorry to seem a bit slow, but what exactly does the nitrates cause?  I know it means something but not sure what exactly.  Too much Nitrate is the issue and that is because the protein is too high?  I know the hay analysis was done with wet chemistry, but I will ask what type analysis it is.

I am getting the hay probe again tonight and will take new samples and add Nitrate to the small squares.  I should have more results to post this week.
--
Kathleen R
Central WI 
2020

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo

https://ecir.groups.io/g/CaseHistory/album?id=252630

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_top_field_1st_crop_rounds_Mixed_grass_hay_2021-08-27_395849_1264%20%282%29.pdf

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_2021_2nd_crop_sm.sq.grass_Mixed_grass_hay_2021-08-27_395848_1263%20%282%29.pdf


Re: Update on Flirt

Eleanor Kellon, VMD
 

Most recent trim is definitely an improvement. When you post hoof photos, please be sure to tape the hair up away from the coronary band - or just clip it off.  We need sole shots.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Supplement Changes/Sore?

Eleanor Kellon, VMD
 

I would ask for the Lyme multiplex from Cornell.  The odds of having Anaplasma but not Lyme are pretty long.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Supplement Changes/Sore?

Eleanor Kellon, VMD
 

Yes, trace minerals on the hays and you need to ask if it was NIR analysis. If so, repeat the sugar and starch with wet chemistry. Also add nitrates on the small squares.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Euthanasia within 24 hours

Candice Piraino
 

HI Amy,

I am so sorry to hear that you have had to make this tough call, but as their trusted owners, sometimes making a tough call is best. My heart goes out to you!

Honestly, if she were my horse, and I have tried everything under the sun to save her, I would let her have whatever she wanted for her last final day on this Earth. I am not a vet and unsure what Dr. Kellon would say, but as a fellow horse owner, if you have already made the appointment and it is in the horse's best interest, then yes by all means give her some turnout time. 
--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Re: Supplement Changes/Sore?

Kathleen Rauchle
 

I thought of another question.  When Echo was diagnosed with Lymes.  The Vet did a quick at farm test.  When I asked her to run numbers again (the ones from March) She said her notes said Ana plasma not Lyme disease.  Which was also confusing because she had Lyme disease symptoms not  Ana plasma symptoms.  I didn't do the Ana Plasma test because I thought it was Lymes and that test was another $100...alone.  Should I still do Lyme titer again anyway?

Thank you,
--
Kathleen R
Central WI 
2020

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo

https://ecir.groups.io/g/CaseHistory/album?id=252630

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_top_field_1st_crop_rounds_Mixed_grass_hay_2021-08-27_395849_1264%20%282%29.pdf

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_2021_2nd_crop_sm.sq.grass_Mixed_grass_hay_2021-08-27_395848_1263%20%282%29.pdf


Re: Supplement Changes/Sore?

Kathleen Rauchle
 

Thank you Dr. Kellon for the response. 

Are my hay analysis incomplete because they do not have the mineral breakdown?  I know I can send in another analysis to Dairyland labs to get the trace minerals.  (I should have just did that right away). 

We have been weighing for the most part.  She gets the small square hay in 3/4 inches hole bags mixed with the large bale hay and then get the difference in either a 1 3/4 net or the porta grazer of just the round bale hay.  We have been giving a bit extra because I am afraid of her sitting too long without hay.  Even with the small hole net she still eats through it too fast. (of course she likes the small square hay more that is why I started to mix it)  She has been having left over round bale hay at night the last few days. Back in the early spring when she was restricted she started to eat the other horse's manure, worried she will start to do that again.

She has been in dry lot 100% since August(It was a short time we tried grass in August about 2 weeks).  Otherwise before then she was also only in the dry lot all spring.  Some grass started to take off in the early spring in the dry lot and we had to make it smaller, because one night may her slightly sore again. I will not lie she is still reaching under fence to eat what she can, its not much but could it make a difference enough?  I have been using a natural weed killer spray (vinegar) to keep it back but has not been possible with the constant rain this lately.

I was thinking the toe could come back a bit more also.  Was a bit disappointed in my last Cody James rasp, feels like it takes more effort to use than last one.  I trim every 2 weeks.
--
Kathleen R
Central WI 
2020

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo

https://ecir.groups.io/g/CaseHistory/album?id=252630

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_top_field_1st_crop_rounds_Mixed_grass_hay_2021-08-27_395849_1264%20%282%29.pdf

https://ecir.groups.io/g/CaseHistory/files/Kathleen%20and%20Echo/KATHLEEN_RAUCHLE_2021_2nd_crop_sm.sq.grass_Mixed_grass_hay_2021-08-27_395848_1263%20%282%29.pdf

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