Date   

Re: Test not collected properly caused abn high reading?

Candice Piraino
 

HI Jane,

I can actually tell you a quick personal story of my own! My very own riding gelding never had shown any signs of being PPID ( well before I found ECIR and went down lots of rabbit holes and then started to realize all the little red flags I had missed!) AND had been seen by numerous vets who never mentioned PPID. Well low and behold at a later date he was footsore, had rads completed and had shown some degree of rotation. I then found ECIR and asked an attending vet to test for PPID. The vet was absolutely shocked by his numbers and so was I!!! His numbers were so high off the charts, they never computed! The only pushing of testing was from me wanting to know more and dig deeper.

So I just wanted to share my little story of how it can be different for all horses, and some horses don't "look" PPID or show symptoms and then test VERY high!

If you are concerned about the validity of the test, you might ask your vet to redraw on their own dime since it was their own mistake maybe? They might be reasonable about it, and you might feel reassured about the test results. It couldn't hurt to ask, right?

Glad you here!
--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Re: Fergus progress weight loss photo

Jennifer Green
 

Hi Dr. Kellon, here’s what I came up with: 

12 lb Hay*** = 11.4 Mcal
1 cup (weighed 5.5 oz) Teff Grass Pellets** = 0.325 Mcal
1.5 carrots* = 0.150 Mcal
2 TBSP fenugreek powder = 0.072 Mcal
Safe Treats* = 1 Mcal
Total ~ 13 Mcal per Day

* = Estimated
** = Info from EquiAnalytical report I found in feed folder
*** = Hay is soaked all meals (not sure that impacts calories much) 
--
J.Green 
MA, USA
2021
https://ecir.groups.io/g/CaseHistory/files/Fergus%20Case%20History
CaseHistory@ECIR.groups.io | Album


Re: metformin dosage

Mary Kane
 

I started my mare Dawn on metformin three weeks ago. 15 of 1000m pills twice a day. I feed 3 x a day. When my vet came to take blood and xrays after two weeks, he said she should take the metformin 30 minutes before each of the 3 meals she gets, so half again more per day. Is this correct? 
Mary and Dawn

--
Mary Kane
Maple Valley WA
2019


Re: Test not collected properly caused abn high reading?

 

Hi, Jane. 

The safest way to introduce pergolide is slowly. In general, we suggest starting at ¼ mg for 3 days, then ½ mg for 3 days, and continue until you reach your target dose. A common side effect of pergolide is lethargy AND loss of appetite. So if your horse stops eating hay and wanders away, it’s time to slow down the introduction. There’s a File explaining the process.  Many of us have found that APF helps with these side effects that are called the “pergolide veil”. 

https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf

One more thing. Handling blood samples for our metabolic horses is fussy and detailed. Mishandled blood samples cost money AND supply bad information. If glucose was “normal” after sitting at 80 degrees for 2 hours, I wouldn’t trust that lab result. If you can manage, repeat labs in a month for ACTH, glucose and insulin would be smart. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: metformin dosage

 

Hi, Vicky. when I used milk of magnesia, it took about 20-30 ml to dissolve that same dose of ground metformin. An important detail is to check insulin labs again quickly, within a week if you can manage. Not all equines respond to metformin. No reason to continue syringing it twice a day if it doesn’t reduce insulin. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Test not collected properly caused abn high reading?

Jane Hester
 

Thank you! Just hope to get that number down fast! Talked to vet just now—he recommended going straight to full tablet since number is so high. Gave 1/2 tab yesterday and today—will start whole tab tomorrow. He is eating well—just seems a more lethargic than usual. I’m pretty worried about my boy!
--
Jane Hester in NC 2021


Re: Hemp Hulls and Hearts feed

Kirsten Rasmussen
 

You can try seaching our messages for "soybean+meal" and "peas" and "whey".  All are safe options although some horses react to the phytoestrogens in soybean meal so we generally don't recommend it for IR horses.  Field peas (dry round or split peas) are very high in starch but it is in an indigestible form so it is safe, but the amino acid profile is not ideal.  Whey is expensive but a good quality option.  You can also add a supplement to boost the 3 most likely limiting amino acids.  Uckele's Tri-Amino or Mad Barn's 3 Amigos are both examples of a targeted protein supplement.

But first, do you have a hay analysis?  What is the protein in the hay?  It's rare for it to be inadequate if a horse is eating 2% of body weight in hay and is not in work.

Losing topline at this time of year could be a red flag for PPID.  His ACTH in July was fine, but if he is in the early stages of PPID then it might only be elevated during the seasonal rise.  Late Sep or early Oct would be a good time to check baseline ACTH to see if that's the case.  Or you can do a TRH Stim test between December and June.  At his age I would probably check his ACTH annually during the peak of the seasonal rise to catch PPID early if he develops it.

--
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

Bobbie Day
 

Oh Amy,

What a agonizing decision this is, I’m sorry your having to go through this, it’s so hard. But I would (also) say if she were mine I would  spoil her, love on her, get those pictures, take some hair before the time comes because you won’t want to do it afterwards. We all know how much you must love her to give her this final gift. I would personally let her have anything and all she wants. Send her on her way with your love and her favorite things.
thinking of you both.
--
Bobbie and Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021


https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 

https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: Use of Valium for Sedation???

Kirsten Rasmussen
 

Valium should be safe based on this file:
https://ecir.groups.io/g/main/files/SEDATIVE%20EFFECTS.pdf

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


Re: Test not collected properly caused abn high reading?

Kirsten Rasmussen
 

Not necessarily.  Not all the ACTH is active, and it seems to vary by horse, so some horses have really high ACTH but not a lot of signs, and vice versa.  There are other hormones involved that we don't measure and they can be more active than the ACTH, or not.  Each horse is highly individual.

Yes, it should be refrigerated or put on ice after being pulled, centrifuged within 4 hours, then refrigerated or frozen for shipping.  Having glucose measured every time will usually provide clues if the sample was mishandled because it is the most sensitive.  But a glucose of 97 is perfectly normal so your bloodwork looks reliable. 

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


Re: Should I test Monte?

Chris Pennbo
 

I did update his file a few months ago but I guess I didn't do it right! I'm having some computer issues right now but managed to pull this info off my phone:

Most recent test 4/20/21   ACTH  45,  Glucose  89,  Insulin 14      (prior to being diagnosed and put on prascend - 9/22/19 ACTH 77, Glucose 90, Insulin 16)

The vet recommended we increase to  1 1/2 tabs and we did but based on his symptoms/appearance after a few months (and multiple abscesses) we increased it to 2 tabs daily in July. 

I will update his files as soon as I get my computer up and running. The reason I ask about testing is that our vet is coming this week but he will not be back again until spring-time so if we need levels I need to get them this week.  I don't THINK we do but there is much more experience here than I have and I wanted to have those who know more review it.

Thank you!
--
-Chris
May, 2019  Big Bear Lake, California
https://ecir.groups.io/g/CaseHistory/files/Chris%20and%20Monte 
https://ecir.groups.io/g/CaseHistory/album?id=95892  


Re: Test not collected properly caused abn high reading?

Jane Hester
 

Thanks! Not surprised if he does have Cushings but read where blood should
be shaken and kept cool after pulled. So if would be lower in heat, guess that’s not it. Would a horse typically show more symptoms with such a high score?🤔
Jane Hester in NC 2021


Re: Test not collected properly caused abn high reading?

Kirsten Rasmussen
 

Hi Jane,

If the sample was degraded the ACTH would be lower, not higher.  Similarly, the insulin and glucose would be lower, too.   But your glucose looks appropriate.  That said, I'm surprised the glucose in a blood sample left out for 2.5 hours wasn't metabolized at least a bit.  It's always possible a sample got mixed up though if the vet had multiple blood pulls that day so if the results really don't fit your horse, then a retest can be done.  We have seen other high readings like yours though, it's not that unusual.

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


Use of Valium for Sedation???

Suzanne and Pilgrim
 

Hi 

Pilgrim will be having a small procedure done and will need sedation. Just checking…. Zylazine/Rompun is a NO and Dormosedan is a NO. Can Valium be used safely on IR/PPID horse?
--


Test not collected properly caused abn high reading?

Jane Hester
 

Been thinking how my horse with minimal PPID symptoms could have result of 995 on ACTH lab results. When the vet drew the blood, he forgot to take it with him. I happened to see in on top of tall cabinet about 2 hours later—so was in warm barn (80 degrees ish) all that time. Called vet as soon as I saw it and after 30 min or so, they asked if I could bring it to clinic. Got it there in 30 min and gave to receptionist. She took it back but don’t know what happened after that. Not sure if it was shaken. Could this be reason for unusually high reading? Thank you for your help!
--
Jane Hester in NC 2021


Re: Hemp Hulls and Hearts feed

Rita Chavez
 

Ok, so NO on the Stance ‘Hemp Hulls & Hearts’ feed. Thank you for the comparison chart - I do love a good geek-out opportunity!  The lady at my feed store had no idea the label said it could have trace amounts of THC! She was pretty shocked by that and didn’t know what to say, except that it probably was such a minute amount as to have no ill effects. Hmmm...not something I need to risk. And you were right - she did deny that Omega 6 being higher than 3 was undesirable in a horse feed. 

What would be a safe protein source to feed? Obviously peas are also off the table, being high in sugar. What about soybean meal? 
--
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: Fergus progress weight loss photo

 

I balanced Jennifer's hay for her.  The Mcal count in the new hay is 11.4.

Carol Broyles 
Spring Valley,  Ohio 
August 2007


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

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