Date   

Re: blood work back/ dr kellon please

Kirsten Rasmussen
 

Metabolically, Tiko seems to be doing great!

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


Re: Testing of EMS

 

Hello Marie,

Welcome to the ECIR group!   Your first post triggers the sending of this welcome from the group with lots of reading material, which may answer some of your questions, and links to much more.  Seeing references to the EEG group, as the Equine Endocrinology Group is frequently referred to, always triggers confusion in my mind as well.  My husband is an EEG expert who reads and analyzes electroencephalograms.  Nothing to do with horses in his line of work although I think some researchers have experimented on horses.
I will give you my answers to your questions but as a non-vet volunteer, you may get further clarification from someone else.  In some cases, Dr. Kellon’s research agrees with that of the EEG while it differs in others, even beyond what you’re asking about here. 


My understanding is that the oral sugar test could trigger laminitis in some cases and that is not a risk worth taking.  We also want to know what the insulin is in the horse under normal circumstances, not artificially created, because that is what the horse encounters on a daily basis.

I, too, was sucked into the high fat diet, having a PPID horse diagnosed with shivers as well.  He was not IR so I did not run into issues with the exception that high fat is no longer recommended for these horses.  The best diet for a horse that is IR has been shown to be one where the forage has ESC + starch is below 10% and in the correct amount.  Unnecessary calories will end up as fat.  Our recommended amounts range between 1.5 and 2%, which is a fairly standard recommendation.

Glucose:insulin is not a test per se but a calculation.  Testing for glucose gives you a good handle on how the sample was cared for between blood sampling and analysis.  It also can give you information about whether the horse might have entered the diabetic range.

I agree there is a considerable difference between 9.28% and 20% but I’m not familiar with these values and don’t know what they are percentages of.  I will definitely leave that to someone else.

Now - onto the ECIR reading material.

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. 


--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Liquid ivermectin use/dosage

Nancy C
 

The question about liquid ivermectin dosage was posted in several places.  For those who need it, this is the response from Dr Kellon.

The 1% solution is 1000 mg/100 mL so 100 mg/10 mL.  Dosage is 0.091 mg/lb, 910 mg for a 1000 lb horse.
-- 
Dr. K
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21.
Veterinary Professional CE certification hours submitted to AAVSB Race 09.08.21


Testing of EMS

Marie
 

Hello,
I doňt know, how ask in our group so I ask here. Equine Endocrinology Group prepared recommendations for the EMS and here I found

1) They recommended only Oral sugar test and Insulin tolerance test (Dr. Kellon Frequent Sampling Intravenous Glucose Tolerance test- too expensive). Why?

2) For Lean EMS BCS 4-5/9 they recommended low suger and HIGH fat diet. Is it ok?

3) The tests no longer recommended: Glucose:insulin ratio. Dr. Kellon recommneded it.

https://sites.tufts.edu/equineendogroup/files/2020/09/200592_EMS_Recommendations_Bro-FINAL.pdf

I believe Dr. Kellon but why they recommended it like that?

4) Dr. Kellon mentioned that overall prevalence of IR is 9,28%. In test was correct aswer 20%, but I donť know, what is true?



Thank you all 
--
Marie Volsicka
Mid Europe
2021


blood work back/ dr kellon please

Daisy Shepherd
 

good morning,  tiko blood work done 10/05/2021;  all cornell  insulin 21.79,  glucose 101,  T4 1.07,  acth 20.5,  leptin 4.29, gi ratio 4.64,  risqi 0.21, mirg 7.9 ; last nite feeding low s&s  hay at 730 pm  11 #,  that am same hay at 730 5#,  out to pasture  at 830 with muzzle 1 inch hole,  in at 1030 with hay, vet drew blood at 1115.  thank you for your review and recommendations.  daisy and tiko and, whisper
--
-- 
Daisy, Tiko and Whisper
CO, April 2019
Case History:  https://ecir.groups.io/g/CaseHistory/files/Daisy%20and%20Tiko 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=90099&p=Name,,,20,2,0,0


File /Euthyroid Sick Szyndrome.doc uploaded #file-notice

main@ECIR.groups.io Notification <noreply@...>
 

The following files have been uploaded to the Files area of the main@ECIR.groups.io group.

By: Eleanor Kellon, VMD <drkellon@...>


Re: ivermectin price increase?

naomi.dechaine@...
 

Hi Sharon,
I have been using the Durvet Ivermectin 1% for many years, and always do the 1ml per 100lb orally. It matches the equivalent dose of the horse paste if you do the conversion. 
 
--
Naomi D, AB Canada, 2021
https://ecir.groups.io/g/CaseHistory/files/Naomi%20and%20Butterscotch
https://ecir.groups.io/g/CaseHistory/album?id=264934


Re: ivermectin price increase?

 

Like Joy, I’ve been able to find it online, although I haven’t looked recently.  Could you ask your vet your question about the injectable?  I’m old enough to remember when we switched from tube deworming, not paste but through a tube into the stomach, to injectable ivermectin.  Although the vet did the injecting, the trauma of the deworming process was greatly reduced.  I don’t recall if there were associated risks.  We were just so thrilled not to have to do the tubing process any longer.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Questions on navigating website /files?

 

Hi Debbie,
I should be able to help you.  We definitely need a case history from you in order to address your horse’s issues.  I live in New England as well and we’ve had gorgeous weather recently.  I’ve been trying to get things ready for winter and not spending much time inside.  If you had a case history posted and a link to it in your signature, I’d be able to step in after a few days, see what’s going on and address your questions about taking care of your horse.  As I can’t, I will try to help you through this.  Please send me a private message so we don’t ‘clutter’ the list with non-IR/PPID issues.  Let me know which device you are using, whether or not you still have access to your welcome letter and where you are stuck, which seems to be finding the case history form at this point, although you have apparently accessed it earlier.

Thanks!
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Questions on navigating website /files?

Eleanor Kellon, VMD
 

Not a pest, Debbie. Start here https://ecir.groups.io/g/main/wiki .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: ivermectin price increase?

Joy V
 

FWIW I found ivermectin online on several horse websites, with no markup to the price.  Most recently I found it on riding warehouse.


--
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


Questions on navigating website /files?

DEBBIE GIRARD
 

Good Morning,   I dont want to be a pest and Im not sure where to ask questions about just getting around in this website.. Is it on this page or is there a page  just for questions?  Ive walked away from filling out my case file twice but know I need it to tackle it . Now I cant even find the page with the file to fill out!    I dont drink or smoke but I get off the computer ready to buy a case of wine and a cartoon of cigarettes!!   Thanks a bunch.
--
Debbie Girard/Massachusetts/202


Re: Hyper thyroid!!??

Eleanor Kellon, VMD
 

Myriam,

That number is really in a grey zone. I wouldn't worry about it unless you start to see signs - nervousness, high heart rate, weight loss.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Hyper thyroid!!??

Myriam Desrosiers
 

Aragon was always on the low with his thyroid, and i understood, maybe i’m wrong, that it was an effect of IR than a cause. Since he was always on the low range. I was wandering if i still needed to give him T4 supplement… i guess not! 

I live very far from a city, having a vet visiting is something difficult. I’m not feeding him Any supplément of biotin… could there be an other reason  why his thyroid is so high!!!?? 

For his insulin management, he does exercise, balanced diet, i weight his hay and put it in a net, so he eats slowly… and hay is at 8.6 sugar + starch. Please let me know if there is anything else i can do for help manage his insuline level… thank you!

 

  
--
MyriamD, Qc, Canada

https://ecir.groups.io/g/CaseHistory/files/Myriam%20and%20Aragon

https://ecir.groups.io/g/CaseHistory/album?id=260540


Re: Fergus progress weight loss photo

Jennifer Green
 

I think the new hay is just 2nd cut Timothy. There’s no sign of alfalfa in it that I can see.

 I did schedule his blood work today to retest insulin first week in November. I’m hoping his insulin and leptin levels are lower, 
--
J.Green 
MA, USA
2021
https://ecir.groups.io/g/CaseHistory/files/Fergus%20Case%20History
CaseHistory@ECIR.groups.io | Album


Re: Fergus progress weight loss photo

 

Sorry, I don't think I ever replied ... some days it won't let me look at photos, or do replies.  Other days, I can.

Is it possible that the newest hay has alfalfa or some other legume in it?  Soaking can bring down the sugar, but it won't reduce protein levels

--
Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History


Re: Euthanasia within 24 hours

Nancy C
 

When I knew I had to let Beau go (2016), after 13 years of good management from what has been learned here, I let him have weeks of grass.

He had a very tight trim which supported him.

He was fine.

Sending you all the best in this difficult time.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21.
Veterinary Professional CE certification hours submitted to AAVSB Race 09.08.21


Re: ivermectin price increase?

 

Hi, Sharon. 
Sorry, I know nothing about using cattle and swine liquid ivermectin in horses.
Can you find moxidectin? It's certainly as good as ivermectin paste, tho less tasty.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Euthanasia within 24 hours

Cindy Giovanetti
 

I love the idea of turning your laminitic horse out to graze for her final day.  That just brings tears to my eyes to think about.

 

I hope it went well.  God bless.

 

Cindy


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Re: Hyper thyroid!!??

Nancy C
 
Edited

Hi Miriam

Thyroid and other hormonal testing can give back wonky tests from biotin in the diet.  It is not a health issue or real changes in thyroid levels caused by the biotin but described as an "artifact"

This is the original thread announcing the human study and Dr Kellon's comments

https://ecir.groups.io/g/main/topic/77731380#256714

The link to Guidance from AACC in Dr Kellon's link  describes the half life of biotin in humans as follows:

"Low concentrations of biotin are cleared quickly from the circulation of healthy individuals, with an elimination half-life of approximately 2 hours (30), whereas experiments with high doses indicate a half-life up to 18.8 hours (11).

Dr Kellon please correct my take that withholding for 24 hours would clear the system. I also wonder about withholding all minerals for a day if the biotin is already mixed in the supplement and that is the only option.You can also buy and add biotin separately.

I would not stop or lower the iodine. It is really important for thyroid health.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

Recordings of the 2021 NO Laminitis! Conference released to attendees 09.03.21.
Veterinary Professional CE certification hours submitted to AAVSB Race 09.08.21

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