Hi Janet, 

That's great that you got a diagnosis!

We usually recommend starting with 1/4 pill a day, for 3-4 days, then increasing by 1/4 increments if she hasn't gone off her feed, until the prescribed dose is reached.  This will work for most horses and if it goes well would have Chicy on 1mg in 9 days.  If she goes off her feed at this pace, then stopping and adding APF is advised.  Some horses don't show any side effects, others are extremely reactive.

Make sure your vet emails you a copy of the bloodwork when it's all in so you actually have the numbers and are not just told "normal".

Keep in mind that at a later stage in the pregnancy the pergolide will need to be stopped because it can supress lactation.  At least 1 month before due date, and ideally 3 months before due date.
https://ecir.groups.io/g/main/message/269019?p=%2C%2C%2C20%2C0%2C0%2C0%3A%3Arecentpostdate%2Fsticky%2C%2CLactation%2C20%2C2%2C0%2C85654207
https://ecir.groups.io/g/main/message/266095?p=%2C%2C%2C20%2C0%2C0%2C0%3A%3Arecentpostdate%2Fsticky%2C%2CLactation%2C20%2C2%2C0%2C83846601


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

Hi Dr. Kellon,

I am still waiting on results for the hay. She is more sore yesterday and today, than before. Digital Pulse in all four hooves now, which it was only the fronts before.

But now I am thinking what grass is growing on the edge of her dry lot is still too much and she could be getting sore from that? 

I started to cover up the grass with dirt and rock, then sprayed with vinegar and Epsom salt what I couldn't get to yesterday. (Will work on that again tonight).

It seemed as if when we turned the fence on she got more sore. I know she got shocked about 3 times could the percussion of her jumping cause a flare up also? Or does that seem crazy?

We were doing so well before this....

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

On Fri, Oct 8, 2021 at 07:41 AM, Eleanor Kellon, VMD wrote:

Hello DR Kellon,

So I have a question.  Does acetyl-L-carnitine replace devils claw?  And When Can I give Jiaogulan?  I was under the impression I could not give Jiaogulan if I was giving Devils claw.  Lime Test came back negative.  Farrier came out today and did find Gas line.  Opened it up.  I hope this helps him.  

Thanks,  Melanie

 
--
MELANIE SCHWARTZ
DAVIE,  FLORIDA 33328
October 30, 2020
Remy's Case History: https://ecir.groups.io/g/CaseHistory/files/Melanie%20and%20Remy
Remys photos:  https://ecir.groups.io/g/CaseHistory/album?id=263092

Martha and Trisha -

That all makes sense.
Thanks!
--
Cheri
May 2020 New Mexico
https://ecir.groups.io/g/CaseHistory/files/Cheri%20and%20Chama
https://ecir.groups.io/g/CaseHistory/album?id=261805

They get a lot of false negatives with baseline insulin but that's because their definition of "normal" is too high.

High fat diet safety in EMS has never been tested and is contraindicated in other species.

G:I ratio was validated by the original proxies study which compared it to intravenous testing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

I would continue the current dosage.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

In ADHD, PTSD, seizures, etc. it's not a matter of flow being blocked per se but rather an imbalance in the production of neurotransmitters.

CBD actually reduces dopamine effects.

PPID isn't a problem with too much dopamine. It's too little. There's no evidence that CBD could actually cause this in a normal individual but it might have a significant effect in one that is already abnormal.  CBD does bind to dopamine receptors, just like pergolide, but it blocks the effects of dopamine. I wouldn't give it to a PPID horse.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hello,

I will update his CH asap, but I retested Ruger recently after his dosage was increased from 3.0 mg QD to 3.5 mg QD in late August.  His ACTH at that time was 24.4 pg/mL, but I was concerned about the seasonal rise, so increased it anyway.  I'm glad I did; on 10/6/21 ACTH was 65.1 pg/mL.  I'm not sure if I should increase the pergolide further, or it would be okay to just continue his current dosage since his ACTH should be declining at this point?  I will continue 3.5 mg QD though, rather than dropping down to 3.0 mg QD in December as previously intended.  Does this sound like a good plan?  Any comments are much appreciated!
--
Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102

Hello Heidi,

Welcome to the ECIR group!  Your first post to the group triggers this welcome message.  There is lots of good information included.  After you’ve digested what you can, store it in a safe place for future re-reading - or just ask us to send you another one.

It’s fairly common for people to think their pets are bored with their diets and try to liven them up a bit.  My dog gets the same meal twice daily, day after day after day and not once has he complained about it.  The Triple Crown timothy balance cubes provide everything your horse needs with added salt, vitamin E and flax and they’re really the only safe product in that category.  I feed some Cavalor FiberForce as it seems to qualify as appropriate although we have not officially designated it as such.  The issue is that other products are not guaranteed to be consistently below 10% s/s.  Here’s a link to those products we have designated ‘safe’.  

The technique we use to set back your horse’s seemingly out of control leptin, is to slow down his access to food. With hay, you can put it in small holes nets and, if that isn’t sufficient, double the net.  With cubes, it’s a bit different.  I add water to my cubes until they ‘puff’ up and feed them like that which obviously isn’t suitable for a net.  At night, I add a dry cubes ball to their stall with a small number of cubes to keep the, busy overnight.  The cubes contain more nutrition than a similar weight in hay so you would replace 20# of hay with 15# of cubes.  My horses get hay/cubes for their main forage and I use a mix of Nuzu, Cavalor and cubes in a very small amount as a carrier for their supplements.

Going through his case history, I have a few comments.  First, thank you for posting it!  Now that you’ve done that, updates will be easier.  Next time you update, please add the approximate date that you took him off the 40 acres of pasture.  I didn’t notice any insulin numbers listed in your blood testing.  Do you have that value or how was he diagnosed IR?  You actually have two numbers for glucose and none for insulin so maybe you incorrectly entered one of the values.  Correcting that would be very helpful to us.  Here’s a link to a short easy user’s guide to metformin.  You mention the number of tablets Remy gets but not the mg value.  Is this given once or twice daily?  Metformin can result in mouth ulceration, depending on how it’s administered, so that’s worth reading about.  We don’t advise giving metformin and NSAIDs together due to the issue of ulcers but we actually don’t recommend NSAIDs  at all as they are not effective as control for laminitic pain, which is not inflammatory.  The primary means of controlling that pain is through eliminating its cause, through diet and/or trim and use of metformin or invokana for really difficult cases.

That seems like enough for now so the general welcome follows.  Please let us know if I’ve generated more questions than I’ve answered.

Welcome!

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

 

--

Why are you soaking the hay?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Message Posting Etiquette - Keeping ECIR User Friendly

When:
10/15/2021

View Event

Description:
Message Posting Etiquette

This is a high volume group that can be difficult to follow. Help make it easier for everyone by following the Message Posting Guidelines below:

1) Sign your posts. This is a very large group.  Whenever posting a message, identify yourself and your equine by using your full ECIR Signature with your first name, location, the date you joined and the links to your Case History folder and Photo Album. The volunteers need all this information to provide quality responses and suggestions for local support, vendors, vets and hoof care. 
 
2) Be clear in your posts. If you need to quote a line this is most easily done using the web to reply (not from email). Once you have the message you want to reply to on your screen, copy the text you want quoted, then paste it into the reply message composer.  Highlight the text you are quoting and then click on the quotation marks in the toolbar.  

3) Be considerate of the Support Team. They volunteer to help members in their spare time. Many have full time jobs. Unless you are in an emergency read the Start Here Files and check the archives to see if your question has been answered before.  Many new member's questions are answered there.

4) Discussion should always take place on the forums so all members can learn from the conversation and the support team can help clear up confusion.  

5)  Try not to hijack threads.  Start a New Message or change the subject line to discuss issues not covered by the subject line.

6) Don't immediately re-post.  Give “missing” posts a few hours before reposting. For unanswered messages, be patient. A lack of response is not personal or a reflection on you in any way. With so many posts some do get missed. Unless in an emergency situation, wait roughly 48 hours before re-posting and edit the subject line with "2nd Try". 

7) Off-topic but horse-related discussions: ECIR Horsekeeping Forum provides a place to discuss issues involving non-PPID/EMS horses, general horse keeping practices, other equine health issues, alternative therapies and any equine related philosophical debates.

8) All discussion about horses with PPID and EMS takes place in the ECIR Forum. Hoof related discussion for horses that do not have PPID/EMS takes place in the ECIR Hoof Forum. 

 Thank you for your cooperation.
 
- The ECIR Group support Team

 

My IR boy, Remy, presently gets 1.5% ideal body weight (16 lbs) of soaked hay along with 2 lbs of Poulin E-Tec balancer per day. However, for a number of reasons, I need to find a sustainable alternative to soaking hay. My initial plan was to transition to a combination of TC Safe Starch, TC Timothy Balance Cubes, and Poulin Forage Extender Mini Bites. This offers a variety and, therefore, options in the event of supply chain delays. All three 'seem' to have appropriate levels of starch / sugars for an IR horse, and I like that the safe starch offers long stem forage. That said, this is all very new to me and, I admit, quite overwhelming. I'd love to tap into the collective wisdom here to get feedback on this combination, a suitable % of overall diet for each (e.g. 50% Safe Starch, 25% Balance Cubes, 25% Extender) or perhaps an even more creative solution for my ravenous, bored, but very adorable redhead.
--
~ Heidi
October 2021, New Hampshire
Remy Case History: https://ecir.groups.io/g/CaseHistory/files/Heidi%20and%20Remy

Hi Nikki,

Lyme can reactivate during the seasonal rise even if there isn't a fresh infection, so it's possible he had a flare-up. Doxy also has mild anti-inflammatory properties, as Martha mentioned, so that could have been helping.

There is sinking present but that doesn't appear to have changed from the 4-2020 set of rads. There is capsular rotation - which means the hoof capsule is not as tightly attached to the coffin bone as it should be. That's what the dishing in the dorsal wall is and it is fixed by getting the trim as tight as possible. Sole depth has increased, although it's not ideal yet. Both feet have underrun heels, which need to be addressed, but you can't just move the heels back as you don't have any extra vertical height to work with right now. Have a read here and pay particular attention to figures 2 and 3 for ways to get the underrun heels fixed:

https://www.hoofrehab.com/HeelHeight.html

LF toe needs to move back a bit more and add a good bevel to the bottom of the toe. HPA is slightly broken back, so preserve all the heel height or you will make that worse.

RF toe needs more backing than LF but the bony column alignment is good.

Best way to deal with navicular is to get - and keep - the trim as tight as possible so that the horse develops and uses the back half of the feet. Wedging may appear to help initially but it just makes everything worse over time.

Metformin needs to be dosed twice daily to be fully effective, and that should be dosed as close to 12 hours apart as is possible so that the levels of medication in the blood stream work properly.

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

I'm not sure if it is a metabolism "thing" or its just that they are prey animals...and their instinct is to be quiet when predators are around...which is night time...My goat does the same thing as he is a prey animal as well...verrry quiet at night...he is way more noisy during the day...... :)--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder

Hi Cherie,
I would think that horses’ metabolism adjusts to accommodate the energy to needs.  The light might stimulate it to be more active.
--

He has not been on pasture for quite some time (none at all this year)...i need to change that in his history. He did go a full course of antibiotics 30 days, while his bloodwork showed nothing...I just had a feeling as everything that was happening was exactly the way it happened 5 years ago when this all started. . Historically he has been fine on alfalfa, but this year his alfalfa intake has been even less as the hay he is on currently is primarily grass with an NSC of 9.9. As for antinflammatories, he has been on 2 grams of bute for 2 months, mixed in with doses of banimine and also tramadol (Thank you Dr. Kellon for this suggestion...it worked well). He generally weighs in at 1100lbs, and he gets about 20lbs of hay a day.  I don't think the xrays necessarily show laminitic changes from june...that's why I really would like the hoof experts here to weigh in. But he definitely acted laminitic. As for the navicular....I have no experience with this disease and am hoping that those that do can help me here.
Thank you for looking  into his case...the more eyes the better.
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396

I have a question for Dr Kellon. I have done extensive research on CBD and am a true fan. I take it and my horses do too. My question is about CBD, Dopamine and Cushings. My understanding of CBD comes from research as to why it appears to work so well for ADHD, PTSD, etc.  The answer I found is people experiencing these disorders have dopamine blocked from getting through normal pathways into the brain thereby are unable to experience happiness and feel good. CBD opens the pathways to allow the dopamine to follow them as intended, thus allowing one to experience happiness and feel good. 

In reading some of the files in this group I read where dopamine plays a critical role in Cushings. I am not a Medicsl professional so may not be using the correct words but I hope you understand where I am headed. This begs me to ask in the case of a Cushings horse is CBD beneficial? Could I by giving Chicy CBD have created a situation where too much dopamine made it to her pituitary gland?
Thank you for your time. 
--
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

Does a horse's metabolism slow down overnight?  Many horses seem to get very quiet at night.

Thanks!
--
Cheri
May 2020 New Mexico
https://ecir.groups.io/g/CaseHistory/files/Cheri%20and%20Chama
https://ecir.groups.io/g/CaseHistory/album?id=261805

Hi Nikki,
I went through his case history.  His recent blood work did not indicate to me that he was ripe for laminitis.  While I thought you might be feeding him a bit much for his height, his photos don’t scream overweight to me.  You have him going out unmuzzled on pasture, it seems, but his insulin, although slightly elevated, seems to be okay with this.  I notice you’re feeding him a hay mix which includes alfalfa, which can make some horses footsore but if he was doing well on that hay all summer, it’s not likely to be causing an issue now.  Did you give him the full course of antibiotics again for tick borne diseases?  The symptoms of those diseases can be fairly unpredictable.  If his symptoms reappeared shortly after stopping the treatment, it may be that he needs a longer course  but doxycycline is lso an antiflammatory and it might be helping somewhere in that capacity.
I’m not an expert at trimming analyses but I think you could effectively bring the toes back more and I’ve seen much thinner appearing soles than those. 
--

Hi Janet,
I know her ACTH is high but it didn’t get that way overnight.  As we are the back side of the rise, the ACTH will decrease some on its own.  If you begin the pergolide abruptly and end up with a disconcerting veil, you may need to stop the pergolide and restart once she has been given the APF.  She may be just fine with the 1mg, without APF.  I did not know about dosing up or APF when I gave Logo his first pergolide and he was slightly spacey for a few days but his ACTH was only in the mid 50’s.  Of course, I don’t know of any direct relationship between ACTH levels and severity of the veil so she may be totally unfazed by 1mg.  

I honestly know nothing about American Ginseng and horses.  For people, it advises against using if pregnant.
--