Thank you, I tried that.  She didn't love it but perhaps she tolerated it a little better.
--
Marcy and Mocha 2021

https://ecir.groups.io/g/CaseHistory/files/Marcy%20and%20Mocha

https://ecir.groups.io/g/CaseHistory/album?id=268259

Hi Sarah,

Welcome to the ECIR group!  This welcome is triggered by your first post here.  I will include our standard welcome with lots of information about the group and its protocol for caring for horses with insulin resistance and/or PPID.  Reading this should keep you busy for awhile but don’t forget to check out all the links.  And it will help you get started on the process.

We use Devil’s Claw to help with pain control.  NSAIDs are not recommended due to their adverse effects on the digestive tract as well as the fact that many of our members are looking for relief of laminitis pain for which NSAIDs are not particularly helpful as laminitis is not an inflammatory event.  J-herb is used to increase blood perfusion and hoof growth.  Chaste tree berry is sometimes used to help PPID horses shed but it doesn’t actually do anything to control  PPID and, once the horse is on pergolide, it’s best not to use it at all as it interferes with pergolide action.  The doses for these are somewhat situation dependent.  Not every PPID horse needs any of these.  Once you post a case history, we will be better able to advise you.

By generic Prascend, I’m gathering you mean compounded pergolide.  They are the same drug, with the exception of the Prascend packaging, which is designed to minimize its exposure to the atmosphere and thus prolong its stability.  A large number of us use compounded pergolide, taking care to use a reputable compounding pharmacy and to do what we can to minimize conditions leading to degradation.  

Our philosophy here revolves around the acronym DDT&E, which stands for diagnosis, diet, trim and exercise (as appropriate).  We will be asking about the testing values your vet used to diagnose her.  We will want to know if she’s had any laminitic events.  My original PPID horse never showed any evidence of IR and his permitted diet reflected that.  Many PPID horses also have insulin resistance and for them it’s very important to tightly manage the sugar and starch levels of their diets.  All of them benefit from mineral balancing their hay, as would all horses, but especially those with metabolic conditions.  Once we know more about the nature of her PPID, we will be better able to advise you.

And, now on to the information filled generic ECIR 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. 

 

--

That is the vet I contacted - the one who did the bloodwork and gave cv me Prescend. He was my original vet that said fetus was no longer alive snd I needed to expel the placenta . He did not mention calling them. He did say it is not listed as a usual side effect. I will ask him to call them. Maybe he is planning  to do that and did not mention. It is not ideal I switched vets mid stream but my original vet would not come to Chicy and I had to get one who would and he showed me the live fetus on 2 untrasounds he did. 
--
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

Hi Sarah,

Many of us have found that compounded pergolide keeps our PPID horses well. In my case,7 of my then-9 herd were IR/PPID, and were on compounded pergolide.They lived into their early /mid thirties, and mid forties. Having been diagnosed for many years,some were on mg. doses into the teens. Others here have fed even higher doses,as needed.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Hi there, 
My horse has just recently been diagnosed with PPID and I am looking for help with doing up amounts of herbs to give her and am not sure where to start... I will be changing her feed to beet pulp and am getting help with her other nutritional needs. Also curious if anyone has had any decent results with the generic form of Prascend? 
Thank you  
--
Sarah Lavergne
NS, Canada 
2021

Janet,
I feel that you should contact the vet who provided the Prascend so that he can notify BI (the company that makes it) for their side effects registry.  They may also have suggestions for some sort of work around.
--

Thank you for asking, Dr. Kellon,

He did not mention trying to determine why the hives. He is going to consult with board certified vets on possible options. She did not get any Prescend yesterday and is on Benadryl 2x day. Hives still present but do not look as bad  

My new vet did not want to do bloodwork the 2 times he was here. Said we would do when he comes to ex ray her feet in a few weeks. Just did the ultrasounds to verify pregnancy and we looked at and discussed plan for her feet.  So I pulled the blood (I have red and lavender tops) and took it to first vet who has a Cornell account and he is the one who gave me the Prascend. It made sense to use first vet for this current situation. Not an ideal situation but I am trying to do the best I can for my mare. I did send a copy of bloodwork to new vet and updated him she started Prescend. Have not touched base with him on the hives. 

I have had Chicy since she was 2.  This is the first time in her life she has been on any meds other than wormers, banamine when she sand coliced once,  vaccinations and titer checks to determine if vaccine needed. A few abscesses over the years and that was it. She has never had a reaction to anything. 
--
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

Thanks Martha! He’s just got a lot of go, but I’m accustomed to his “zippy” personality, so I’ll just leave things as is. Bonus is he works harder, so more calories out. Also he does seem to like the taste of the flax :)
--
J.Green 
MA, USA
2021
https://ecir.groups.io/g/CaseHistory/files/Fergus%20Case%20History
CaseHistory@ECIR.groups.io | Album

Hi Jennifer,
We generally recommend 2-6 oz of flax for non grazing horses regardless.  It provides the omega-3 fatty acids that are present in grass in a similar omega 3/6 ratio.  I would more likely attribute it to the cooler weather and being beyond the peak of the rise.  Maybe a little longeing before you start your ride?  
--

Absolutely no truth to it. Vinegar is basically acetate in water. Acetate is also the major fermentation product of hay and beet pulp so the horse won't even notice the amount in vinegar. I don't know of anything you can feed that really makes a difference.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

A while back during the summer, I posted that Fergus was sluggish on the new diet and it was recommended that I start adding flax. It seemed to work great and we I’m the energy sweet spot of not too much and not too little.

Well fast forward to fall and he’s back to having a little too much spring in his step ha ha.  I know some (or maybe all) of this is related to cooler temps, but do I reduce the flax or is it likely not to make much difference and I should just leave things as is. He gets 4 oz of TC flax per day.
--
J.Green 
MA, USA
2021
https://ecir.groups.io/g/CaseHistory/files/Fergus%20Case%20History
CaseHistory@ECIR.groups.io | Album

Hi Patty,

--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019

Hi Tonya,
You will know if you need to add MgOx by having your hay tested and the minerals in the hay 'balanced' by the addition of more minerals.  There are people who can do the balancing for you for a small fee.  You can take Dr. Kellon's NRC+ course and learn how to do it yourself or Dr. Kellon will do it without charge if you use Uckele products to do the balancing.  It all begins with having your hay tested by wet chemistry techniques.  If you are a boarder where the hay is changed frequently, as many people here are, there are work arounds for best estimates or you could consider setting aside the tested hay you need for the season.
If the casting doesn't give you the results you are looking for, you can ask Lavinia here for trimming advice as she has lots of experience in setting up trims to promote sole growth.
--

Yes, that ACTH is within what would be expected for seasonal rise. If it's in the budget you could retest in January. Otherwise I wouldn't change a thing.

Pain might play a role in keeping insulin elevated but that has never really been studied. Acute pain, which has a temporary increase in cortisol, is more likely to be involved than chronic pain. My first suspicion for the improvement is that being more comfortable is resulting in him moving around more on turnout.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Martha,
Thats interesting about her eyes, I willl ask the vet to look at them but she does hang out in her pen during the day. It’s been in the 70’s here cool at night, I put a light blanket on her at night because she is thin and I think her breed does get much of a winter coat. Her stall and pen are separate from my other horses. When I rescued her she was in a large pen with several horses and had a pretty bad bite wound, she really prefers to be by herself , I think it was a pretty bad experience for her on the kill lot.
--
Cyndi Carlson in Colorado 2021

What's the plan for figuring out if pergolide caused the hives?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Weight reduction and controlling IR are the only ways to reduce leptin. Leptin drops with not eating.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Good Morning,  I have read the articles in the files on Leptin and still have a question about reducing the level of a horses leptin....Is there a feeding strategy that has been shown to work to reduce  Leptin other than the protocol for IR horses?  Do long periods during the night with no food have any affect on leptin ? Slow feeders slow a horse down while eating but with a horse who gets adequate but limited hay there are hours and hours during the night where they are without food.   Im wondering if automated feeders that deliver a small amount of food on a timer thru the night are helpful even though the horse eats that food quickly it would still be something in his stomach..
Thank you very much
Deb Girard
--
Debbie Girard/Massachusetts/2021