Date   

Re: New member

Deanna Avery
 

Thank you for the response to my question! I have the same philosophy as this group regarding caring for both conditions. This is my husband‘s horse and the vet suggested Metformin straight away. This really has bothered me a lot. The side effects when reading the insert to metformin include G.I. disturbances and kidney side effects. I share this with my husband and he continues to use the Metformin . I will forward the answer you sent and hopefully he will read it and reconsider


--
Davery ; Southwest Washington; 2021


Re: Diet questions

Kirsten Rasmussen
 
Edited

Hi Kate,

Orchard grass is fine, but it should be soaked until you have wet chemistry hay test results back showing ESC+starch are <10%.  Some horses need that cut off to be even lower, but you won't know until you feed it and see if insulin goes up or your horse gets footsore.  We recommend the 603 Trainer test at Equi-Analytical, or its "wet chemistry" equivalent elsewhere. 

No horse should be eating only alfalfa hay due to the high calcium content, and some IR horses can't tolerate even the smallest amount of it.  LMF Low NSC is not guaranteed to be below 10% s+s; better to switch to Triple Crown Timothy Balance cubes if you want a safe treat for him.  Whether the Platinum Performance CJ is a good choice or not depends mostly on your hay analysis.  It certainly is not correcting the Ca:P imbalance feeding alfalfa causes, and it has some ingredients that can be a problem for IR horses, such as rice bran and molasses.  Once you have your hay tested, you can hire one of our approved hay balancers to help you pick the best commercial mineral supplement or design your own custom supplement.  The balancers on our list were trained by Dr Kellon and understand how to design diets for horses with metabolic issues.

I use a digital suitcase scale and a big plastic bucket to weigh hay with.  The weight you feed depends on your horse's weight, and whether or not they need to lose weight.  20lbs should maintain a 1000 lb horse that does not need to lose weight.  An arab's ideal body weight could be significantly lower than that though as they tend to be lean, fine-boned and not tall, so 20 lbs is on the high side.  We need more info to help you determine what weight of forage to feed.  You also need to include the weight of your 'extras', like the beet pulp, LMF, etc into the total forage weight.

I grind 1-2 weeks worth of flax in my Vitamix, then store it in the fridge.

It would be great if you could post a case history and some photos so we can help you better.

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


Re: DIXIE UPDATE

Eleanor Kellon, VMD
 

Hi Terrie,

I didn't see any mention of abscesses or how much bute she has been given and for how long.    Can you add that history?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Low sugar tested Grass/Alfalfa question….

Kirsten Rasmussen
 

I'll just add to Martha's reply that alfalfa is high in calcium so feeding too much of it can lead to a relative phosphorous deficiency.  Since horses do NOT like the taste of phosphorous in their minerals, it can be hard to correct the deficiency.

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


Re: Gypsee Introduction and Problem

Kirsten Rasmussen
 

Hi Jessica, 

I agree with the others here that you need bloodwork to diagnose or rule out metabolic issues.  Usually mild laminitis pain (which is sub-clinical and often chronic) is bilateral, not unilateral, so it often goes unnoticed because the headbob isn't present or is present bilaterally.   What you are describing sounds more like an abscess to me, which can be due to trim alone, or injury/bruising, as well as metabolic issues.  After soaking, apply Numotizine and wrap in for a day or 2 at a time.  Numotizine is very effective and will change colour if some fluid comes out.

Can you get the vet out to pull blood and do the hoof xrays?  While you are waiting for your bloodwork results, working on the trim is a good next step.  After you post the xrays, you can request trim markups from Lavinia by starting a new message to get her attention.  BTW thanks for the extremely clean hooves in her photos!

I did want to add that it would be nice if you could edit the dates for your first 2 entries in the Comments section at the back of Gypsee's case history to the correct year.  It's a little confusing.

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


Re: Understanding Test Results

Eleanor Kellon, VMD
 

Palpable pulses don't only mean laminitis either. Pulse strength changes quickly and for many reasons. If lameness was only RF, the problem is only RF.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: High Leptin, Low T4

layzdequineservices <layzd@...>
 

Thanks Dr. Kellon.  He doesnt have a case study as I dont believe he is PPID and other than these 2 numbers on the test that had me puzzled, he is healthy.  Yes, he has gained weight since last January but he is not overweight.  I'll speak with my new vet, who I acutally have a good communication with, about the T's.  She was also a bit puzzled but like you attributed the numbers to doing the blood draw after the lameness test not before.  I will be more vigilant about when the blood is drawn at each appointment.  
--
Debora, Montana 

 

Joined 2/7/12

CIR 0113/0615, NRC+1112,  NAT, MPG 0911


2nd try Re: Deworming Strongid 2

Kandace Krause
 


New member

higardener
 

Hello -

I joined to get help with my 19 year old thoroughbred gelding Valentino.

About three weeks ago (October 15) he came up with digital pulses in both hinds. Bounding so that I could actually see them.
No heat in feet, (body) temperature normal, pulse normal, slight lameness which has since resolved. We have a vet appointment on Nov 19.
I would love advice on which tests to get and whether to do x-rays. Thinking PPID, insulin...

Started soaking his hay immediately  - 1.5% of body weight (1100) of medium quality orchard split between morning and evening.
Replaced 1lb of Triple Crown senior with 1lb of Blue Seal Sentinel Performance fed in a.m. He gets a daily mash of 1.25 lb of beet pulp, 2 oz wheat bran,
and 1lb alfalfa cubes, top dressed with magnesium citrate, salt (iodized), vitamin E, U-7 and Ester C p.m. (am re-evaluating supplement measurements -
presently using package recommendations by weight, and 3-4 Tbs salt depending on weather)

Val is housed on a mostly dry lot (sand) but was getting 30 minutes daily of grazing on (sparse centipede) grass in a separate paddock.
No access to grazing after finding pulses.

I transitioned him to barefoot 13 years ago. The trim cycle varies, unfortunately - mostly 6 weeks but occasionally longer. This is out of my control
as we live on a remote barrier island off the NC coast. Val has thin soles and feet that like to flare. We have battled with chronic white line/separation.
Val has a history of abscesses for the last 3 or 4 years - twice or three times annually that I know of - usually following rainy periods, spring /fall.
Since the beginning of this summer he has had a persistent crack in one of the fronts coinciding with the farrier stretching our cycle to 8 weeks several times.
There are no event lines as of last farrier visit 2 weeks ago. I have learned to trim under my farrier's instruction, and have increased my touch-up frequency to weekly.

Val started with respiratory allergies last spring which have been well controlled with cetirizine. That same summer (2020) he also became anhidrotic for the first time -
controlled well with ONE AC. The anhidrosis returned this summer as soon as it got really humid.

The only other things I can think of are until 3 years ago Val's water source was an iron-rich well point, and I mistakenly was feeding loose un-iodized salt until
mid-summer this year when I switched to ionized.

Thank you in advance. I am looking forward to learning about improving my horse's health with your help.


Re: DIXIE UPDATE

Sherry Morse
 

Hi Terrie,

You may find you need to dose the metformin (info on that in the files) rather than trying to feed it.  I'm not sure what good a venogram will do at this juncture (will it change treatment?) but as always I'll bow to Dr. Kellon on that point.  Jiagogulan will increase hoof growth so wouldn't add that in until you know her trim is where it needs to be.  You can increase the Devil's Claw dose if needed though and I would do that over bute at this point.

There's nothing wrong with just using diapers/pads/duct tape to create a 'boot' that fits to her feet until they're in a shape that will fit into a commercial boot.




Re: DIXIE UPDATE

Bobbie Day
 

Terry
Before we lost our girl we had issues with rubs too, her high heels made it hard so we would get a good pad and duct tape a diaper over that, if you cover the diaper well with duct tape then put it on at once then wrap again around her hoof it stays on pretty good. We used a good pad and I would also buy some good wool rug backing , put gold bond on top of that.
It worked fine for us, you might experiment with something similar. I bought the diapers from the dollar store.


--
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: DIXIE UPDATE

 

Hi Terrie,
We don’t recommend feeding alfalfa to IR horses because it can make them foot sore.  Not every IR horses is susceptible but many are.  I have not run across this phenomenon with my own horses so I can’t describe what you might see, nor does anyone know the cause of this and soaking doesn’t help.  You may already know this and been feeding it successfully before she was foot sore but I would recommend eliminating it from Dixie’s diet.  There may well be something I’m missing when comparing Australian Lucerne to North American alfalfa if Carol is working on your diet and has not brought that up.
--
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


 
 


DIXIE UPDATE

terrieheining
 

Have just uploaded an updated Case History and would appreciate any ideas to help move forward with treatment for Dixie as she continues to be very sore.  She is still on the emergency diet while Carol finalises her diet details, so Speedibeet, lucerne chaff and weighed Teff hay only.  The test results for the Teff from EquiAnalytical have also been uploaded and show less than 7% so not soaking it any more.  Dixie responded well to 2 tblsp twice daily of Devils Claw for about 2 weeks, but efficacy appears to be waning.  Started her on 9000mg twice daily of Metformin on 26 October which she accepted well in a small amount of Speedibeet and chaff 30mins before the main course, but is now starting to leave more and more of it, however I will persist. Dixie arrived to me ribby and continues to me to look underweight and even when she was eating massive amounts of Teff when I was feeding it ad lib, she never put on any weight so could this be because she is in continual pain? Her background is cruelty and neglect, so when on a lead she will step out without hesitation, then when the lead is removed, she will limp and not want to move at all (except for the first 2 weeks on Devils Claw when she was transformed..sigh).

Seven weekly sessions of PEMF treatment back in July/August did not appear to help Dixie and my vet yesterday suggested some type of imaging where a dye is injected into the vein then scanned to reveal if any areas of her hooves have impaired blood supply (have forgotten the correct name for the procedure) which I think is a good idea as possibly then PEMF treatment could be restarted and concentrated on any problem areas revealed?? Your thoughts please?   Have been reading back through your archives and wonder if jiaogulan would help with pain relief for Dixie, or an increase in the dose of Devils Claw, or anything else at all that I can do for her. My vet has suggested stopping the Devils Claw for a few days and putting Dixie back onto Bute to give her body a rest from the pain,  so I really don't know what to do for the best.
As Lavinia mentioned previously, it is very difficult to get a boot to fit Dixie due to her hoof shape. Have tried larger size boots, thick comfort pads, thin comfort pads and combos thereof, human tube socks inside the boots, bandaging her feet before putting the boots on, but she often has rubbed areas, mostly on the heel bulbs whatever I do. My trimmer is organising some gaiters that will fit down inside the boots which may be helpful but is there anything available that would hold the comfort pads in place but not be fully enclosed as her RX therapy boots are which make her feet really hot now and we are heading into the Australian summer?  Can I just duct tape or bandage the pads onto her hooves and change them daily/ twice daily/ whatever?  

I do understand that Dixie and I have a long journey ahead of us, and an even longer journey is behind her, so if there is any way I can lessen her discomfort while we sort this out,  I will do whatever it takes.  Thanks in advance
--
Terrie H in Australia 2021
Case history: https://ecir.groups.io/g/CaseHistory/files/Terrie%20and%20Dixie
https://ecir.groups.io/g/CaseHistory/album?id=268416





Re: Time period to safely go without chewing on hay

Sherry Morse
 

Hi Kim,

You need to reduce calories by feeding no more than 2% of Tuck's ideal body weight per day - that amount includes hay and concentrates and may need to be less than 2% depending on how much Tuck weighs vs. what he should weight.  As far as how long a horse can be without food in front of them - they'll be fine for up to 6 hours at a time.




Re: Understanding Test Results

amariepeer@...
 

This time it was definitely worse in the right front, then both hind had digital pulse but no heat. The front left was unaffected. Any thoughts on a cause? 
--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze


Re: Understanding Test Results

Eleanor Kellon, VMD
 

If you are only seeing that in one foot, laminitis is highly unlikely.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Diet questions

 
Edited

Hi Kate,

Welcome to the ECIR group.  This welcome is triggered by your first post here.  I will try to answer some of your questions specifically and then follow up with the very informative group welcome which should address many questions you didn’t know you had.

What prompted you to test him for insulin resistance?  His cresty neck or is he lame?  Was glucose the only test run?  We really need to see the results of an insulin test as well as glucose, taken at the same time.  We might also suggest ACTH but, at his age, PPID is not likely.

We don’t recommend feeding IR horses alfalfa.  The sugars and starches aren’t high but for some reason it causes some IR horses to be footsore.  Getting your hay tested with wet chemistry should be high on the list.  If its ESC + starch is under 10%, you most likely won’t need to soak it.  In Vermont, I feed a grass hay which generally tests fine.  Metformin is generally recommended only if insulin can’t be controlled with diet alone.

As we recommend feeding hay from hay bags to slow down their rate of consumption, it’s fairly easy to hang the bag from a (fish?) scale and weigh it while filling.  Triple Crown sells a stabilized flax.  I feed flax oil from Santa Cruz animal health but I have enough horses to go through a jug before it spoils.  Others grind flax daily.  I buy MgOx from my feed store in 50# bags.  We recommend 2-3 tablespoons of salt daily, accounting for any that might be in your other products.  He most likely won’t like all that salt in one meal so I put some in my horses’ meals and sprinkle the rest on their wet hay.  You can also dissolve the salt in hot water and spray it on dry hay.

I realize I did not address all of your questions but we can go back to them.  I want you to have the opportunity to catch up on all the information in the welcome that follows.

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. 

--
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: Understanding Test Results

amariepeer@...
 

I have old X-rays I could share when we were struggling with laminitis and navicular in his left front. He was managed completely different then (on pasture, unbalanced diet, shod, central sulcus thrush, etc). This year, the issues have been in his right front. I do not have recent images. 


I have suspected laminitis because he will get very tender footed, have a bounding digital pulse and heat in his hoof. 

These are from October 2017 

these are from June 2016

--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze


Re: New member

 

Hi Davery,

I’m here to pass on our formal group welcome, sent to all new ECIR members upon their first post.  I’ll begin with a few thoughts specifically for you and your situation and follow up with the reading material which contains lots of important information regarding the management of your horse and even more links leading to more important bits.

You’ll find here that we use diet primarily to help manage insulin.  Metformin is used in cases where insulin can’t be managed with diet.  Here’s a write up on Metformin usage.  It doesn’t always maintain its effectiveness over time so we usually recommend saving it to use when nothing else helps.  I’m curious about what side effects you are noticing.

Our philosophy here is summarized by D,D,T&E, which stands for diagnosis, diet, trim and exercise (as appropriate).  For diagnosis, blood work and Xrays are the most important.  When we see your case history, we’ll have a better idea of whether or not your horses is insulin resistant and/or has PPID (Cushings).  You can read more about that below.  Let us know if you have questions.

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. 


--
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: Understanding Test Results

amariepeer@...
 

So sorry. I’ll update the case history. That is correct, I first started adding info in his case log prior to testing which was done 10/26/2021.

I’ll grab some updated photos tonight. He’s thin in that he could use weight, I think. His condition yo-yo’s and he looses weight very easily. Especially as the weather turns cold. 

Thank you for the advice on the trh atom test and pergolide trial. 

Do his glucose, leptin and insulin results appear normal in your opinion?
 
--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze

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