Date   

Re: Help with newly diagnosed horse with PPID -- higher meds or different management?

Laura Caplins
 

If Dandy ends up getting too much sugar in his hay/rations/grass etc what is the response time between when he eats 'too much sugar' and when it shows up as discomfort in his body or feet? I am having a hard time identifying triggers for him and thus weighing different management choices. 

Also, I was clearly reading my hay analysis incorrectly. Thank you for the connection. If I am aiming for 10% or less of combined ESC and Starch and my hay comes in at 10.5% - 11% (MT is currently experiencing a MASSIVE hay shortage, and I am frankly shocked I was able to get hay this low) how dramatically bad is this hay? Clearly less than 10% is better, but how 'bad' is slightly higher hay? Im trying to understand the relative nature of increasing ESC/Starch numbers. Is it a exponentially negatively bad relationship after 10%? Linear relationship? Is 10% a tipping point?

Thank you. 
Laura

--
Laura C in Montana 2021

https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Dandy


locked Re: rice bran

Eleanor Kellon, VMD
 

All rice bran is much too high in sugar and starch, likely high arsenic, loaded with proinflammatory omega-6 fatty acids and perpetuates the common low copper and zinc, high manganese mineral profile. Why feed it?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


locked rice bran

Daisy Shepherd
 

is there a safe brand of rice bran about 4 oz per day for the ir horse. thanks, daisy, tiko, 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


Re: Story won't eat supplements

Michele Einarson
 

I get fenugreek on Amazon.  search for "Kasoori Methi" to get the herb used in Indian cooking.  Much cheaper than as a health supplement.  https://smile.amazon.com/s?k=kasoori+methi&rh=n%3A724714011&ref=nb_sb_noss
--
Michele & Mosey IR, Feb 2019
Reno, NV, USA
https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Mosey
https://ecir.groups.io/g/CaseHistory/album?id=88791


Re: Deworming Strongid 2

Kandace Krause
 

Thanks Lorna,
It seems I must look closer at item trying to purchase.

--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Deworming Strongid 2

Kandace Krause
 

Thanks Kirsten,

What antihistamine have you used?

K won't take out of hand feed or treats at all, period.  Too much distrust from Metformin and Pergolide I guess.
I bought a Riva's remedy spray and I have sprayed it into a small syringe but it was administered after the fact on the reaction to the three way, so I am not certain if it may have had some antihistamine effect of I had started the treatment before the vaccine.
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Deworming Strongid 2

Kandace Krause
 

Thanks Cass,
It could be, I usually have to buy online and I didn't register that detail as I went WHOA when I saw caramel flavour.  From others it looks like I can get unflavored so I will just make certain when I order or pick up from feed store.
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Update and new blood work for Riosa reveal severely increased insulin

hdavis
 

Dr Kellon- how shall I proceed with Riosa to best prepare for the coming winter and the deep dive of cold temps which always makes her insulin jump but never has it been close to the levels of our last blood draw.

Her current tested hay is 8.5% S&S and she is not on free choice hay but about 25-8 lbs currently. I adjust hay based on temps over the winter as well.  She is being exercised but not as strenuously as previous winters due to some issues she is having and we are building up her exercise tolerance. Most days min she gets 20 minutes walking and every other day minimum 30 mins which includes 20 min walking and 10-15 minutes trot/canter. Walking is more like hiking includes varied terrain and hills.

Do I reduce feed?  I don’t think she is gaining weight on the current feed amounts but worry about higher insulin.

Should I pull bloods again shortly to see if insulin has gone down or is still climbing?  

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Re: Where to find all my messages

 
Edited

Good work, Suzanne!
I generally follow messages on the ECIR website, mainly because I have so much email I’m afraid I’d miss something.  If you’re on the website here, you can see your total activity by clicking on  the “Suzanne and Pilgrim” link next to your photo near the top of the page* and then on ‘All messages by this member’.  Seeing the note there, I can tell you that at that point in time his insulin resistance was ‘compensated’ or well managed with your care.

*edited to add - it is not actually at the top of the page once I added this message, but at the top of one of your messages.
--
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: Cupcake's high insulin

Carla Anderson Peters
 

Dr. Kellon,

Her last triglycerides on October 8th were 45.

How would that change to Steglatro (ertugliflozin) work?  Would you stop the Invokana immediately and then start the other medication immediately?

Thank you!!


--
Carla

 

December 2013, WI

Cupcake and Gunnar's Case Histories 

Cupcake's Photos

Gunnar's Photos 

Ω



Re: Question Pergolide Dose For Relevante

Lynn
 

Thanks Dr. Kellon. I will keep the boots on, continue to monitor him and wait until after our vet appointment. 
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Re: Where to find all my messages

Suzanne and Pilgrim
 

Lol, just after sending thi message.  I stumbled upon the answer myself.  Pat on the back fo me for a little win on my own
--  


Where to find all my messages

Suzanne and Pilgrim
 

Hi all,

Right now, I'm trying to keep all the emails received in the digest in my inbox on my computer to remember all the info I've been given.  It is really a mess.   know I've seen  somewhere where to access all the messages I've put out on the site.  If I found this, I''m pretty sure it would be easier for me to follow the threads of multiple conversations and input from others.  Problem is I don't remember where I saw this and how to access it.  Can anybody point me in the right direction?
--


Re: Iron in diet

Eleanor Kellon, VMD
 

Rebecca,

 Yes, you don't need to worry about it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Vinnie Update November 2021 - high tryglicerides again

Eleanor Kellon, VMD
 

When he is on an effective dose of Invokana he should be able to tolerate ESC/starch of up to 10.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Question Pergolide Dose For Relevante

Eleanor Kellon, VMD
 

Lynn,

Since he is not in crisis, I would wait until after your vet visit. If you increase the dose now and he improves you won't know if it was the pergolide or time.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Help with newly diagnosed horse with PPID -- higher meds or different management?

Cindy Q
 

Hi Laura

Welcome to the group! I will be setting out our official welcome letter below.

Dr Kellon has already commented on your hays not being suitable. Soaking the hay for 1 hour (30mins if hot water) will reduce the sugars but not the starch. The starch is too high as well. Could you source for a different hay? You can see below under the DIET section the details of what hay would be suitable but our recommendations here are not based off WSC (as was commented by you in your Case History notes at the end) but on ESC + Starch not being more than 10% and Starch itself not being more than 4%.

Do you have access to unmolassed beet pulp like Speedibeet? If this is rinsed, soaked then rinsed again (to remove all the surface dirt and iron), it is safe to feed and helps with horses that need more calories. Again this is set out in the DIET section. Please look at the details of the emergency diet as there are other things recommended as well such as white table salt and flaxseed.

Under the TRIM section below are also instructions on how to setup your albums and take clear hoof pictures so that you can get some input from Lavinia how to optimise your trim. Your earlier rads seem to be from June and show quite long toes increasing the leverage on the compromised laminae. 

Right here comes the letter and there's a lots of details so take the time to go through it and ask more questions if you need to.

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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





Now: Commercial Feed Analysis Library - 11/08/2021 #cal-notice

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

Commercial Feed Analysis Library

When:
11/08/2021

View Event

Description:

Commercial Feed Analysis Library

Over the years individual ECIR Group members have sent various commercial feeds to be tested then generously shared the information. The Commercial Feed Analysis Library is a new term for an old file folder where any member can go and view unbiased analyses of commercial feeds. These analyses are a valuable part of the science that the ECIR uses to help our IR and PPID horses and are valuable tools used to prevent laminitis. 

If you have an analysis of a commercial feed please, instead of uploading it to your own folder, please consider sharing it with the entire group by by notifying us here.

View the Commercial Feed Analysis Library 

Thanks for your help and cooperation.

- ECIR Group Owners and Support Team


Re: Iron in diet

Rebecca Reddicliffe Bigelow
 

What I get is 0.6 for iron. Do I just assume since the TBCs are balanced that I don't need to worry about it?
--
Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .


Re: Iron in diet

Rebecca Reddicliffe Bigelow
 

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