Date   

Re: Chicy PPID In Foal Trim Pictures at 2 months Lavinia

 

Hi Janet,
I’m going to leave the response to Lavinia but I’m interested to know what happens when you switch to a few farrier.  Did you review the Xrays and Lavinia’s markups with him?  I find it’s so hard to find any sort of expert, from plumber to trimmer, who doesn’t find something about the previous work that doesn’t need changing.  If he was receptive, I would take that as a good sign.
--
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: Hay analysis -needs to be soaked or not for a EMS horse please

 
Edited

Hi Andrea,
Could you please post the hay analysis for us to have a peek?  You will need to create a case history folder on the CH subgroup in order to post.  While you’re there, maybe post a case history as well?  The difference between WSC and ESC is due to fructans, not fructose.  The fructans are longer chain molecules which will dissolve in water but not ethanol.  I’ve never seen that great a difference between WSC and ESC but I’ll admit to not having a lot of experience with unusual results.

I would say that you should go back to soaking for now and see if that relieves the pain.  If not, there may be an abscess brewing and your hay may be fine.
--
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: Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)

 

I would say absolutely!  Does she seem hungry enough to eat more?  Could you include some body shots in your album?  Those numbers are just guidelines, mainly geared toward keeping a horse at good weight.  It may be that some of the numbers you’ve used to calculate the hay are incorrect or that she just needs more hay.  Extra unneeded pounds on her body will just get in the way of whatever is being done to relieve hoof pain.  

I keep returning to the diagnosis part of DDT&E.  In my mind, this has not been completely resolved but someone else might feel more comfortable about it.  I can’t quite dismiss the possible involvement of the puncture wound, even though I’m not sure how it might have contributed.  From her breed and her elevated insulin, I have no doubts she should be treated as IR but the cause of the laminitis isn’t clear to me as the insulin hasn’t been high enough to trigger that.  

--

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: New to the group, new to laminitis

 

Hi Wilmary,
I’m glad you found your way here!  I read through your FB post and the comments it elicited.  I’m not sure what the take away from that would be - a good reminder of why, although I used to be very active on FB, I try to stay away now.  While I’m not the X-ray expert here, I feel I can safely say we’ve seen much worse.

Laminitic pain is not inflammatory so bute doesn’t do anything for that sort of pain.  It may help with associated stiff muscles and such but it’s not worth it with its associated risks.  It interferes with healing as well as with the mobilization of abscesses, which are likely to arise.  We recommend Devil’s Claw instead. I looked up the Absorbine product that Susan recommended.  It contains DC but also yucca, which we don’t recommend for a metabolic laminitis situation.  Uckele’s Phyto-Quench pellets contain DC but I understand they are on back order now.  I’ve seen other products containing DC recommended so perhaps doing a search on the messages here for “Devils Claw” or some iteration of that.  The most reliable way of controlling the pain is to eliminate its cause.

In the material Trisha sent, you will learn about DDT&E, something we refer to repeatedly.  The first D stands for diagnosis, which is where we need to start.  Until you have guidance from blood testing, it’s best to stick to the Emergency Diet (as I believe you are) with soaked hay or one with tested hay, below 10% ESC+starch.  You mentioned looking for the right vet before starting to test.  A good many of us are here because we never found that vet.  You obviously need one for testing and medication but no single vet is likely to have the depth of knowledge and experience with metabolic laminitis that this group has.  My experience has been that older, more experienced vets are perhaps more accepting of modifications to their protocol.  Be sure to have insulin, glucose and ACTH tested to get started.  And do what you can to obtain actual copies of the test results, as well as the vet’s interpretation.

Looking forward to seeing those additions to your case history!
--
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: New to the group, new to laminitis

 

Good luck with everything you’re trying to accomplish! I have replaced bute with Absorbine “buteless bute” at the recommendation of a natural hoof care farrier. She told me that in her experience it was a valid substitute. I don’t know for sure since she also trimmed my horse’s sore club foot at the same time, but for whatever reason my horse is walking much better. This was an abscess rather than a laminitis situation but just wanted to share the bute info.
--
Susan H TX 2021


Re: New to the group, new to laminitis

Bobbie Day
 

Wilmary
I hope you don’t mind my two cents, although these other groups have very good intentions it is not something you will ever hear from Dr. K or Pete. He doesn’t run that site anymore or I’m sure he would have suggested that you join here and encourage not discourage. Pete has actually helped many here but he handed over that page awhile back because it just grew too much. My little mare had a very bad case and when he was there he actually did markups for me and never once suggested I put her down.
On this group you will get nothing but support, I’m sure I speak for everyone when I say that when or if that time comes it’s your and your horse’s decision not ours. We support each other and we will all help you every step of the way. There have been many, many severe cases here, and many successful rehabs but of course you have to commit to the protocols to give your horse the very best chance.
We’re here for you and we will never discourage!
Your not allowed to beat yourself up, just dig in your heels and get to work!
Your off to a great start, you found us 😊


--
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


Chicy PPID In Foal Trim Pictures at 2 months Lavinia

Qhgirl
 

Hi All-
I was able to find a barefoot farrier and posted pictures after trim on 2021-11-23.  He said he did not have much foot to work with on the front feet since my regular farrier trimmed her a couple of weeks ago. He said he had to take heels down of front as they were high and creating a pressure point where the coffin bone is pushing on the sole. He had to clean up bars quite a bit. He said lowering the heel would give her some relief. Also she is shedding her frogs which he said is really good as it shows she is remodeling her feet.
I am not sure that her angle has changed much. And she is still very flat footed. He will be back in 3 weeks and then every 5 weeks after that. 

Would love some feedback from Lavinia to see if we are on track. Does it look like she is having less stretch in her sole and is gaining sole depth?


-- 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


Re: Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)

Jessica Gunderson
 

Given Khan is so skinny, can I up the pounds of hay soaked she is getting from 20 to 22? 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Re: Hay analysis -needs to be soaked or not for a EMS horse please

Andrea Thomason
 

The WSC is 24.2 and the combined starch and ESC is 8.5%
--
Andrea Thomason 
Cheshire, UK
Joined 2021


Re: Hay analysis -needs to be soaked or not for a EMS horse please

Andrea Thomason
 

Thanks Trisha, I appreciate the info and advice.  He did have an episode July/August time with high insulin levels and lameness so we have soaked his hay since  Everything was going great and we tested the hay, followed the ESC & Starch 10% guideline and gave him dry hay this week and he's hopping on one leg tonight.  There are no pulses......and it's one leg.  The hay is the only thing that changed.  Should i consider the WSC figure as this includes the simple sugars such as glucose and fructose which I thought for EMS/IR horses can be problematic?

Many thanks, 
Andrea 
--
Andrea Thomason 
Cheshire, UK
Joined 2021


Re: Hay analysis -needs to be soaked or not for a EMS horse please

Trisha DePietro
 

Hi Andrea. Welcome to the group. First- You are absolutely doing the right thing by soaking your hay. Our general rule of thumb, is less than 10% ESC and starch combined- you would not have to soak. BUT, when you say he is lame- do you mean he has laminitis?  If the answer is yes to laminitis- then I would keep soaking the hay.....  Be sure you are soaking your hay for one hour in cold water or 1/2 in hot water and rinse it very well at the end. Let it drip for a few minutes before hanging it up for the horse. I have seen many different versions of "how to" soak hay, but that is the process we follow here. If you end up soaking longer than one hour- some of the minerals might leach out into the water. However, you can test your soaked hay to see what it might be lacking just like testing your dry hay. The wet hay would be soaked for what ever time frame you use ( hot water or cold water) and let it air dry....then take that sample and send it for analysis. Then one of our balancers can recommend minerals to balance out the results.

In the meantime, what follows is our Welcome letter and in it you will find our complete protocol of Diagnosis, Diet, Trim, Exercise and all the details in between! Grab a cup of something soothing and settle down to read....You are in the right place. If you have more questions based on this background information- let us know and we can assist you. 

Hello 

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. 

Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)

 

Hi Jessica,
Are you using the pelleted Phyto-Quench?  That is popular because it contains Devil’s Claw but I’ve seen others here using other products with DC or DC by itself.  If you search the messages here on “Devil’s Claw” you’ll most likely find some alternatives.
--
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: New to the group, new to laminitis

Wilmary
 

Hi Nancy, sorry I should clarify. It was not Dr. Kellon’s ECIR group but it is a Dr. Kellon and Pete Ramey based fb group which I love most of the time. The majority of the commenting parties to my post were owners not professionals but it still put a bit of a dent in my hope. 

Wilmary in southern, AZ, USA, 2021

David Case History: https://ecir.groups.io/g/CaseHistory/files/Wilmary%20and%20David


Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=270201


Hay analysis -needs to be soaked or not for a EMS horse please

Andrea Thomason
 

Hi I am compiling my file for my horse and wanted to check initially if my hay looks ok.  It’s below the  10% ESC & Starch levels but certain minerals are out. We currently soak as he’s had high Insulin readings and lameness. 

 



--
Andrea Thomason 
Cheshire, UK
Joined 2021


Re: New to the group, new to laminitis

Nancy C
 
Edited

Hi Wilmary

Welcome.   You are in the right place to help your new guy. You are off to a good start with Trisha's welcome post.

I was concerned about this bit of info, as it is not usual for our Facebook Group to respond in this way. We have seen a lot of horses turn around when given a chance.

Was this another metabolic FB group?

Thanks for any info.


On Wed, Nov 24, 2021 at 02:29 PM, Wilmary wrote:
My spirits were shattered by a ECIR Facebook group dead set on him being put to sleep so I came here instead. I want to give him a chance and see if he responds.

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

2021 NO Laminitis! Conference Video Recordings available to new subscribers 11.09.21
  www.nolaminitis.org



Re: Vitamin E for IR horse and non IR horse

 
Edited

Judy, may l butt in here to report my experience with Vitamin E in two IR mares? For years I had used the same approximate dose of  powdered Vitamin E in oil, around 4500 IU for both my mares. When I checked serum Vitamin E levels at Cornell, one tested 547 ug/dl, pretty close to the middle of the reference range of 200 to 1000 ug/dl. The other tested 222 ug/dl, close to the bottom of the reference range. That's not the reflection of optimal nutrition I want! I want them in the 500-600 ug/dl range.

 I reexamined the low mare's supplements and realized she's that horse who always leaves about a cup of supplements in the bottom of the feed bin, and that's where some (most?) of the Vitamin E ended up. I first jumped her Vitamin E up to 6000 IU using a natural water-soluble Vitamin E. A subsequent lab showed Vitamin E only rose to 300 ug/dl range. Now I'm giving her 7500 IU Vitamin E/day. Labs are pending. 

Bottom line: if you check serum Vitamin E levels, that's your best bet. If you can't, I'd give 4000-5000 IU Vitamin E to any horse on a hay-only diet. The green color of the hay is more an indicator of Vitamin A content, not Vitamin E.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)

Jessica Gunderson
 

I have been using Phyto-quench for Khan and it is on backorder since Nov. 10, contacted Uckele and it sounds like it will be on back order for a few more weeks. What other alternatives can I give Khan given she will be done with bute tomorrow and only has a few more days left of phyto-quench after that?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Re: Khan pulses with heat since Friday evening

Trisha DePietro
 

That's ok...we do like it all to be on the same thread- so we can follow along....If you change the topic, ie hives, choke, etc then a new thread would be fine.....:)  (Because your new questions are all falling under the same topic)
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)

Kirsten Rasmussen
 

Hi Jessica,

Martha answered for me, sorry I wasn't clear where the 14% came from, I was in a rush.  

So it looks like the Emergency diet, including soaking, were implemented before her first bloodwork that showed an insulin of 38 uIU/ml, is that right?  Similarly, her most recent bloodwork in August, before you stopped soaking, showed an insulin about 30 uIU/ml.  I suspect the soaking was helping her because during her laminitic event in early April insulin would have been much higher.  With insulins that low, if she was in pain it would be related to trim, damage due to the earlier laminitis (which takes time to resolve because the hoof must grow out first) and/or abscess mobilization, but not acute laminitis.  Unfortunately, soaking hay doesn't help with non-laminitic pain, but it might be that since you stopped soaking, her insulin has climbed again and you may be back into acute laminitis.  Your new bloodwork will tell us if her current pain is from acute laminitis, assuming blood was pulled before you restarted soaking hay today/yesterday.

Another volunteer mentioned to me privately that the numbers on your hay analysis are reported as dry matter, so the as fed/sampled values that we go by would actually be 7.9% ESC + starch once moisture is accounted for.  She also said that your hay analysis is by NIR, which as Martha pointed out can be inaccurate by a significant amount.  We find that NIR commonly UNDER reports actual sugar and starch contents.  If you add 20-30% to your as fed/sampled total, your actual average ESC and starch content could be as high as 10.27%.  Many IR horses will be sore on hay with this high of an ESC and starch, especially if not being exercised (which you cannot do at this time).  I would definitely be soaking.

While many of us have trialed pergolide, and it has helped some horses that did not appear to have elevated ACTH, usually we look for other signs of PPID, like topline loss or elevated ACTH during the seasonal rise to also justify meds.  However, I don't think a trial would cause any actual harm, other than the usual temporary veil effects we see, like lethargy and inappetance.

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


Re: New to the group, new to laminitis

Trisha DePietro
 

Hi Wilmary. Welcome to the group. You have a lot of great questions and David is lucky to have you advocating for him. 

Pain control is a sticky point. You were right to take him off the bute. There are other options- first making sure his trim is ideal is really important. You can submit your photos and Lavinia, who is our hoof expert,  she can review them and make recommendations for your hoof care providers next trip in. Its good to stay on top of the trim, every 2 weeks or sooner depending on his response. Please see this link on how to do the photos and what is needed for the very best advice- 
  https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help  
The next  link talks about what "safe" feeds are for horses with PPID/IR I did not see the Mountain Sunrise on that list- that maybe something you want to replace with one of the feeds in the link.
https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/Safe%20Bagged%20Feeds.pdf-- 

Also, you can search in the search box at the top of your screen for more information with in the messages, files or WIKI areas.  AND within our welcome letter there are blue links that will take you to more specific information. There is a section on pain control as well....I see your vet diagnosed the PPID...but I didn't see any bloodwork posted...you might want to consider getting an ACTH level, insulin and glucose level to ensure that you are dealing with a true PPID case. Sometimes these horses also have Insulin Resistence too and that needs to be addressed as well. Getting a good diagnosis is part of the building blocks to returning health to your horse....If you have more questions- let us know. 
 

Hello 

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. 

 

 Trisha DePietro
Aug 2018
NH
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