Kinsey -

In terms of treating chronic Lyme, which my PPID horse has had since I've owned him (14 years):

After many years treating him on and off with doxy and tetracycline, with minor improvements and ongoing high Lyme titers, my vet suggested a 30-day minocycline regimen followed by a shot of the canine Lyme vaccine. HUGE difference. Now he just gets the canine Lyme vaccine 2x a year, and his Lyme titers are down in normal range. I don't know why the vaccine works to bring down his numbers and help resolve his Lyme symptoms, but it does, and it only costs $40 per shot, vs. the huge amount I spent on doxy, plus all of the worry about what the antibiotics were doing to his belly. 

It's off-label use, but most vets here use it for horses, and I've never heard of any bad reactions to it.  
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EdieFr
Cape Ann, Massachusetts
Joined March 2021

Hi, Maria.
The information in the Files is now outdated. It will be corrected when possible.

Current information is that after the baseline blood specimen, a single post-TRH blood specimen at exactly 10 minutes is all that is necessary. It's unnecessary to have the veterinarian wait another 20 minutes after the 10 minute specimen.   Here is the link to the Cornell website describing the test. https://www.vet.cornell.edu/animal-health-diagnostic-center/testing/protocols/equine-ppid 

1. Collect a Pre (or baseline) blood specimen into a purple-top (EDTA) tube.
2. Inject 1 mg TRH intravenously (IV) for horses >250 kg; inject 0.5 mg TRH IV for horses and ponies <250 kg.
3. Collect an additional EDTA blood specimen at exactly 10 minutes (necessary) and 30 minutes (optional) after injection.
4. Process and submit multiple plasma samples together, following the endogenous ACTH processing/collection procedure above. Please ensure samples are labeled appropriately: i.e. are labeled pre and post and as plasma.

I have no information about your second question. It's only a theoretical possibility. Michigan State testing information is identical to that from Cornell: only one single blood draw 10 minutes after the TRH injection.
https://cvm.msu.edu/vdl/laboratory-sections/endocrinology/equine-endocrine-testing 
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Chickpeas seem to be about 60% starch and 10% sugars, but who knows what kinds of starches.  Split peas have similar starch levels but less sugar and we recommend them occasionally.  It may be the salt he’s craving.  Is he getting plenty of that in his meals?  I’m with Cass in that moderation is key.
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Rita,
There are several safe treats we know about: Beet-E-Bites, Stabul Nuggets available from Chewy, and Uckele Equi-Treats. Are you feeding a whole ounce at a time? Or just a few? How much starch in an ounce? Here's more information on treats from Files that you may find helpful:
https://ecir.groups.io/g/main/files/Treats%20for%20Horses/Safe%20Treats%20for%20IR%20Horses.pdf

Using 2 grams of sugar alone as ESC, these chickpeas still have more carbs than the combined ESC and Starch of 1.7 grams in an ounce of Nuzu Stabul1 and the Stabul treats. This is according to my own analysis of a 10 bag lot of Nuzu Stabul1 in 2018.

Assuming the starch in chickpeas is reasonable -- it could be a resistant starch that is safe for EMS horses -- a few chickpeas would probably be fine. We  need to train ourselves to have a very light hand while treating our metabolic horses. My mares are thrilled with a single treat the size of one or two chiclets. 

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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Thank you all for the responses! Yes, I know we are at the start of his weight loss journey, I want to make sure it is safe as possible for him!  The Vet had wanted me to give him Platinum Performance Beta Lip-Ox for weight loss, but when I talked to them, they said if he was on stall rest and wasn't exercising they didn't recommend it because it would be ineffective.  That is when he had me give him the Thyro-L for weight loss.  So much information to absorb and figure out what is best for him! I have signed up for Dr. K's NRC Plus and Cushings and IR courses, so hopefully that will help me figure this all out.
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Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655

I bought a bag of roasted, salted chickpeas to snack on. Turns out Stetson loves them, too! Would they be considered a safe treat to give him?  According to the label there are 2g of sugar per 1 ounce serving. I’m having a hard time figuring out what is too much. He hasn’t had any handfed treats since his diagnosis in June. 
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Rita C. and Stetson (2001 Tennessee Walking Horse/Gelding, diagnosed IR)
Aiken, South Carolina USA
June 2021

https://ecir.groups.io/g/CaseHistory/album?id=265166 

https://ecir.groups.io/g/CaseHistory/files/Rita%20C.%20and%20Stetson

EMS does not affect the ability to regulate body temperature. PPID and old age in general can make them less efficient at keeping warm.

Eleanor in PA

www.drkellon.com 
EC Owner 2001

My mare is almost 29, does not get blanketed, unless she were to show signs of needing it, hasn't been since diagnosed.  She has a good oily coat, goes to her shelter and sleeps in the shavings if it is raining.  She likes the dirt/mud to sleep in when not raining.  Right now it is 36 and rain but she is staying dry and comfy.
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Patti and Penny 
Washington, USA
May 2017 (this time)
Case History

When I first owned horses I was in a boarding situation, and I thought my horses needed blankets in the winter.  I had light, med, heavy and a rain sheet for every horse.  I was always repairing blankets!  After having 8 horses at home over the last 13 years, I have come to realize that in most cases, blankets serve to make the owner feel better, but the horse would like to ditch the blanket.  Mother nature set them up to handle winters without a blanket.  My horses are easy keepers, so I like the idea they have to burn a few more calories in the winter to stay warm.  I also like the idea that a blanket is not putting pressure on their withers and neck.  I have a couple different body workers that say they can tell when a horse has been blanketed by the tightness in their withers, neck and shoulder area.  They told me sometimes all they had time to do is address getting rid of the tightness a blanket caused rather than address other issues.   I also have noted that blankets can cause the horse to get itchy, can cause rub marks, and they can't wait to get out of their blankets.

If you have a way for the horse to get out of the rain and wind with a shelter, that in effect serves as a blanket, and the horse gets to decide what he needs.

But if your horse is thin, doesn't have a good coat, shivers, or is at risk of winter laminitis, then a blanket might be a good idea.  All 8 of the horses here are EMS, but there is only one older horse we blanket because she doesn't grow much of a winter coat and tends to get thin easily.  One of my horses had a serious steroid induced founder, and his feet were severely damaged.  I turn him out in boots but no blanket.  He hasn't had any trouble with winter laminitis, thanks to the great advice from ECIR.
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Heidi Wright
joined Aug 15, 2018
5130 State Route 38
Malta, IL  60150
815-761-2341

https://ecir.groups.io/g/CaseHistory/files/Heidi%20and%20Skyler 

https://ecir.groups.io/g/CaseHistory/album?id=69604

Michelle agree that he definitely needs to lose some weight 😊
He is a cutie for sure, my little mare was just about this overweight too, I took many of Dr.K’s courses, balanced everything and omitted most everything that I was feeding her, she wasn’t a happy camper (at first) but at least we know (now) what we can do to help them, laminitis doesn’t have to be death sentence anymore.
And it’s wonderful that your wanting to help him, you just need “less” of him to love!
He’ll feel so much better when you get his diet sorted out.


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Bobbie and Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020 , NAT , C&IR March 2021
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821

Hi Kinsey,
I would encourage you not to throw your IR cautions to the wind, just because he has tested positive for Lyme.  I don’t know how Lyme causes laminitis and I don’t want you to risk Buckley’s health by making unwarranted changes.  Challenging his system with increased sugar and starch while he’s already suffering from laminitis for whatever reason would not be a good mix.

Your first insulin test was done fasting, which we don’t recommend.  Was your second test fasting as well?  That makes a difference in how the results are interpreted.  
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Assuming Fergus grows a nice winter coat he should be fine keeping warm, but of course check on him when temperatures drop.  If he seems happy and isn't shivering or huddled by a wall to avoid wind he is probably fine.  I do increase hay 1-3 lbs (depending on temp) when it gets really cold here but I find my horse doesn't eat it all.  I keep Shaku outside with a 3 sided shelter year round and have never had to blanket him, even at temps as low as -25C (-13F).  On cold windy days I often find him standing outside in the wind with his coat all puffed up and his mane blowing around, happy as can be.  He also often stands out in the rain by choice.  We had freezing rain a couple days ago and both horses (including his less cold-hardy buddy) were happy standing out in it with ice forming on their hair.  What we think is uncomfortable as humans is not the same for horses at all.  But I always check when we have temperature drops to make sure they are still ok unblanketed.  And when it's wet and cold at the same time I check that the base of the hair in his coat is dry, and the wet is only on the surface.

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

Good morning all,

I have two questions about the TRH test please:

- One file says to pull blood at 30 min after 1 mg TRH, other says at 15 min- 30 min and 60 min after. How should be done, only once at 30 min after or multiple at 15-30-60 min?

- Positive is if the result is over 100 pg/ml per one of the files but if multiple ACTH readings are done at 15-30-60 min, what normal values should be expected for each interval?

Thank you very much.

--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Martha,

Thank you! He isn't able to reach the hay on the other side, it looks close in the pictures, but it is about 3 feet from the stall.  I will definitely weigh the hay once the scale comes in so I know for sure what he is eating.  How long should he be on the Thyro-L? It was started on 8 Nov 2021.
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Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655

Thank you Martha! I just called Equi-Analytical and they still have the sample and can run the #603 test without resubmitting the sample.
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Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655

Hi again,
I looked at his body photos and, while he’s quite adorable, he still has too much weight on him.  Think about how he needs to support all of that extra weight on feet built for a smaller horse.  We’ve found that it’s pretty much impossible to lose weight on a diet that doesn’t restrict intake.  The Thyro-L will jump start his weight loss but that’s entirely a push in the right direction as he will adapt and quit losing.  We advocate using small hole hay nets for feeding hay and weighing it out (once your scale arrives).  The total feed (hay plus supplement carriers) should weigh either 1.5% of his current weight or 2% of his ideal weight, whichever is the larger amount.  If 900# is his ideal weight (and that seems high to me), you may find that he doesn’t lose enough and need to cut back a bit more.  It’s a slow, steady process.  I have a 14.2 h pony here, whose body score I would put at 4.5 and whose weight I estimate to be 750#.  

edited to add - I’d also keep an eye on the hay stall next to him.  My horses would finish their hay nets and begin snacking on the hay in the next stall, right through the grate.  My horse, Logo, used to share his feed with the horse next to him.  He would literally push it through the grate between them, cubes, hay, whatever.
--

I wasn't sure if it would be useful, but I posted photos from about 2 months before his laminitis diagnosis.
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Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655

I uploaded body condition photos.  Sorry about the front, he kept wanting to say hi, that was the best I could get without someone to hold him.  In the x-rays, I should have said he was due for a trim by the farrier the next day after the Vet took them.  The Vet trimmed the fronts before he cast the pads on his feet.  The back feet were trimmed on 18 Nov.
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Michele in Ohio, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Michele%20and%20Odyssey
Photos/Xrays: https://ecir.groups.io/g/CaseHistory/album?id=270655