Thanks, Jeannette. You made my day.

I can't wait to get back to them myself over the holiday.

All the best.

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

2021 NO Laminitis! Conference Video Recordings available to new subscribers until 12.31.21  www.nolaminitis.org

I just want to express my appreciate for all the work done to make this conference recording available to us who missed it the first time!  So far, it's great!

Sent from Finest Planet WebMail.

--
Jeannette Mc, NoCA 2021

Hi Rhonda,

You’re not the only one to learn the hard way that the s/s of straw is not as low as you might guess.  It seems counterintuitive but it’s good to be aware.

I’m not aware of allergies causing ACTH to be elevated but allergies can be more problematic in horses with PPID that isn’t well controlled.  Your ACTH level is right where it should be but, unfortunately, that doesn’t always tell the entire story.  You could try increasing his pergolide to see if it helps with his allergies and brings his insulin down.  There’s no harm in increasing it and then bringing it back down if you don’t find it helpful.  Keep in mind that cold temps can cause elevated insulin.  You state that it was 2°C which isn’t too far below the 40°F I think I’ve seen suggested as a dividing point.  However, we advocate for striving to achieve an insulin value midway in the range, which would be 150 +, depending on the lower value of the reference range.

--

I had Scooter tested in November 11,2021 and his insulin level was sky high(1435).  Back up to earlier in the late summer he was on a mixture of straw and grass hay.  My vet had recommended this and it seemed worth a try and the result was the high insulin level.  I immediately got his diet changed (he lives in a large boarding stable) to no straw and timothy grass hay and his insulin/glucose/ACTH levels have gone down but his insulin level is a tiny bit high at 367 (should be under 300).  Is this a concern?
I also had Scooter checked for allergies at the same time.  Do allergies affect his ACTH/Glucose/Insulin levels?
His case history has been posted.
Otherwise he is very healthy and back in dressage  training and is getting fitter.
--
Rhonda Turley
Brampton, Ontario
April 2020
Scooter and Rhonda     
https://ecir.groups.io/g/CaseHistory/album?id=258159

Hi Deb,

I'm so glad Scotty is doing better.  Let's hope that was just a little blip.  He gets such good care...

If you are trying to make a decision, tracking/charting on vs off days can help you see more subjectively when the off days outweigh the good days.  It might help manage the daily emotional roller coaster and make it slightly easier to decide when it is time to say good bye.

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

Hi Rebecca,  

I agree with Martha that regression at this time of year could be PPID-related.  It could also just be colder temps, which will elevate insulin.  Or a combination of both.

If she is struggling she should be on our Emergency diet, which is detailed in your welcome letter from Candice here.  Even if her hay has low ESC and starch, it should be soaked 1 hr in cold water, rinsed and drained.  Maybe you are already doing that?  A complete Case History really is needed.  Even if you can only get her current details in it for now, that will help us.

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

Hi Catherine,

I think 0.5 mg is a good starting dose.  Given his age (17?) his ACTH probably shouldn't have been higher than about 80.  After he has been on his current dose for at least 3 weeks, he should be retested to make sure ACTH is brought down into the low 20s or less.  You will need to keep it in the low 20s all year, including through the seasonal rise, for the best outcome.  This will invariably mean he will need progressively higher doses so you may want to discuss switching him to compounded pergolide, which is significantly cheaper.   Usually when doses go above 1mg Prascend it becomes more economical to use the compounded form.  Vet's are not permitted to prescribe compounded pergolide for cost reasons alone, there needs to be some other justification.   Some other reasons are it can reduce the number of pills fed, or it tastes better or is less offensive so the horse ingests it more easily.

Even though ACTH was elevated, his insulin was only slightly abnormal (different labs use different assays, so it's not exact but insulin should be less than about 12 uIU/ml), so hopefully you won't have to be overly strict with diet and can just keep him away from the obvious no-no's like sweet feed.  Be careful with pasture, too, especially towards the end of summer into fall when the seasonal rise is at its strongest.  If his ACTH is climbing faster than you xan control it, the insulin will climb, too,  and it is the high insulin that causes the laminitis.

One last note.  Your glucose was at the bottom end of the normal range.  This suggests the sample may not have been handled properly.  After drawing blood it needs to be on ice or refrigerated immediately, then centrifuged within 4 hours, then frozen and shipped frozen on ice by overnight courier, and received by the lab the next day (ie don't ship it so it arrives on a holiday or weekend if the lab is not open).  If any of these steps aren't done properly the glucose can be partially metabolized and will be low.  Insulin and ACTH will also be affected, although not as dramatically, so keep in mind the actual numbers could have been a little higher.

One more "last" note: Cyrus has bony changes/calcification visible in his xrays that are not related to laminitis but could be causing arthritic pain, esp on the right front, so he might never be fully sound.  This might explain the mild on/off soundness issues you noted before the laminitis...or the on/off may have been the laminitis brewing from being on pasture as the seasonal rise started to affect him.  I hope your vet discussed the calcifications with you.  Keeping his trim as tight and balanced as possible will go a long way towards minimizing any related arthritic pain.

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

Hi, Rebecca. 

You need a word-processing app like Apple’s Pages.app on your iPad to work on a case history. Kirsten sent you instructions back on December 7. Let us know if you’d like us to send those instructions again. Details are in the Wiki too. Here’s the link: https://ecir.groups.io/g/main/wiki#Case-History-Help
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Because it come up often, just wanted to add you need only the original APF.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

2021 NO Laminitis! Conference Video Recordings available to new subscribers until 12.31.21  www.nolaminitis.org

One winter I thought Bugsy was being affected by winter laminitis. I had hoof boots, shipping boots, blankets,  socks (heated battery operated) - ditched those and just used wool socks and started  using “hot ones” toe warmers. Bugsy was definitely moving more comfortably with his winter garb on. There were no “typical” symptoms of laminitis and he got more sore the colder it got. When it did warm up, he was sore if his pen was wet and didn’t have boots on (I’m thinking his sole got soft from the wet conditions).  

However, this year we have had -30 Celsius temperatures and only wearing boots - no socks, not even a blanket and he is moving very well. Without boots, the ground is frozen rock hard and the manure is frozen as well - he is more cautious where And how he walked.   With boots and cleats on he is moving around very well - trotting in his pen.  Looking and bucking in indoor unheated sand arena. 

I wish these horses could communicate better with us - they leave us with more questions than answers half the time. With thinking he had winter laminitis, I was preparing for having to deal with it every winter and him being sore every winter. In seeing him move now, I wanted to definitely pass along hope to others. 

Was it even winter laminitis that Bugsy had? Hard to tell. But I continued to follow the advice and protocols of this group and continued with getting regular hoof trimming mark ups and he is moving oh so much better. 

--

 

Judy and Bugsy

Regina, Saskatchewan, Canada

Feb. 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Judy%20and%20Bugsy
https://ecir.groups.io/g/CaseHistory/album?id=243358

 

Hi Kandace,
I’m not sure what the purpose of adding a mineral mix is unless you know what your hay is lacking.  It’s not too late to do a wet chem test on the hay you are feeding so you know what needs adding, if anything.  Of course, you would want to continue with adding the flax, vitamin E and iodized salt, no matter which mineral mix you use.    Could you better describe the ‘pushback’ you see in the messages?  My take would be that the added iron and the wheat germ base are problematic, as well as not knowing whether the minerals are adequate or necessary.
--

I just found this reply Nancy, I will do as recommended on the IP as I have until end of month to register.
--
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

My feed supplement supplier has had to change vitamin mineral mix she is supplying.  She is a certified Equine Nutritionist and is very familiar with my mare K.
My partner went to pick up some more for me yesterday and they called me to tell me that they store had had to switch to Nutrequin Elite.  

She said it had iron in it, where as her formula had no added iron, but I see that the Elite formula is actually a little higher than the Classic.

On looking through the past emails on this procut I see a lot of pushback from this group on this product.  Is there a problem besides the iron?  The dosage my mare would be taking would be smaller than the 500kg as they recommend.  K will not eat the Mad Barn product and I was not able to get a wet chem test on my current hay for balancing.
--
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

Hi Deb

I'm sorry this is a hard time.  It sure does sound like winter laminitis. Good the vet is coming out for rads. Agree that assessing trim is in order. It can make all the difference.

Your CH indicates you are giving a good amount of jherb, presumably in food. Make sure his gums are pink.  APF added has also been successful for some. Or you could switch to Laminox which has other ingredients along with the jherb that can help with nitric oxide production.

Dr Kellon has said The whole winter laminitis project started after some members had found that the only thing which snapped their horses out of the winter foot pain was APF.

You may know this already. Hope today is a good day.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

2021 NO Laminitis! Conference Video Recordings available to new subscribers until 12.31.21  www.nolaminitis.org

Gosh, you have a wonderful husband! Give him a great big hug from me.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382

Hi Rebecca,

Here’s a link to the case history form used on anything Apple related.  I use an iPad myself without issues so feel free to contact me with related concerns.  We will be looking forward to reviewing your case history once you post it as so much is lost in the relaying of messages.

My assumption is that you’ve had ACTH, glucose and insulin tested as the vet has made diagnoses with those in mind.  I agree that adding pergolide would be a good thing to try if the diet is tight and insulin remains high.  Not all PPID horses show an elevated ACTH as there are many other hormones involved.  Her fall relapse may well be aligned with the fall rise, which elevates the hormones associated with PPID even further, increasing insulin and the probability of laminitis.  The fact that she still has concerning fat pockets indicates to me that you still may have room for further diet improvements.

Not sure what you’re feeding but any pelleted feed will be higher in iron than something less processed.  I also have used a filter meant for an RV to screw onto my water tap.  As it gets well below freezing here, I cannot use it in winter so I subsequently installed a filter closer to the water source, in my basement.  This is purely a mechanical filter so I’m not sure how much good it does but the filter does turn dark and iron colored.  If her reported iron levels are from serum, that would be reflective of dietary iron.  It’s more complicated to learn if she’s iron overloaded but it can be done with the correct testing.

Looking forward to reading your case history!
--

Deb, if you want to have ACTH levels tested today, that’s not a timing issue.  The vet can prepare the sample for shipping and then tuck it in her freezer until it’s convenient to ship.  Many vets do that anyway, in an effort to send several samples at once.  If you decide not to have it done after the blood draw, she can discard the sample.
--

Hello, 

My little Welsh mare in her late teens remains in a cycle of laminitic episodes no matter what treatment we follow. 

My vet has diagnosed EMS/IR and we have been following a highly stringent protocol following the advice of this group and horse carers successful in getting positive and lasting results. Diet wise; we have been following the ECIR guidance to a T and have been extremely strict/overly cautious with the diet management. Grass has been eliminated from her diet for well over 6 months and around April/May 2021, we appeared to make good progress but have since sadly have regressed. 

Recent ACTH and TRH results show her levels are normal but vet advice is to trail Prascend to determine if any positive changes occur. 

She has always had a very firm and cresty neck but the fatty pockets have exploded in recent weeks and are at the worst I have known. Pulses fluctuate but on certain days they are bounding and on others, hard to detect. An nightmare rollercoaster of frustration in that the root cause is not being addressed and I feel horrendously guilty that I can’t stem the cause. 

Recent bloods taken (October) show no cause for concern with functioning of major organs but iron levels were abnormally high. 

Any advice offered would be greatly appreciated. I feel I’m so concerned and engrossed in searching for answers that I can’t see the wood for the trees and I must be missing something vital.

I use an iPad and I am waiting on the correct form to complete her entire case history. 

In hope, 
--
Rebecca , Surrey UK 2021

Exercise maybe the key, as our Appaloosa broodmares get plenty, so maybe saving grace.  We move the wagons of hay all over the 100 acre field to get it evenly fertilized, and as far from the water source up by the building as we can, so they have a hike to walk to water. Plus grazing in the alfalfa and digging for that when buried in snow  And, out in the open fields with single shelterbelts for protection, am sure they use up their nutrients.

Thank you all who have input.
--
Kim_North Dakota_2021
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20QT

Thank you to all for your support.

Just a few clarifications...when I say I kept Scotty locked in his barn...it's an area that is huge...as big as his dry lot. He can choose to move as much as he wants, or choose to stand where we pile thick shavings.

Jennifer - I would have had my vet pull bloodwork for re-tests tomorrow if she deems it's not time...but I can't because of timing. In order to send things to Cornell overnight and keep iced...it needs to be shipped on a Monday or Tuesday. Not even to mention whatever they are taking off for the holidays. So *if* she thinks I should wait...it will be another barn call. The dollars just keep piling up.

Frances...you are so right. I swore I would never let Scotty get to that point ever again.

So...I went down this afternoon, after my husband had fed and mucked, etc. Scotty hadn't moved much. And as I am in *my* side of the barn I hear him...and ran over to watch him walking the entire perimeter of his dry lot...flat footed...not limping...and not taking a short cut across. Hmmmmm. I went out on his dry lot to change his socks and boots, and it seemed like he was trying to be more helpful.  Then I did some work on his automatic waterer...it gets mucky...and watched him walk around the entire perimeter again, wait at his gate for me to take him for a walk (I didn't) and finally come inside and eat.

This is why it is such a hard decision. It seems I am being told it's over...and then it turns around. He has exhibited soreness since early December. We are going into a warm-up the next few days (crazy for N. IL winter) and I will have to take his socks off, etc. I just don't know.

This is why it is so hard. One day can make all the difference. I considered cancelling my vet tomorrow, but my husband convinced me to keep the appointment and get more x-rays.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619