Date   

Evaluation of pre and post trim radiographs and bare foot pics from today.

Jean
 

Merlin was trimmed and re xrayed today. I took photos of all 4 feet. Rads of both fronts. We had to nerve block RF today only. was sore without clog, but understandably so d/t not being trimmed from the get go. 
Vet is happy about his weight loss. She gave him a body score of 5. Maybe 40# left to drop.
Easy boot clouds were put on today. 
Thank you very much.... YOU ARE GREATLY APPRECIATED!


--
Jean Hinrichsen WI 2022
https://ecir.groups.io/g/CaseHistory/files/Jean%20and%20Merlin
https://ecir.groups.io/g/CaseHistory/album?id=273256


Re: Wedgewood Pergolide Quote

 
Edited

Hi, Tracy. In brief: Prascend is only one formulation of pergolide that was effectively marketed to veterinarians as the only safe way to prescribe pergolide to horses. As Dr Kellon hinted, a big problem is that animal drugs are a tiny fraction of the pharmaceutical market, and there is no rush to market a generic to compete with Prascend.

The list of patented animal drugs is in the Green Book, and Prascend is NOT on the list.  It’s detailed, but Prascend is an FDA-approved formulation (packaging tablets in foil) shown as "effective." The manufacturer  BI *had* a period of exclusivity for that formulation that is a standard benefit of FDA approval. It is not a patent but did give the manufacturer the exclusive right to sell that formulation for 5 years. The period of exclusivity expired on September 7, 2016.

Part of BI’s business model was to convince vets that other formulations of pergolide were unstable. It’s been very effective, in part because some of those formulations really are unstable — old capsules, loose powder or pergolide suspension in water. CP in capsules, properly compounded to appropriate potency, used within 30 days, safely stored at the same temperatures as Prascend and protected from moisture, was shown in studies to be retain potency. Here's one study: https://aaep.org/sites/default/files/issues/proceedings-10proceedings-z9100110000274.pdf  

Another part of the model was to convince vets they could not prescribe compounded pergolide without risking personal liability. This was very effective initially. Broad language adopted by AAEP guidelines makes it sound like compounding is illegal and substandard, using language like, "The prescribing veterinarian should understand that his/her professional liability policy may or may not respond to allegations of negligence arising from the use of compounded drugs." As veterinarians gain more experience with CP, they find that the dire consequences of prescribing compounded pergolide are overstated.

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


Re: As fed or dry matter basis

Marie
 

So when I have 600 kg horses and hay has 1,94 Mcal/kg and I need 24 Mcal, it is 12,37 kg of hay. In UK calculated 13 kg and I dont know why. Moisture 10,2. One horse 590 and second 630 on diet so I calculated with weight 600 kg.
--
Marie Volsicka
Mid Europe
2021


Re: Ashwagandha for pain/stress relief

Heidi Wright
 

Where do you buy ashwagandha for horses?  Is it a loose powder or do you feed human capsules?  What dosage?
--
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


Trace elements content dry beet pulp/wet beet pulp Dr. Kellon please

Marie
 

Hi,
I found on Dairy one that average of trace minerals in beet pulp is calcium 1%, phosphorus 0,089%, magnesium 0,241%, IRON 652 ppm (mg is same?), 25 ppm of zinc, 8,5 copper and 64 ppm of manganese. Is correct count with this number or soaking numbers changes a lot? My horses have only first 350g and second 100g.

Thank you a lot
--
Marie Volsicka
Mid Europe
2021


Re: Pain Relief for Olaf

Cecile Johnson
 

Thank you!  I will look into them.  I have an Epsom Salt poultice.  Can I apply that to the hoof and cover with a sock and boot?  

I have also updated the case history and will upload it tonight.  I have ordered all the supplements that Dr Kellon recommended and started him on Stabul 1. 
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Re: Wedgewood Pergolide Quote

Eleanor Kellon, VMD
 

Tracy,

Going off patent isn't likely to help for pergolide since it's banned for human use.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Wedgewood Pergolide Quote

Tracy
 

Linda I feel your pain - and like you said - the joy is diminishing.  I'm waiting on new lab results for Salsa (sent to Cornell last Friday) and suspect will need to go to 2 Prascend.  Vet so far has refused pergolide - but now seeing these posts - UGH!  Even perg is this expensive?

I love Salsa and he will get what he needs - but when he crosses over someday I don't plan to have another horse.  I'm done.
All the breeds I enjoy are prone to metabolic issues - and I'm....well...beat.  It's exhausting.
I'm getting my motorcycle endorsement on my license this summer - that will get me my "wild and free" kick and for a lot less money and emotional ups and downs.

Prascend is the biggest insult though.  My vet and I were talking about it last week - isn't this crap off patent now?
Sigh.

Good luck to us all and our beloved equines!

--
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827


Re: "Mad Barn" supplements - ok?

Eleanor Kellon, VMD
 

The cubes are only 10% beet pulp and we accommodate for that in the mineral balancing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: "Mad Barn" supplements - ok?

Gymah
 

I was able to find somewhere to get the Ontario Dehy timothy balance cubes! 
So even though this product also includes some beet pulp, it doesn't need to be rinsed? 
--
Helene A. in BC 2021
Photo album:
https://ecir.groups.io/g/CaseHistory/album?id=271068
Case history:
https://ecir.groups.io/g/CaseHistory/files/Helene%20and%20Rosie


Re: Managing feeding with three different equines

Sherry Morse
 

Hi Laura,

Ideally you would separate the fat pony from her friends so she can only get a properly weighed amount of hay each day.  That would mean splitting the current pasture so the younger pony and the WB are in one area and she is in another in a situation where she can't reach any of their hay.

The other option would be to keep doing what your doing and put her in a muzzle 24/7 as well.  That is less ideal because you would have no way to measure how much hay she is eating and based on your description she is IR and in need of a restricted (as in weighed amounts of intake on a daily basis) diet. 



Re: Wedgewood Pergolide Quote

Sharon Manning
 

Try Mix lab in New York. My horse gets 16 mg and it’s 135.84 per month on auto ship. Their customer service is excellent .


Sharon
Knoxville TN

Please forgive any errors 


Re: Pain Relief for Olaf

Sherry Morse
 

Hi Cecile,

If you're using Equioxx to help with pain from laminitis it's probably not doing anything other than possibly keeping abscesses from mobilizing since it's a NSAID.  We would recommend getting him off of that and onto the Phytoquench pellets with Devil's Claw or straight Devil's Claw instead. 

The x-rays do appear to show an abscess in the right front in the section of his toe that is still in need of trimming so that's something you may want to discuss with your trimmer.




Re: Blood test results terminology

Maxine McArthur
 

Thank you Dr K, and thanks for the reading list, Cass. We will have to check directly with the clinic about the handling. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Re: Grooving

Qhgirl
 

Hi Chloe 
I am not an expert but what you described was recommended to my by a trainer friend when he learned my mare had foundered. He said he has seen it done by old timers below the coronary from side to side just in the front on many horses over the years. He told me it would not hurt the horse and he saw many horses grow new hooves just fine afterwards.  I did not have it done to my mare as I was already in this group and following the recommended care but wanted to mention with the hope you will not worry about what was done.  I know it's hard to watch them suffer so we must be strong for them.  The important thing is to tighten up the diet and follow the advise in this group. If your horse seems more comfortable then that would be a great benefit and something to feel good about.  We all want to see our babies more comfortable. And our horses pick up on our worries. This is the time when they need us to love on them, give them as much comfort as possible and be confident when we are around them so our horses feel safe.  Hope this helps a little. 
--
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: Blood test results terminology

Eleanor Kellon, VMD
 

Maxine,

They only lists the types, or not, of anticoagulant. The fluoride tubes are used for glucose (although no better than EDTA plasma in horse blood). This has nothing to do with whether or not they arrived frozen.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Managing feeding with three different equines

 


Hi Laura,

Welcome to the ECIR group! 

Your first post here prompts this welcome from the ECIR group with lots of information to help you understand metabolic laminitis and PPID, how they differ and relate and what you can do to to help out your pony.  First, I will address your specific concerns.

Your WB is unlikely to develop insulin resistance, with the possible exception of any IR developed as a side effect of PPID, should she develop that.  The two Welch ponies, on the other hand are very likely candidates for developing IR.   Signs often begin to appear after reaching maturity so keep an eye on the younger one as well.  Being fat doesn’t cause insulin resistance but it is frequently a sign of its existence and proper weight is much easier on their feet so it’s good that you address that.  

What is the issue with getting insulin, glucose and ACTH tested in mid Wisconsin?  How long will it be before you move?  

I have a group of horses in my barn with varying demands, fewer than I’ve had earlier but still needing special feeding care.  I separate them for most of their feedings, giving them each weighed amounts of hay. When I have them in mixed groups, I bring in the ones who need more food but you also bring in the one which needs less.  I realize you don’t have a barn but portable fencing should do the same job.  It might be possible to hang the WB’s hay nets high enough that the ponies can’t reach them but you would need to keep track of how much is spilled by the WB and eaten by the ponies.  My horse, Logo, used to shove feed through the grating between his stall and the stall of the fatty next to him.  He also spilled hay out into the aisle for his chicken friend who knew which stall to camp outside.

You will need to weigh out Nova’s hay.  She should get the larger amount of 1.5% of her present weight or 2% of her ideal weight in hay.  The ECIR horse weight guide might help you to determine her weight if you don’t have access to a scale.  I’d be more likely to suggest muzzling once her weight is down and she needs less for maintenance but others may have different experiences.

And now for the informational group welcome letter.  Don’t hesitate to ask about anything you don’t understand.

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck. 

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating". 

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 

--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Managing feeding with three different equines

Laura
 

I have three equines on a sacrifice pasture, dry lot situation. I do not have a barn, but have three run-ins. Rhys is a 20 y.o. 16.1hh Warmblood mare with no issues, proper weight. Taya is a 2 y.o. 10hh Welsh Mountain Pony (Section A) filly, no issues, proper weight. Then my problem child, Nova. Nova is a 7 y.o. 12hh Welsh Mountain Pony (Section A) mare, who is overweight. She has suspicious patches of fat on her sides about 6" down from her spine with some cresting of her neck. Nova has had no lameness issues but I am hoping to avoid them. I suspect that she is IR/EMS. I have not had any testing done yet. The vets here are limited in their approach to testing and laminitis. I will be moving in the future and will have testing done by vets with more experience and up to date information. I am in the process of having my hay tested. In the meantime I need to help my fat pony lose weight and hopefully avoid any problems down the road. 
Does anyone have any suggestions on how to feed multiple horses with multiple issues? I feed the warmblood a pelleted feed, with a balancer (EquiShine) and s/r/s no mo beet pulp, the ponies get the s/r/s beet pulp (about a cup volume) with the 1 oz. EquiShine, and Vit. E, Magnesium and Salt (per ECIR recommendations). My biggest problem is feeding hay. I don't feed the ponies any grain/pellets.  At this time I have slow feed hay nets, and slow feeder boxes that we made. I am planning on having my hay tested ASAP. The 2 y.o. and the Warmblood maintain a proper weight with condition scores around 4-5. The fat pony is at least a 6-7. I haven't taped but will. Last summer she was in driving training the entire summer and I don't think she lost an ounce. Because of the lack of a barn and the extreme cold and my horses are fed hay together on a dry lot. Would soaking the hay for everybody be the answer? (If hay testing so warrants it) Or should I put a muzzle on her 24/7? I read an article stating that equines wearing muzzles 24/7 were not stressed out - as determined by cortisol levels, but taking off the muzzles did cause gorging behaviors. (https://thehorse.com/173975/ess-symposium-take-homes-from-the-final-day/) Is wearing a muzzle appropriate for dry hay?
I am just wondering if anybody else had a workable solution to horses that are out 24/7 and feeding hay in a group. The big mare seems to bully everyone enough to get her fair share of hay but I hate to start restricting hay for the 2 year old. Obviously my fat pony is getting more than enough.
TIA
--
Laura W (Rhys, Nova & Taya) 
Central Wisconsin
2021


Re: Blood test results terminology

 

Hi, Maxine.
While you wait for an authoritative response, I found a couple of useful links to get you started. We can't ease your worries about whether samples were frozen. However, it sounds to me like the lab is doing a good thing in specifying the types of blood samples it received. I've learned to give my vet the lab instructions for each lab test at time of the blood draw. Some are really detailed! 

Here’s a nice summary of different blood collection tubes, the additives they contain, and their uses for serum, plasma and whole blood.  https://www.labce.com/spg263741_blood_collection_tubes.aspx

Only the lab can clarify the meaning of "fluoride oxalate," but it looks like a shortening of  sodium fluoride/potassium oxalate (NaF/KOx).” In that search, I ran into this PubMed study of different tubes for collecting blood samples for glucose testing. https://pubmed.ncbi.nlm.nih.gov/25002707/ 

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


Re: Ultimate to boots?

Sue Shaner
 

I am happy to report that, through multiple referrals, I found a farrier who is ECIR protocol savvy, as well as Ultimate savvy. He is coming out next week to remove the Ultimates, and move Ruby into wooden clogs with DIM. He doesn't believe in nails in inflamed feet, and has worked with my vet in the past! I finally feel like we are moving in the right direction. 
She will be off Gabapentin tomorrow, and then I will start getting the Bute gone.
She is looking pretty thin. I got the hay test back yesterday, and will get that posted today. Thanks again, all.

--
Sue and Ruby, NE Utah, 2017
Case History 
https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Ruby?p=updated,,,20,1,0,0
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272221

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