Date   

Re: Hoof pain

Eleanor Kellon, VMD
 

Lisa,

Her toes needed to come back more in both sets of films and she has a thickened horn-lamellar zone which indicates chronic low level damage but there's no real rotation and sole depth is better than most.

Are you wrapping her legs and putting socks under those boots? Cold could be playing a big role.

When they bite at the boots it usually means they are being rubbed by them. Check heels especially.

How much is she drinking? Horses with stomach pain sometimes drink more. It doesn't sound like there is a problem and no danger of interactions or toxicities.

Yes on the vet coming back to repeat insulin and consider TRH stimulation for ACTH.  You could also ask the vet to prescribe metformin, start that at 30 mg/kg twice a day, then wait to do blood work for 3 to 7 days.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Hoof pain

Rita Chavez
 

Hi Lisa,

I'm no expert and I know the professionals here will chime in. But I wanted to ask, are you adding salt to her meals? I never used to before, but once I started the emergency diet for Stetson and started giving him loose iodized salt with each meal he really increased his water intake. Still is. 
--
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


Re: Requesting advice about Fizzie's trim

Eleanor Kellon, VMD
 

You can recheck 3 weeks after your dose change. If you wait until you are well into the seasonal rise it will be too late. DEFINITELY check insulin. Only about half of IR horses are overweight. Laminitis in both IR and PPID is caused by high insulin.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Acetyl-L-Carnitine

Yvonne
 

how much would i give to my horse?  Thank you
--
Yvonne
Rego Terrace BC 2022


Re: Compounding Pharmacies - Avrio

Shawn Gould
 

The compounding pharmacy saga is exhausting. My 5mg pergolide base in oil for 30 day supply went up $48 at Avrio. Mixlab was even more. So I tried Thriving Pets, after some discussion with Ian decided to switch to capsules and got a great price, $103 for 2 months supply of 6.5 pergolide mesylate!! I was elated. Called my new vet to inform her I needed to switch and why. Next thing I know she is quite upset because some pharmacy (college) called her and who the heck is that?! Made worse because I told her Thriving Pets would be calling her. Got a lecture on how bad compounding pharmacies are and there are only 2 in the nation that she trusts, Precision and Wedgewood. (I stopped using Wedgewood years ago as I felt they had a good reputation with vets but have very poor customer service and price gouge. I used them for dogs, cats and horses.) Ok, so I call Precision in Bakersfield. I talk to the pharmacist, Phu. He is GREAT, super patient, listened, had good ideas AND THEY PRICE MATCH to the best of their ability. He said let’s stick with the liquid and get 2 mos at once. So we compared to Avrio which was going to be $117 a month. Precision will do  2 mos. for $140! Thank you very much! So now I would recommend Precision. He let me know that I am getting a very special price. Again, very appreciative. Out of curiosity I called back to do a price check and their regular price for my Rx would be $240. Whew, so whatever you’ve got going on give them a call and ask to talk to Phu, tell him you are thinking of changing pharmacies because of huge jump in price and see if you can get a better deal. This is all so frightening and frustrating. 
--
Shawn and Candy
Dec 2020, Santa Cruz, CA
Candy Case History:  https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy
Candy Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=258140


Re: East Coast Canada Low Sugar/Carb Hay sources??

Bobbie Day
 

Greetings Sydney
Welcome to the group, since this is your first post I will be sending along your welcome message, which you will find below. It doesn't appear that you are in a crisis, that's always great news!
We want you to have all this useful information to help you with any questions that may come up, the blue links will take you even further into the subject so it's a great resource to keep handy.
I try to answer any questions you may have, but I am afraid I can't help you with a hay supplier in Canada, but rest assured we have many members that will most likely jump on that may be able to answer your question. And there is country specific information included in the message as well. We all know that the struggle is real trying to find suitable hay for our IR/PPID horses so hopefully someone will have some information for 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. 

--

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

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: Hoof pain

Lisa
 

Hello again,

I need help.

I have updated my case history on Nira. I managed to get her off of all pain meds by March 8. The farrier came out on March 11, he took back her toes on her fronts, some toe off the back hooves, and took off a bit of her LF heel. On the 13th I started Nira on Jiaogulan. I am giving her 3/4 of a teaspoon AM and PM.  

She didn't seem any better after the trim. I tried leaving the boots with pads off yesterday, but after an hour or so she seemed even more reluctant to move, so I put them back on. Today she was chewing on them, so I took them off again. She walked around a bit after that, but then after an hour seemed more reluctant to move again, so I put them back on. 

I am also concerned because she doesn't seem to be drinking much. I wasn't too concerned when she wasn't drinking as much after I started soaking her hay, but since I got her off all pain meds last week she is drinking way less, sometimes nothing at all over night. She is eating well, pooping and still urinating, but not as heavily. The color seems normal and it smells like usual. 

Are any of the supplements a problem? The vet wanted me to start her on Insulin-wise and Thyrol-L (2/24/2022), and if I think back I believe that may have been when she started to not drink as much. Should I stop these? I'm thinking yes. I know Dr. Kellon said they don't help, I just didn't think they would hurt and maybe help her lose some weight, so I was using them since I had them. Now I am scared. Have I caused her harm? Do I need to have the vet come back and do more blood work or something? Is the Jiaogulan interacting (although this has only been three days now)?

I'm at a loss as to what else to do to help her feel better and because of my concussion issues I am struggling to think clearly, formulate a plan and I am struggling with anxiety and worry over everything I do. 

Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Re: New-ish Member questions

Mialisa@...
 

Hi Sherry
I did double check on the date, my case history is correct.
I have updated my Case Histories for both ponies. If you notice anything else missing let me know.
Thanks for your help!
--
Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


East Coast Canada Low Sugar/Carb Hay sources??

Sydney
 

Anyone in the group from Maritimes or eastern Canada who knows where to source low sugar/starch hay? 
--
Sydney


Re: Compounding Pharmacies - Avrio

Deb Walker
 

So, I re-spoke with pharmacist at Avrio. They are going to be able to offer a slight reduction, so anyone comparing prices may want to compare apples to apples. Since everyone uses a different dosage, it depends on what your dosage is. I specifically mentioned some other pharmacies that have been discussed here during our conversation, and he said any information would be helpful, as the costs should be pretty much the same.

I had a crazy thought, and asked as an aside if there was any type of product to help with insulin in equines. Nope. Metformin is not something that can be compounded and they didn't have any other insulin related product.

The quality of customer service has been exceptionally nice, so I am sticking with what I know for now.
--
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


Re: Requesting advice about Fizzie's trim

Mandy Charmam
 

Thanks You Dr Kellon, 

Will get my trimmer to look at your advice. 

We've had his ACTH tested and was at 59. Hes on liquid pergolyte. In last month we have changed him to the Prascend tablets with a higher dose of the active ingredient. I thought I'd give that time to take effect and then retest in the next month or so - our Autumn. (this would mean he would have been on capsules for 2 months.) Is that OK? 

Re insulin test. He doesn't show any signs of the IR - he is quite lean, no fatty lumps, or the other symptoms etc. Vet said not to test . Happy to get it done though if you think he could be affected by this - even without the obvious symptoms. What would you recommend?  

Thank you so much!!

Mandy 


--
Mandy C, Macedon Australia, 2022
https://ecir.groups.io/g/CaseHistory/files/Mandy%20and%20Fizzie
https://ecir.groups.io/g/CaseHistory/album?id=271974


Re: Lavinia: New photos uploaded on Merlin for evaluation for next trim.

Jean
 

Merlin is not showing any signs of being uncomfortable for the past two days, no meds. Hand walked today on the soft grass area for about 5 min. no signs of pain. He was very happy to go out for a short walk, very perky and prancy.  
--
Jean Hinrichsen WI 2022
https://ecir.groups.io/g/CaseHistory/files/Jean%20and%20Merlin
https://ecir.groups.io/g/CaseHistory/album?id=273256


Re: Discount

Eleanor Kellon, VMD
 

No code needed but I had the dates wrong.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Discount

Eleanor Kellon, VMD
 

CORRECTION!  Starts on St. Patrick's day and ends midnight on the 21st.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Discount

Nancy C
 

Is there a code, please? Not seeing it on website.

Thanks
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Discount

Eleanor Kellon, VMD
 

20% off Uckele products until midnight for St. Patrick's day.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Omeprazole contraindications for PPID horse

Eleanor Kellon, VMD
 

The only contraindication is mixing it with phenylbutazone.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Acetyl-L-Carnitine

Eleanor Kellon, VMD
 


Omeprazole contraindications for PPID horse

Sue Ring
 

Hello,

I searched in files but could only find the mention of possible contraindications for a PPID horse for omeprazole, but no specifics.  Vet has prescribed omeprazole 1 X daily in AM, and Shifty is being fed 5# of soaked TC Timothy Balance cubed divided into 2 feedings daily.  Feedings include the cubes, 2 handfuls TC Sr for flavor, 1/2 tsp electrolytes, 1/3 Tbsp salt, 1/3 cup ground golden flaxseed, 1/2 scoop Phyto Quench, 1/2 scoop Fast Track probiotics, 8 ml APF given orally, separately in PM.  Hay has been tested and balance mix from Horse Tech is also being fed.  Both feed mixes are fed completely soaked.  Horse receives 3 mg of Pracend daily.  Thanks so much for any information you can provide.
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


Acetyl-L-Carnitine

Yvonne
 

Where can I buy Acetyl-L-Carnitine in BC?  Has anyone had any luck with it?  thank you
--
Yvonne
Rego Terrace BC 2022

8941 - 8960 of 280087