Date   

Re: Critique of Case History and Photo album

Sherry Morse
 

Hi Michelle,

Apparently 1mg of Prascend is not enough to keep Dusty's PPID well controlled.  If the test in your Case History was the last one done I would suggest you test him now and be prepared for him to need double or triple the current dose of Prascend to get his ACTH down to an appropriate level prior to the seasonal rise.  Once his PPID is controlled you may find he has less issues with abscessing.




Re: New shedding protocol and worming

Sherry Morse
 

Hi Elizabeth,

As Onyx has always been a bit overweight it's not really surprising that his insulin has always been elevated.  Do you have an actual weight of the amount of timothy balance cubes he's eating right now?  As a reminder they're meant to be fed at a 3:4 ratio for the hay they're replacing so if they're meant to replace 2lbs of hay (as an example) you would feed 1.5lbs of the cubes.  Is the weight of hay an actual weight or also an estimate?




Prascend once or twice a day

Katie
 

I'm gathering from my reading here that splitting a pergolide dose into twice daily instead of once, is not a good idea; however I also read in a Kentucky Equine Research newsletter from 2019 that twice daily might be more effective. What is the current thinking?
--
Katie
VT 2022


Re: Best grass varieties for hay

Nancy K.
 

Thank you, Dr. Kellon, Nancy C., and feme fedeli
I will pass this information on.
We will take your advice and hope for the best.                   
--

-Nancy K. with Jalila & Shiraz

March 2021, Blaine county Idaho

Case Histories: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Jalila

Jalila’s Photos: https://ecir.groups.io/g/CaseHistory/album?id=262313
Shiraz's Photos: 
https://ecir.groups.io/g/CaseHistory/album?id=262467 

 


Re: Best grass varieties for hay

Nancy K.
 


Nancy Camp
Whole Horse Training
Carey, Idaho 83320



--

-Nancy K. with Jalila & Shiraz

March 2021, Blaine county Idaho

Case Histories: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Jalila

Jalila’s Photos: https://ecir.groups.io/g/CaseHistory/album?id=262313
Shiraz's Photos: 
https://ecir.groups.io/g/CaseHistory/album?id=262467 

 


Re: emergency protocol

chemelle
 

THANKS!
Can metformin be given in tandem with the invokana?
just curious - if laminitis is thought to be caused by vascular constriction, why does icing help?
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

https://ecir.groups.io/g/CaseHistory/album?id=94380


Lavinia - Requesting New markups for Pilgrim

Suzanne and Pilgrim
 

Hi Lavinia,

I hope all the photos are clear and show what you are requiring. Pilgrim’s last trim was on Monday, April 18. 

All the photos (other than sole) we’re taken on April 27. 

The sole photos were taken on May 3 - May 4

So I have several questions. 

1). With these new markups, should the changes be made over the next 2 trims or all at once?

2). In your opinion, when should I schedule my next farrier appointment?

  3). We were doing 3 weeks. Should we stick with that schedule?  Or 4 week intervals till we have the changes you recommend?

4). Once we reach the goal of desired trim, how often should Pilgrim see the farrier?

Thank you in advance for your help  


Re: Vinnie and Invokana update 4/2022

Eleanor Kellon, VMD
 

Frances,

Not pastern wraps but maybe fetlock.However, DSLD horses typically have lesions along the length of the ligament and tendons.  Not the far infrared.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Best grass varieties for hay

ferne fedeli
 

I'm sure the suggestions to contact your local extension agent is the best idea.  Here in No. California (much different growing conditions, I'm sure), my local hay guy said that they have had better luck securing Meadow Grass than Orchard the last couple of years (when we have been in drought conditions).  He said the grower told him that Meadow didn't need as much water as Orchard.  Don't know if that is really true or not, but I like the Meadow better.  Softer, and less weeds, etc. than Orchard used to be.  Always low in ESC & starch too, so far anyway.
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


Re: Critique of Case History and Photo album

Trisha DePietro
 

Hi Michelle. Welcome! Because this is your first post to the forum, we send you a welcome letter. This letter is full of information for you. I see you and Dr. Kellon have connected which is great. When you read through the cornerstones of our protocol, Diagnosis, Diet, Trim and Exercise- you will see blue links that will take you deeper into the subject...If you have any questions for us after reading, just let us know. Nice job with your signature, case history and photos! 

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: Vinnie and Invokana update 4/2022

Frances C
 

Dr. K. Do you think that these magnetic pastern wraps (or far infrared wraps) would be of any comfort to a DSLD mare?
--
- 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


Re: emergency protocol

Eleanor Kellon, VMD
 

Yes. Standing the horse in ice water before lameness appears can help. Also ask your vet for an emergency metformin prescription, 30 mg/kg twice a day for a week.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


emergency protocol

chemelle
 

If an EMS horse gets access to pasture (unknown period of time) - Are there any preventative measures that can be taken to avoid a potential or imminent laminitis episode?
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

https://ecir.groups.io/g/CaseHistory/album?id=94380


Re: Critique of Case History and Photo album

Eleanor Kellon, VMD
 

I'll be happy to help you, Michelle. Send your hay analysis to kellon "at" uckele.com.

Your horse has a typical QH foot with broken back pastern axis and also has clear navicular bone inflammation.  What caught my attention most though was the LF solar margin view. Unless there is a large crescent shaped divot taken out of the toe you have to consider the possibility of a keratoma.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Best grass varieties for hay

Nancy C
 

Hi Nancy

I have been involved with my grower in getting best mineral profile for our hay.  I contacted our extension agent just as Dr Kellon suggested. Understanding your soil and what it need to balance the minerals prior to growing is also important to get the best quality hay.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Re: Best grass varieties for hay

Eleanor Kellon, VMD
 

Nancy,

The best thing to do is contact your local agricultural extension agent and see what they suggest. There is no single "safe" answer here. The sugar and starch levels fluctuate widely depending on stresses like climactic conditions. Drought resistant grasses will have high sugar. It's the universal survival mechanism for grass.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Critique of Case History and Photo album

strader.michelle@...
 

Hello everyone! Happy to have this resource available. May I ask for some constructive criticism of my Case History & photos? Any tips on connecting with Dr. Kellon? I've tried emailing her about her mineral balancing services. I realize she is extremely busy but I would love to work with her! 
--
Michelle 

May 2022, Catlettsburg KY

Dusty Case History: https://ecir.groups.io/g/CaseHistory/files/Michelle%20and%20Dusty 


Re: New shedding protocol and worming

Elizabeth Kuzma
 

Hi Insulin has never been close to 10 for the years that he has been tested.  This was one of the lowest insulin levels I have ever seen from him. 

I updated the case history and my hay analysis.  
--
Elizabeth
Aug. 2019, Patchogue, NY
Case History: https://ecir.groups.io/g/CaseHistory/files/Elizabeth%20and%20Onyx
Onyx's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=94258


Best grass varieties for hay

Nancy K.
 

I'd like to know what considerations go into planting grasses for horses, especially EMS horses. I live in south central Idaho and our drought conditions are worsening. We are at about 5,000 feet above sea level and, in general, grass crops are a challenge in this climate. We are in a high desert ecosystem, dry, cold, windy, low water. My friend has grown hay here for many years and has always grown a grass/alfalfa mix. With predictions that some of her fields may only get first cutting this year and the knowledge she has gained about EMS, she is considering trying some grass. Which is better, Orchard grass or Timothy? Are there any other, preferably drought resistant, grass varieties that are recommended as stand alone crops or to use in a mix?
I'd greatly appreciate answers to these questions and any guidance as far as where and what to research.

All that said, I'll update Jalila's Case Study in a few weeks, but the short story is: MUCH better. Sound, volunteers to trot in the round pens. Sole depth is increasing, Less bruising. Happier. Crest is pretty much consistently soft. Weight is staying down. Happy she is. Happy I am.
Thanks to all of you!
--

-Nancy K. with Jalila & Shiraz

March 2021, Blaine county Idaho

Case Histories: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Jalila

Jalila’s Photos: https://ecir.groups.io/g/CaseHistory/album?id=262313
Shiraz's Photos: 
https://ecir.groups.io/g/CaseHistory/album?id=262467 

 


Re: laminitis mini pony

Sherry Morse
 

You don't need that much Stabul-1 - as noted previously the majority of her diet should be hay and you only need as much carrier as is necessary to get supplements in.  As she needs to lose weight I would certainly not be feeding that much concentrate. 



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