Date   

Sudden onset of stallion behavior in 30 yr old gelding

Cathie Vincent
 

My 30 yr old PPID gelding is suddenly acting like a stud and very possessive of my mare, threatening my other gelding. This herd has been together for over 2 yrs without issues until this Spring. I read that issues with the pituitary May cause this change. What should I do?
--
Cathie
February 2018
Whidbey Island in WA
https://ecir.groups.io/g/CaseHistory/files/Cathie%20and%20Chief


Re: Invokana labs

 


Re: Balanced Timothy Cubes in Ohio

Janet
 

Glad you were able to get an order.  If you every get in a bind, I would be more than willing to help you out.  
--
Janet M. OH 2021


Re: Invokana labs

Sherry Morse
 

Hi Elizabeth,

The timing of the medication doesn't matter but you want to make sure you schedule the draw for 4 hours after the first meal of the day.




Re: trh stim and exercise

Sherry Morse
 

Hi LJ,

The best thing you can do is schedule the blood draw for the morning so you can do exercise afterwards.




Re: Invokana labs

 

Oops that’s supposed to say: or does the time Invokana is given not matter? 
--
Beth & Flame dx 2013 & Diana dx 2020

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  




Invokana labs

 

I am doing labs on Monday because Flame has been on Invokana for a month now. I’m also rechecking insulin, glucose & ACTH. I’ll be giving Pergolide & then drawing blood 4 hours after. Do I need to do the same with the Invokana or does the time the it’s good enough not matter for drawing blood? Thanks in advance! 
--
Beth & Flame dx 2013 & Diana dx 2020

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  




Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

Maxine McArthur
 

Hi Susan
We know you are a long-time member, but I'm attaching our welcome message for new members below as it has useful links to things like the case history instructions and how to upload and label photos/radiographs, plus links to recent research on suitable feeds, metformin, etc.  Have a read through, as there may be information there that is new to you, 

Let us know if you have any issues uploading a case history for Remy. 

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. 


--
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: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

 

Susan, 
As an alternative, buy CP in the target dose, say 1 mg. To taper up the dose at the beginning, use a dosing syringe that show ml marks. I use this one.   https://www.amazon.com/dp/B01M9BHTTS Dissolve the contents of a 1 mg capsule in 4 ml water, shake really well to dissolve and then give 1 ml/day for 4 days to administer a 0.25 mg dose. Do similar math for the next 0.5 mg gram dose, except divide 4 ml in the syringe in half instead of quarters. Store the syringe tightly capped in the refrigerator. Alternatively, you can taper using Prascend tablets and do the same math: divide in a known amount of water, dissolve really well, and then divide the liquid by quarters to administer 0.25 mg/day. That way you only need to buy CP in a single dosage and can skip the 0.25 mg CP.

Do shop around for CP.  I did recently get a medication compounded by Wedgewood through my vet with no prescription information on the container. I sympathize with owners and with vets. We are all being squeezed by price increases and unreliable supply.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: ?? Vaccine Reaction

 

Nancy,
Many of us give our vaccine reactive horses both an NSAID and Benadryl right after the injection. Details here: https://ecir.groups.io/g/main/message/274367 
I check for a site reaction, fever, loss of appetite, lethargy (which can be a sign of a fever).
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


locked Re: Urgent Advice Required (Part II)

Rebecca.speed@...
 

Dear Cass & team. 

I’m very sorry it’s taken me this long to sort out both addresses I have logged here. I’m hoping what I’m sending here is now using the correct one. 

I was hoping to check it Dr. Kellon had revived my vets email address so information regarding the use of Ertugliflozin could be sent to them. 

I followed a link to what I assumed was Dr. Kellon’s email address but perhaps I incorrect as both my vets tell me they haven’t received any info. 


Thank you x
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Re: Laminitis, ppid and ir

maed@...
 
Edited

Hi Eleanor,

I know that for people there’s the blood removal for higher iron levels.  And so I was kind of thinking that there was just a written up protocol out there for the horses too. It’s interesting getting more of a glimpse into how that happens.  


And the place that I board at - it’s just swimming with excess Iron. The bowls are rusty in the automatic waterers, the hay is higher in Iron and I’ve even seen that there are red salt blocks around.  I told them that this is bad for the horses general health and I’m currently working to try to get them to change some things around.  However I was also reading in the article that there’s other reasons for the Ferritin to come up as high such as illness, injury, and active Laminitis.  And he might have been in active laminitis when we took the blood sample.  Or maybe he has something else going on?  So maybe I’d have to test it again?  And I was also wondering if he’s got some kind of possible anemia going on - that might prevent blood from being removed.  


Still working on getting the CH sorted out and actually my computer and printer as well.  I think that they’re both possessed or something-uggh

 

 



--
Mary E in Wi 2021


?? Vaccine Reaction

 

Yesterday the vet came out and I had Akira's teeth floated and he gave a tetanus shot. She hasn't had a vaccine of any kind since 2018 because of all the horrendous reactions she has had but I was on the fence with the tetanus only. She did fine and last night I checked her feet for heat and pulses and there was no site reaction. Yay me. FF to this morning and she came out of her stall walking like she was in pain and hadn't finished her evening meal or her hay. No heat in her feet no bounding pulses no temp. I gave her a dose of banamine because she was clearly in discomfort but I couldn't tell from where. I checked on her this afternoon and still not walking normal and no fever, no heat no bounding pulses. So I put her in her soft ride boots out of caution. My question is...what other reaction could she be having? Joint or muscle pain? I am really scratching my head on this one. She let me pick up her feet no problem and clean them out before putting her in her boots and she is eating her hay normally.
--
Nancy and Akira
3/20/2018  Burkesville KY

Case History: https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Akira


Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

LJ Friedman
 

It’s the same thing with ordering pentosan. through wedgewood. If you go through your vet and purchase from him he marks it up double, but if he send the script to wedgewood and you pay for it directly to wedgewood,you get it for half of his price
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


trh stim and exercise

LJ Friedman
 

Cornell says that exercise can increase ACTH levels. When I draw for my stimulation test, how many hours after exercise would you consider this not being a factor? Would you consider the walker at the walk exercise, and if taking a riding lesson on majestic, how many hours after the lesson would you consider enough rest to not raise ACTH? I can always do no work for him that day ,but often like to do something for him
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

Eleanor Kellon, VMD
 

If you want to learn about laws and AVMA policy on writing prescriptions go here https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/pharmacy/prescriptions-and-pharmacies-faqs-veterinarians
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Laminitis, ppid and ir

Eleanor Kellon, VMD
 

Here is the latest paper on iron https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971364/ . Those reference ranges are NOT normals. I've spoken with the laboratory director and the population they tested for those reference ranges was mainly senior horses. The article link describes how the founder of that laboratory determined normals.

Would it help to have a blood draw? I don't know for sure because it hasn't been studied but in other species, yes.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

Eleanor Kellon, VMD
 

Mark up on dispensed medications is often a major profit maker for the practice. This allows them to keep prices down for things like call expenses and surgeries.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

canequinmorgans@...
 

ACK!   I'm trying not to disparage your vets (except in my head), but I just received my Wedgewood order: Pergolide granules 1 mg/5 cc's, 100 doses for $90.25.  Your 0.25 mg dose, even in capsules, should have been less, probably in line with the Avrio quote.  Granted, my wonderful vet faxes a script (and even searches for the cheapest pharmacy for me!), but I also have "autofill," so I don't pay shipping, and am tax exempt as my farm is a business.   

Last month, my 90 1mg capsules from Wedgewood were $115 for Horse # 2. (Horse #3 is on 6mg...you don't want to know.)
--
Beth Benard
2003
Rome. NY


Re: Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

LJ Friedman
 

I think the diff is you went thru your vet at wedgewood and you paid him... so he marked it up.. if you were to have him call in an rx and you were to  pay to wedgewood your price is very much less
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 

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