Date   

Re: ACTH Results seem too high - could the blood have been compromised?

Maxine McArthur
 

Lisa, when you say the vet froze the blood for the ACTH test, was it after he spun (centrifuged) it? If so, that’s the usual practice, to preserve the sample while in transit. However, if he froze the blood without spinning, that could affect results—but the lab would have commented and probably rejected the sample. Do you have the actual lab report? 


--
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

 


Woody case history

Chris Hanson
 

Hi,
I’m not sure if I’m posting on the right board here for these questions but here goes (apologies if this should be posted in a different spot):
I’m on a Mac laptop that is not able to run its normal Word programs so I’ve put together my horse Woody’s history on a Google drive.

I was not able to open the program suggested for Mac users on my laptop (didn’t try it on my phone, there’s a thought…).

when I finished a lot of the history I saved it in Word to my laptop and loaded it from there to ECIR website.

one more apology…the link to Woody’s file that I uploaded is on my laptop and I won’t be able to add to this message until this evening.

Chris
--
Chris H in CA 2021


Re: Laminitis, ppid and ir

maed@...
 

Also wondering if the normal levels for the labs on Iron we’re changed?  It has a different listing for lab normals on the case history than what the vet told me.  
--
Mary E in Wi 2021


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

maed@...
 
Edited

 


Most of the time everyone you go through gets a cut. And it’s that way with prescriptions, glasses, mattresses, etc.  And the more middlemen you have the more expensive it gets.  And to some extent it helps businesses be able to make a profit and to stay in business.  Also each Pharmacy marks up each medication differently too.  Like some Pharmacies will price drug A cheaper than drug B.  But another Pharmacy will do just the opposite.  And with me, if I need something quick and easy - I’ll go through the vet.  If it’s going to be long term I’ll shop around.  
--
Mary E in Wi 2021


Re: Questions about Bullitt's High Insulin

Lavinia Fiscaletti
 

Hi Sarah,

Good to hear that Bullitt and Kate are doing well.

I hear your frustration. My mini Dinky also appears to be doing really well, his ACTH came in at 17.5pg/ml but his insulin is over 200uIU right now. Diet is tight.

If the Wedgewood pergolide is their Medimelts, there has been some concern regarding the potency stability of this form of the medication but it would show up as Bullitt's ACTH not being adequately controlled. There are no inert ingredients that would account for the high insulin reading, however. You could consider upping the pergolide dose a bit more to drop his ACTH into the teens to see if that will help.

Getting his BCS down a bit further to no more than 4.5 may be helpful as the minis appear to do better when they are kept on the lean side. He may also benefit from starting Metformin to get the insulin lowered as it is definitely above the levels that induce laminitis. Dosing is 30mg/kg, twice per day. More info here:

https://ecir.groups.io/g/main/filessearch?p=name%2C%2C%2C20%2C1%2C0%2C0&q=metformin

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Re: list of balancers

Lavinia Fiscaletti
 


Hello Kimberly,

Welcome to the group! 

Glad to hear that your boy is not currently in a crisis situation. The list of people who do diet balancing is found in the Files section of the group, in the Diet Balancing Folder. Here's the direct link:

https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf

The remainder of this message contains our new member Welcome, which will provide an overview of the group's philosophy and lots of links to more in-depth information. Warning: there's a LOT of info here, so grab a comfy seat and a cup of your favorite beverage to help with the read. Most find it helpful to tuck this away somewhere easy to locate for future reference.

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.


--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


list of balancers

klane4444@...
 

Hi , I’m a new member,
was looking for list of balancers who were
mentioned on this site, I can’t seem to find . I do have a hay analysis. I have an ems
horse that is not currently in crisis.
I am just trying to make sure his diet is optimal.
Thanks for any help
--
Kimberly Lane, Oregon, 5/2/2022


Re: Diet for IR horse

a.k.a.petpalace2@...
 

Okay, so basically we've trying to treat a clinical sign of an underlying disorder.  Not surprising Apollo's having problems. Vet thought it would help him feel better and get him started on losing weight.  I was hoping it would only be for 2-3 months as it depresses his own thyroid function. Is there any benefit to keeping him on Thyrol-L any longer?   I know he will need to be weaned off of it and I think I saw ECIR has protocols for that.
 
If I'm interpreting his most recent bloodwork correctly, it looks like right now his biggest problem is the uncontrolled EMS/uncompensated IR given his baseline ACTH was only 12.1 pg/ml.  There's also been a huge reduction in urine output since starting Prascend.  Participating in the TRH stim test study could be helpful in reassessing the current status of his PPID.  It would not have been picked up last fall without using it. 

At this time, Apollo is definitely standing and walking more comfortably although he's still quite stiff when goes out in mornings.  I suppose I could retest his insulin and glucose level to see what impact changing his diet has had but I suspect Metformin would still be useful.  I'll contact the vet again regarding using Metformin and provide him with ECIR handout of its use as well as a link to study in horses (from another member's message).  I know Apollo's not going to be really comfortable until his insulin comes down.  I do have a couple of questions:  why does the lab report his insulin level as >200?  That could mean it's 201 or 500, so how can you tell it's improving?  When I put Apollo's insulin and glucose values in ECIR IR calculator: IR considered uncompensated and his pancreas can't keep up.  So why isn't his glucose also high?

I'll get his diet balanced by someone on ECIR list I recently received in message. Sorry, I didn't know there was such a list months ago or I would have used it.  We do have a third cutting of hay that's low ESC/starch but iron content is even higher than what we're feeding now.  At what level is it too high to get minerals properly balanced?  Apollo ate more hay during coldest parts of winter and wondered if that caused his relapse.  Does his iron panel results suggest too much iron is contributing to his EMS.  Apollo's not a fan of beet pulp but would it be better to feed than high iron hay even though it's higher in calories than hay?


--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo


Re: ACTH Results seem too high - could the blood have been compromised?

Lavinia Fiscaletti
 

Hi Lisa,

Short answer is that mishandling will lower results, not increase them.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Re: Balanced Timothy Cubes in Ohio

barefooted4
 

Carla, I’ve still got an order in with them and they are quite a bit closer to me!  Thank you for the lead!  We’ll get it sorted out!

--
Kristie Brand  2010
Arcanum, Ohio


Re: Balanced Timothy Cubes in Ohio

barefooted4
 

I’m north of Dayton and near 70 ~ 20 miles from OH/IN border and would be happy to combine orders and pick up.  I’m so glad any confusion is clearing up!  
--
Kristie Brand  2010
Arcanum, Ohio


ACTH Results seem too high - could the blood have been compromised?

Lisa Toms
 

Hi there.  Can blood be compromised and return a high ACTH for a non-cushings mare?

My IR mare lost quite a bit of muscle tone nearing the end of our summer, around 5 weeks ago.  I have checked faecal count, teeth and increased her roughage intake.  I also requested a Gluocose/Insulin and ACTH test just as a precaution not expecting the ACTH to come back as cushings because she isn't showing any signs of cushings apart from the muscle loss.

The ACTH test results came back as 157 pg/ml - the vet said this was 4 times the norm.  The vet was quite young and firstly froze the blood for my sugar/glucose test <sigh> along with freezing the blood for the ACTH test (so I couldn't get a glucose insulin reading).  The ACTH blood stayed frozen for around 4 days as he didn't get it couriered before the public holidays started.

I am wondering if its worth getting another vet out to draw blood again and do a new ACTH test?  I really don't want to start her on Pergolide unless I have 100% confirmed she is cushings.

I have posted recent photos in her photo album and the ACTH test results in her Case History files folder.

Thanks so much!

--
- Lisa & Bonnie
August 2012, Cape Town, South Africa 
Bonnie Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Bonnie 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=21740


Re: Laminitis, ppid and ir

maed@...
 

Hi,

Thanks!  The hct is at 31 so I’ll give the vet a call tomorrow morning and see if she’ll be willing to do the therapeutic phlebotomy.  It does seem kind of odd  - but whatever will help him- 



 

--
Mary E in Wi 2021


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

Lavinia Fiscaletti
 

Hi Susan,

Wedgewood does prefer to deal directly with vets, not the end consumer. In this case, the vet was Wedgewood's client, not you, so they would give pricing to the vet.

You were the vet's client so your cost was determined by the practice.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


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

Susan Vaughan
 

Sherry.    I know.
It just doesn't sit well with me that WW won't give cost info.
They had the prescription but wouldn't tell me the amount charged.  
--
Susan Vaughan in Houston Texas
Member since 2004


Re: Sudden onset of stallion behavior in 30 yr old gelding

Cathie Vincent
 

Blood test through Cornell. He seems to have settled own now that her cycle is finished. It will be interesting to see if he gets worked up next month. Mean while I'll talk to my vet. Thank you
--
Cathie
February 2018
Whidbey Island in WA
https://ecir.groups.io/g/CaseHistory/files/Cathie%20and%20Chief


Re: Sudden onset of stallion behavior in 30 yr old gelding

Sherry Morse
 

Hi Cathie,

Could you please update your case history with test results/diet/weight?  Is his IR well controlled at this point?




On Sunday, May 8, 2022, 02:11:27 PM EDT, Cathie Vincent <cjv10@...> wrote:


He gets tested every year no changes.

--
Cathie
February 2018
Whidbey Island in WA
https://ecir.groups.io/g/CaseHistory/files/Cathie%20and%20Chief


Questions about Bullitt's High Insulin

Sarah Orlofske
 

Hello All

We have made substantial improvements with care of our two PPID&IR Minis because of this group. Thank you! I have some questions about each horse, but decided to make them separate topics because they are so different. Stay tuned for Kate's question soon! Here we go for Bullitt...

Bullitt has maintained a healthy body condition and he is the lowest weight he has ever been, even after getting some extra feed during our brutally cold winter. He is excited and energetic to go for walks now that the weather is starting to cooperate. He is eating his soaked hay and minerals mixed with wet TB Cubes and some beet pulp. His hooves have improved substantially and farrier says they look great (I will try to post updated photos soon). 

But bloodwork on April 23 revealed that his insulin is over 130 (range 10-40) and the highest it has been since he had laminitis in August of 2020. His ACTH has actually never been better coming in at 21 (range 2-30) on 1.5 mg Pergolide. This is the level of medication we increased to after blood work last July indicated we were still above range and I was so happy with how he was doing in the fall I decided to leave him at that level and I am glad I did. 

I have updated his case history with more details, but really looking for help for what could be going on that would cause this increase and then of course what else we can do about it. I know we need to increase exercise and that will hopefully be happening starting soon.

I am concerned that the spike is due to the compounded pergolide we got from Wedgewood in the tablet form. This is what our vet got for us. She gets the prescription for us and then gives it to us. She didn't give us a choice and just brought it. I never thought there could be enough inactive ingredients to cause a problem, but now I am worried it might? Prior to this I had been syringing the Prascend with a little homemade unsweetened apple sauce so I thought a tiny amount of sugar was OK in order to get in the meds that are super important. The only other thing that changed was the supplements. I did the balancing myself after Dr. Kellon's class, but have reached out directly to her for advice about that. Any other thoughts or ideas would be welcome. I just struggle believing this because by all other measures he seems like he is the healthiest he has ever been. 

I appreciate your help. Thank you for all you do for our horses. 

--
Sarah O. 
Rudolph, WI
2020


Re: Diet for IR horse

Sherry Morse
 

Hi Karen,

Rinsing hay is not enough - if it hasn't been tested it needs to be soaked, 30 minutes in hot water or 60 minutes in cold water.  There are plenty of options to feed an IR horse and if you've had your hay tested you can contact one of the balancers listed in our files (https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf) for assistance with balancing that portion of his diet. 

Thryo-L can help jump start weigtht loss but the only way to really see improvement in thyroid levels is to get his IR under control. If you decide to stop Thyro-L you will need to wean him off of it at this point.  You can read more about that here: 

If you can confirm Apollo's ideal and current weight you can certainly develop a diet tht will help him lose weight even without being able to exercise.  This would require that you feed him 1.5% of his current weight or 2% of his ideal weight (whichever is greater) with possible tweaks down if needed.  This total would include ALL intake per day (hay and any concentrates).  

As far as his feet we will not be able to make any recommendations without pictures.



Re: Dumb questions about pads

 

Thanks, Nancy. I’ll try again. We’re just trying to make it day to day. In her opinion nothing makes her comfortable. I’m not sure anything can make her comfortable because I can’t replace her suspensory ligaments to remove the mechanical component.  We’re working on ruling out metabolic issues. It takes an eternity to get bloodwork to and from Cornell in an emergency out here in the far west.  IDEXX results aren’t credible. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

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