Date   

Re: Private: Re: Test results for Emmy

Sherry Morse
 

Hi Joy,

Thanks for getting those photos up!  Were she mine I'd want to see her trimmer for sure but she's not what I would consider an 8.  I'd put her at a 6+ but she's not quite pushing a 7 based on the pictures so that's a good thing.  https://ecir.groups.io/g/main/files/Case%20History%20Tools/Tools%20and%20How-To%20Help/Body%20Condition%20Scoring%20Guide.pdf for a visual guide to body scoring may be helpful.  

For arguments sake I'd feed her as if you want her to be 1000lbs as an ideal weight so no pasture time without a closed muzzle, no alfalfa hay and cut back on the concentrates.  I'm not sure why I typed 18lbs the other day - 2% of 1000 would be 20lbs a day max but you may need to tweak that down if she's not losing weight on that amount. Also, no Himalyan salt as the color comes from impurities like iron which Emmy definitely does not need.  

I'm curious to see where her ACTH tests on the increased dosage (which she definitely needed) and also where her insulin falls with increased exercise and a tighter diet.




Re: Attn Lavinia - Hoof markups request please UPDATED BODY PHOTOS IN FILES

Joy V
 
Edited

Good morning Lavinia,

The body shots of Willie are in his photo folder now.  Thank you again, so much, for helping him and me.

Joy


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275142


Re: We lost Alley...

Carla Anderson Peters
 

I am truly very sorry.  Healing hugs to you. 

--
Carla

 

December 2013, WI

Cupcake and Gunnar's Case Histories 

Cupcake's Photos

Gunnar's Photos 

Ω



Re: 31 yr old mare newly diagnosed PPID/IR

Sherry Morse
 

Hi Mary,

I'm so sorry to hear about your MIL.  As you haven't started Vandy on meds you may want to start her on APF and then titrate her up to 1mg of Prascend as outlined in your welcome letter, but you do want to get her started on that ASAP.  When you have a chance you'll want to update the CH to show she's 14.2 and that the previcox was stopped as well as adding in her dose of Prascend and what the start date for that is.  

Once you are weighing her hay please update that information in the CH as well and include a date.  Was the hay tested via NIR or Wet Chem?  Do you have the actual test results? 

As she has elevated insulin she should not be on pasture at all unless you are able to turn her out in a closed muzzle.  It is very important with an IR horse that they eat a very controlled diet which means you need to know exactly how much she's eating of each product per day.  We ask all these questions because this is where we identify where the diet can be tightened up.  

If she's quiding hay and her teeth have been checked and are in decent shape you can replace her hay ration with the timothy balance cubes.  Those are fed at a 3:4 ratio to hay so if she is eating 2lbs of beet pulp a day and should be eating 17.2lbs of hay you would feed her 12.9 lbs of cubes per day - no more timothy pellets (which may or may not be under the 10% ESC+Strach numbers we look for) and no more TC Senior (which is definitely NOT under the 10% limit).  You would then only need to add salt, vitamin E and flax in as the cubes are balanced to themselves.  Those can be added to the beet pulp so again, no other concentrate needed.




Re: Metformin Added/Not Eating Food

Eleanor Kellon, VMD
 

Don't wait any longer than a week after starting to syringe it in to recheck insulin.  There are some horses where it does not work, no  matter how you give it. Recheck in 3 to 4 weeks too.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Vetoryl

Eleanor Kellon, VMD
 

I wouldn't use Vetoryl. If ACTH is not controlled, increase the pergolide dose or go to cabergoline. Do you have a support wrap on his opposite leg?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Hauling Ruby

Eleanor Kellon, VMD
 

There is NO hay that is always safe! You need to test. No benefit from increasing her PQ but I would stop every hour to unload and walk her around, offer water.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Question - laminitis or too much trim?

Sherry Morse
 

Her trim is much better than it was last year which points to the issue being her diet not being tight enough and/or that she should not be eating ANY grass.  It would be really helpful if you could get a proper side shot of her to compare to where she was last August and also if you could update your case history with her current diet.  If she were mine she wouldn't be out on grass unless she was in a closed muzzle - we recommend the Tough 1 or Best Friends Small hole muzzles as those are the easiest to totally block.  




Hauling Ruby

Sue Shaner
 

Just a brief update on Ruby, and then a new question. She has been on Phyto Quench, one scoop per day, and off of Bute for a good 6 weeks, and  is doing very well. I grind it with her flaxseed, salt, magnesium oxide, and natural vitamin E oil everyday. We are still soaking orchard Grass, but have found a source for lovely Timothy Hay that should be available year-round. Is Timothy always safe, or should I still have it tested?
Her activity level has increased, and she seems really excited to go for longer hand walks. She has been in Wood clogs for about 6 weeks, with trims at 4 weeks. We have a very knowledgeable farrier now, who has been able to work well with the new vet and ECIR guidelines.
The newest vet is a holistic practitioner. She discovered that Ruby had actually torn a left abdominal muscle when she had been cast in early January. The three vets before her did not discover that. I am assuming that was a big reason why Ruby did so much better on Bute. It no doubt actually helped with the pain from that muscle tear. It has healed, but in a torn position, so we are rehabbing for that.
We will be transporting Ruby about 2 and 1/2 hours on Thursday, to our new home. My question is, should I increase her Phyto Quench dose for that, or leave everything as it is? Thank you again for all that you do.
--
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


Re: Unexpected very high insulin on low carb feeds—Dr. Kellon

Eleanor Kellon, VMD
 

Regarding the sweet lupin in Hygain Zero, see table 1 on page 2 here: https://www.foodstandards.gov.au/science/monitoringnutrients/afcd/Documents/Industry%20Report%20-%20Australian%20Sweet%20Lupin.pdf . "Carbohydrate" is starch and the inulin is a fructan so NSC 15%, ESC+starch 10%.  Did you have it analyzxed? They don't guarantee any levels, just say it's low."Roughage products" could be anything from alfalfa to corn cobs. It has about 2% rice bran oil, minimum. The information on Chewy doesn't list Canola meal.

Yes, Ally is very sensitive but WSC cannot affect her insulin beyond sugar component. Fructan is not a dietary carb any more than wood is.

The numbers for the latest batch of the cubes is ESC 5.5 and starch 0.4 [WSC 7.6 just FYI] from the raw materials. You could soak your cubes inside a lingerie bag then submit a dried sample for minerals also to see what you need to supplement.

IR does become more difficult to control as they get older and you could have a component of that here. You could try metformin 30 mg/kg twice daily.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Vetoryl

Bobbie Day
 

Welcome Kimberly,
Since this is your first post, I will be including your welcome message, I am sure your familiar with it but since you've not yet received one, we want you to have the information, it can be a lot to read but please take your time and let us know if you have any additional questions. The blue links will take you even deeper into the subject as well.
As you know the cornerstone of the ECIR'S philosophy is DDT/E which is Diagnosis, Diet, Trim and Exercise. The latter is safe only when your equine is ready to move about freely. Although it's the best insulin buster there is we don't want to comprise the already fragile feet.
I do not know anything about Vetoryl, I am hoping that Dr.Kellon might chime in about that but there are other avenues you can take if you think Mouse may have an abscess brewing. First off it would be really helpful to have a case history and photos of his feet and any x-rays you may have. It's really important that we have that information before offering too much advise. If his trim is in good shape, you can try J-herb (Jiaogulan). 
Do you know for sure your hay is under the 10% recommendations for sugar and starch? I would try soaking it for a few days and see if that makes a difference, if it does you will see improvement pretty quickly. Have you had it balanced? Are you rinsing his beet pulp? Is it molasses free?
If he happens to be on any NSAIDS that will keep the abscess from mobilizing as well, we do not recommend that.
If his insulin is high it can drive up hoof pain, or it can mean he needs an increase in his prascend. There are a lot of variables here that's why I mention a case history. You can also try Lamin-Ox from Uckele. If the insulin is the cause, you could try Metformin if your vet is on board. It's just really hard to offer sound advice without knowing more about Mouse. I may also add that lab "Normals" aren't normal, we want ACTH to be in the low twenties at the most. 
https://uckele.com/laminox-3lbs.html
https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

--

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: Vetoryl

Sherry Morse
 

You'll be getting a full welcome shortly but what 'trouble' are you having with Prascend?  Is the current dose adequate to control PPID?  Having a full case history (you have received an email about this) and current hoof photos will be very helpful for us to help you.  Abscesses do not cause laminitis, elevated insulin levels do.  To control insulin you need to have diet dialed in and PPID well controlled. 




Re: Is there safe foraging in a Paradise Paddock?

Sherry Morse
 

This is a question for the Horsekeeping group (where you can do a search on "Paddock Paradise" or "Track System" and get a ton of advice and answers) but the short answer is you will still need to muzzle any IR horse on a track that has any grass or greenery that can be eaten.  You can have a look at Katrina's last note about Tartine who lives on a track and is muzzled 24/7 except for her bucket feed.  She's been a struggle to get controlled and she's doing well muzzled and in heavy work.




Re: auto hay feeder info needed

Ronelle
 

Maxine-  Thanks.  I keep forgetting to look at other groups.  I'll do that.
--
Ronelle and Yoyo
2015 Bend, Or, US


Re: Unexpected very high insulin on low carb feeds—Dr. Kellon

Ronelle
 

Mary- Have you called Haystack directly about the Teff pellets?  If not, their phone number is on their website.  One of the owners is a vet.  They've been very helpful with me.  If you've already tried this, I apologize for being redundant.  Also, where in the PNW are you?  
--
Ronelle and Yoyo
2015 Bend, Or, US


Re: Unexpected very high insulin on low carb feeds—Dr. Kellon

Sherry Morse
 

Hi Mara,

You don't need to go back to 2006 but doing a current history from now going forward will help us help you.




Re: Metformin Added/Not Eating Food

Sherry Morse
 

Hi Jamie,

I think you have your answer - the metformin being given in his food is obviously not going to work for him.  I would recommend syringing with the milk of magnesia and then making sure you rinse his mouth and wipe off his lips as Cass recommended.  Given that he's a picky eater and he now thinks you poisoned him it may take him a bit to get back to eating his bucket feed on a regular basis, but he still should be getting the metformin regardless.




Re: Unexpected very high insulin on low carb feeds—Dr. Kellon

quatzie_baby@...
 

Mara --

I have extra low carb hay, I lost my Cushing horse in February. I hay extra hay tested to be under 10% sugar and starch. If your in the Salem, Oregon area/or near please contact me.
I am more that willing to sell you a some to get you by. It's Valley Grass Mix. You can e-mail me @ quatzie_baby@... if your interested. 
Beet pulp and Haystack Low carb low fat pellets are also very helpful. Wishing you the best 
--


Jeannie 
2010 Oregon
NRC +, CIR0813, NAT0413

Case History   https://ecir.groups.io/g/CaseHistory/files/Jeannie%20and%20Zena
Photo  
https://ecir.groups.io/g/CaseHistory/album?id=57253&p=pcreated,,,20,2,0,0

 

 


Re: auto hay feeder info needed

Ronelle
 

I forgot to write that the auto feeder must do hay.
--
Ronelle and Yoyo
2015 Bend, Or, US


Vetoryl

Kimberly
 

My DVM is requesting information on Vetoryl in laminitis cases that have trouble with Prascend.  Mouse, our horse has been successfully on Prascend since 2017 but we are currently fighting what is believed to be a hoof abcess.  He has been very lame on RF for over a week, DP medial side.  Using epson salt soaks, Ichtammol wrapped boot.  His hay is safe (we grow our own and test) and is on Stable 1, soaked beet pulp, flax.  magnesium.  We did blood work in 2017 and he was marginal IR.  Did blood work last week and are awaiting results.  Very concerned that if this abcess does not blow we will have laminitis develop.  Any help appreciated.  
--
Kimberly joined 7.17.2018 Virginia

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