Date   

Re: Is it too late in the season for TRH-response test?

Eleanor Kellon, VMD
 

We have this detailed study as a guide to seasonal changes in that test https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2011.0712.x . Unfortunately they only used nine horses but it's a start. I would do it ASAP. It would be a really good idea to do a Lyme Multiplex too. That tends to flare during the seasonal rise.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is it too late in the season for TRH-response test?

Sherry Morse
 

Hi Jen,

From January to June TRH stim testing is ok but now that we're past the solstice the general advice is: 

TRH stimulation testing can only be used to identify negative cases in these months due to many false positives

How much wiggle room you have as it's 'just' into July I'm not sure about, but Dr. Kellon might be able to comment.




Re: Need help quickly

Eleanor Kellon, VMD
 

Shelly,

I'm sure you have seen how little an effect the bute has on his pain. However, when used long term like this you have to wean off slowly because if you don't there will be a rebound effect, which is probably what you are seeing. The other thing that can happen is they prevent abscess collections from mobilizing so actually are prolonging his pain. No one here has seen any significant effects from gabapentin either - and that is THOUSANDS of members.

He hasn't lost weight from herbal supplements. It's from chronic pain. As your welcoming post said, this has to be approached in a comprehensive fashion.

D: Diagnosis: We need to see you blood work and there may even be something else going on
D: Diet and Drugs:  To control insulin and PPID
T: Trim: Very, very important and often the thing people have the most trouble accomplishing

E: Exercise, when sound. Until then, movement as he feels comfortable doing but in a sealed muzzle.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Is it too late in the season for TRH-response test?

J
 

HI all. We had been scheduled earlier to get the TRH-response test  but the appt got rescheduled. Then there was a vet emergency and got rescheduled again. Vet was out today and I thought we were doing the test but apparently some miscommunication re which tests were supposed to be done. In any case, is it too late in the season to do this test or should I get it done ASAP? I realize a pos may not be reliable but a neg I was thinking would be good info.

Sparkles is doing excellent. Back to her normal self ... cantering daily around the track.

Thanks

Jen
--

Jen and Sparkles in New England 2022
CaseHistory@ECIR.groups.io | Album
Sparkles Case History


Re: Need help quickly

Bobbie Day
 

Hi Shelley and welcome to the group!
I'm sorry your boy is struggling right now but we'll do what we can to help. Since this is your first post, I will be sending your welcome message along, it is quite a bit to read, but it will help you immensely while navigating through this. The hyperlinks will provide you with even more information on the subject, just please take a breath and read it when you can. 
First off, we really need a case history with all his test results, x-rays and pictures of his feet and body just as soon as you can manage. We really need as much information on him that you can provide, even if you have to do it a little at a time.
It's very important to keep him off grass completely, if you feel he "just needs to be a horse", please get him a sealed muzzle for turn out. Although exercise is the best insulin buster there is, if he is in pain and not moving freely by himself, please don't force it. 
Now then, NSAID'S are not recommended here, you don't say what breed he is but there are a lot of thrifty breeds that are genetically predisposed to IR, so diet and exercise is very important for these horses, and since high insulin can result in laminitis (which isn't inflammatory), any NSAID may hinder his recovery, I will include some information on getting him off the Bute and provide you with pain alternatives instead. We don't recommend gabapentin as most members here have not seen a difference with this medication either, if his trim is good, you can certainly give him Jiaogulan.
What is diet like otherwise? I would get him on the emergency diet first thing, and if you haven't already get his hay balanced.
Again, if you can provide pictures, we can better help you. 
We have a lot of members that board that have had the same issues, we know for some it just isn't possible to have their horses at home, but maybe you could move him somewhere closer to a facility that would be more inclined to follow your wishes? I for sure would insist on the no grass. What herbal supplements are you feeding him? All the details matter. Are you able to get Uckele products there? You can also use Devils claw for pain just be sure to taper the bute if you take him off. 

How to Taper Off NSAIDs.pages (groups.io)
Why NSAIDs & Icing Are Not Recommended .pdf (groups.io)
Pain Relief Alternatives to Bute and Banamine (groups.io)
Uckele Phyto-Quench Pellets 5lb
Uckele LaminOx 3.3 lb

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


Need help quickly

tippy@...
 

Good Morning
I have just joined your group today and am looking for help.

I have a 9 year old gelding that was diagnosed with IR and Metabolic syndrome and no cushings back in Sept 2021. I have been working with several Vets since he became laminitic March 6th, 2022.
The Vet still has me giving him bute twice a day and gabapentin once a day. I have tried to reduce and he becomes worse. 
Now where I board the Family is vey stressed and feels I should put him down as it is too much trouble for them. I need to possibly relocate him because I am not giving up on him. I have boarded him there for 8 years.

My biggest question is because he is still so lame after all this time and I would like to be off the bute to start the J Herb I really don't know what to expect. I need the support of my boarding facility and go out everyday for 4 or 5 hours but it is a 2 hour drive there and back. The trimmer said she has never seen a hoof grow back peeling the way it is doing. She believes there is something else going on because he has been so bad for so long.
The Vet was out when he had a colic episode near end of May 2022. He said let him be a horse and graze early mornings. I know that shot his insulin up and have tried to explain to the barn that he needs exercise but also should not be grazing. He was around 1,400 lbs but has lost significant weight in the last 2 months due to herbal supplements. He looks great now and needs to leave more but am working on it.

What is my next move???
--
Shelley C MB Canada


Re: Haylage Cushings/Laminites

hildekittelsen@...
 

Thank u😊

yes,and i have tested it.But we a buy a lot of balls at once and can only test one or two because it cost a lot for testing haylage and hay🥺So i could never know If all of the balls are safe really🥺Just assume that haylage from the same batch would be getting same results🥺
--
Hilde
Norway
https://ecir.groups.io/g/CaseHistory/album?id=273158


Re: Severe lameness in IR horse under vet/trimmer care

Eleanor Kellon, VMD
 

An abscess can brew for months, especially with NSAIDs on board. They do little for the pain but slow down resolution. This mare needs to be tested for PPID. She didn't suddenly become IR 18 months ago.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Haylage Cushings/Laminites

Kirsten Rasmussen
 

Hi Hilde,

It is important to test her non-fasting baseline ACTH (to see if your pony is getting enough Prascend to control the PPID) as well as insulin and glucose to see if the diet is low enough in sugar and starch.

We are not overly familiar with haylage but it seems very popular in the UK and northern Europe.  It is a great feed for equines with EMS, if you can be confident mold is not a problem.  In the US and Canada hay can be tested for mold toxins at various forage testing labs (like Equi-Analytical)...can you look into that type of testing in Norway?

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Re: New Blood draw

Kirsten Rasmussen
 

My question about the bloodwork is that to me, we ran blood a month ago, diet is the same, exercise for Ryn is more but for Mouse is just walking in his paddock so wonder if doing bloodwork now is not prudent or if we should wait until Mouse can be exercised which cannot be until he is sound.  Just looking for some guidance.
I'm not sure this was answered.  You can do bloodwork as often as you like.  Usually for best value we advise it after making a change (diet, exercise, medication), or seeing a change in the horse (increased/decreased pain and/or voluntary movement for example).

I know it's a lot of working keeping 2 up to date Case histories, let alone the details we are asking to be corrected, and what we are asking applies to many ECIR members (not just you!!).  But it really helps.  :)

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Re: Update on Isaac

Mialisa@...
 
Edited

Thank You, Cass! At this point I was just trying to isolate Isaac's preferences. We are still feeding without the timothy pellets and he is still eating his supplements which have the fresh ground flax seed base. The olive oil will be added to help with the absorption later. It was not my highest priority at the moment. So...it is looking like I will not need any other carrier, but I will see how he responds to the trial samples of Stabul 1. With four to feed it is much simpler if they all can eat the same meal. Everyone else has accepted the timothy pellets and Isaac did at first too, until the increase in Prascend.

This is another question: I just noticed Isaac has fecal water as his tail started getting dirty. I have noticed hind gut issues with Joshua, but not Isaac ever. Has anyone else ever noticed a problem with loose stools or stomach upset from Prascend? Should I search or start a new topic?
--
Rene` in WI 2021
CaseHistory@ECIR.groups.io | Album
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Re: Severe lameness in IR horse under vet/trimmer care

Bobbie Day
 

Hello Karen and welcome to the group! Since this is your first post here it prompts a welcome message which I will include below. It's great that your seeking help for this horse, is there a chance the owner would consider joining and create a case history for her horse? We're assuming you have permission to share the information with the owner, but we do strongly encourage them to join.
There is obviously a lot going on here, first off, no horse with IR issues (cresty neck, feet issues) should be on any kind of vegetation, weeds or not without a completely sealed muzzle.
I will also start with the hay; we don't find that alfalfa is suitable for most IR horses as it can make some foot sore. Is there a chance that you could obtain a good quality grass hay, or something from our safe feeds list? 
You say it's been tested, was it a wet chemistry test? As you will see in your message below, we suggest under 10% sugar and starch, but some horses need much less. What was the insulin number? 
There are drugs to help lower insulin, but we want to be sure we first address the cause of the elevated insulin first. You could talk to the vet about metformin.
Metformin 08.08.20 FINAL (groups.io)
I cannot stress this enough, we don't recommend NSAID'S as laminitis isn't inflammatory, you could try laminox, Jiaogulan (if the trim is good) to encourage circulation. Or Uckele's Phyto-quench is also recommended. 
Pain Relief Alternatives to Bute and Banamine (groups.io)
Uckele LaminOx 3.3 lb
Uckele Phyto-Quench Pellets 5lb
Just be sure it's the pellets, as the powder has yucca which isn't recommended. Or you can source devils claw for pain from bulk supplements and feed that if you prefer.
We also don't recommend PP, the owner would be much better off by balancing the hay to what the horse actually needs in their diet, the problem with these supplements is that they have so much that you don't need and not enough of what you do, it's also morse cost effective. I would really encourage the two of you to start the emergency diet outlined below until things settle down.
We really need a case history will all blood work and the x-rays you refer to, if you need help with this let us know. 
As far as abscesses, it can take a while for them to work their way out, but NSAID'S will hinder that process, so again it's best to taper off and start with the J-herb to help with circulation.
How to Taper Off NSAIDs.pages (groups.io)
Why NSAIDs & Icing Are Not Recommended .pdf (groups.io)
I know I've given you a lot to think about and you will find so much useful information included in your welcome message below, we realize it will take you awhile to get through this but please keep it handy and maybe share with the owner? It also includes many links to very important information, let us know if you have any questions. 

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: Returning to work after a laminitis episode

Kirsten Rasmussen
 

Hi Louise,

If Nugget is comfortable in boots and has had a corrective trim you can start handwalking in straight lines.  We generally like to see trim photos and existing rads before we give the green light to exercise though since we've seen a lot of very poor trims.  If returning to exercise is driving work, it can be started earlier than ridden work in a larger equine.  Let his level of comfort dictate how much you do: don't force him to move, and if he is the type to overdo exercise hold him back to a walk.

In North America it's the "Karo" syrup test.  But as Maxine stated it is not necessary.  You need baseline non-fasting insulin, glucose and (if over the age of 15) ACTH, as detailed in the Diagnosis section of your welcome letter.  Adiponectin is nice to have but not as important as insulin.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Re: Was chewy and compounded pergolide / Now Welcome Susan Vaughn from Texas

Bobbie Day
 

Hello Susan,
First off thank you for providing your experience with Chewy and compounded Pergolide. It appears that although you have been a member for a few years now, that you may have not gotten your welcome message, so I will be including that below. 
Yes, a case history on your horse (s) would be very helpful, especially important if you are participating in the study, background information is vital to our work here as you know. It sounds as if Remy is doing well so kudos to you! 
And we want to officially welcome you, so here you go!


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


Severe lameness in IR horse under vet/trimmer care

kkellyglennon@...
 

I am the caregiver the past approximately 4 years (not owner) of this horse:
19 year old draft dam, Friesian sire mare
Approximately 15.2 hands.
Overweight since I've known her, more so after her dam, who she's always been pastured with, died about 3 years ago. Living solo since but has 50+ cows in next pasture.
Cresty neck developed gradually,  approx 18 mo ago. Annual vet check and vet didn't bring concern to owner.
Intermittent lameness, became more problematic, vet put on bute. On bute for probably a year before I got owner onboard with a new vet. Changed to Previcoxx this spring.
Diet: on about an ¾ to 1 acre of weedy pasture. About ¼ to ⅓ if it is limestone rock outbreaks.
Free choice first cutting hay in a slow feed hay net - mixed grass with a little bit of alfalfa. I've had it tested at Equi-Analytics.

June 27, 2022
Finally got new vet in to look at her.
Insulin resistant 
X-rays show 10.8 degrees rotation front left and 14.6 degrees front right.
Possible abscess in right front observed on x-ray. Poultices with Epsom salt goop.
Vet started on Platinum Performance hoof supplement, Thyrol supplement on a 6 week step down schedule and switch from previcoxx to bute 2 grams twice a day
Begin feeding soaked hay.
Start 30 day stall rest 

Trimmer came and trimmed 4 days after vet visit, which was her scheduled 6 week trim. Vet emailed x-rays to him to go off of.

Continue supplements, meds, retrim in 2 weeks. Trimmer said she'd have good days and bad days and lameness remained fairly consistent. Retrim at 2 weeks and he took off heel mostly. No signs of abscess.  Things going along fairly the same until last Monday, June 27, when she was not wanting to weight bear on right front. Absolutely hoping lame.
Had vet out same day. Difficult to get her to stand square, wanted to park out but got xrays. Rotation on left 4.6, right 11.5. unsure if the right has additional rotation. No gas pockets noted on x-ray and positive for hoof tester all around hoof. She is standing with the hoof tipped, resting on the toe. She doesn't want to walk on the sole. She'll drag it back to back up and tip toe hop on a forward step. 

My question, how long can an abscess brew? How do you know it's something else? 

When I figure out how to attach the x-rays, I will.

Thank you,
Karen
Novice horse owner of my own little cob.



Re: chewy and compounded pergolide

Susan Vaughan
 

I wanted to reply to this.
After another round of fisticuffs with Wedgewood I transferred the Rx to Chewy.
Info asf:
Pergolide compounded 1.5 mg capsule.

Order placed June 29,
Shipped June 30,
Received July 2.

Bottle label:
Compounded June 21, 2022
Filled on June 30, 2022,
Use before December 18, 2022,
Refill by June 29, 2023.

It was not my plan to go with Chewy, but seeing they had it - I went with it i/o
filling the Prascend - also on file at Chewy.

60 capsules cost $66 inc. shipping.

I don't have a CH on file yet.
Will do that when I can - so many things going on.
My horse is enrolled in the TRH Stim test study.
We've done the two tests.
Paperwork for that to be mailed soon.
His level increased post Stim - having been on 1 mg for a month.
For two weeks prior to the 1 mg dose we slowly increased the dose from .25 to .50 to .75 mg.
He sailed through it with no problems and was given APF.
Remy is my third horse in a row to develop Cushings.
--
Susan Vaughan in Houston Texas
Member since 2004


Re: Sugar in common ragweed

Eleanor Kellon, VMD
 

If they really enjoy eating it you need to be concerned about it. Ragweed is usually only palatable in the early growth stages. When it gets tall, they won't eat it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Sugar in common ragweed

fullcirclefarmhorses@...
 

Thanks, Sherry!  I never thought about reaching out to my extension office.  I did find and read the article yesterday you posted.  



Heather W in WI 2022
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Ava
https://ecir.groups.io/g/CaseHistory/album?id=273564


Re: Sugar in common ragweed

Sherry Morse
 

Hi Heather,

You can contact your local county extension office and ask them if they have any idea about this information but most likely you would need to collect samples and send them to Equi-Analytical for testing to get this answer if the Google hasn't provided you an answer.

Personally I would keep the horses from eating it by any means possible if you have worries about laminitis until you have an answer. 

You might find the following link useful:




Re: Trim Advice for Ribbon please Lavinia

Sherry Morse
 

Hi Courtney,

Please see the directions on how to take hoof photos in the Wiki: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help.  We really need you to back the camera up enough so the cannon bone is in the picture as well as the hoof - this will probably put you a few feet away from the horse.



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