Date   

Re: Lavinia - hoof review request, 2nd request for Ero

Lavinia Fiscaletti
 

Hi Laura,

I've added some mark-ups to Ero's album:

https://ecir.groups.io/g/CaseHistory/album?id=255939

In general, the trim has definitely improved since the rads were done. Radiographs showed mild sidebone, start of some arthritic changes, toes that were much to long, underrun heels. Sole depth was adequate. The HPAs were broken back, severely on the RF, with coffin bones that were ground parallel.  Toes are still needing to come back more but the heels are being lowered too much relative to the height at the toe. Although they are underrun, you need to preserve the vertical height while getting them to stand up taller, otherwise you are making the broken back HPAs much worse. The angles in the Jan 7, 2021 pix were much better than the Jan 21, 2021 pix so need to work to regain the lost heel height. Below are some links to more reading on breakover, sole depth and heel height:

https://www.hoofrehab.com/HorsesSole.html

https://www.hoofrehab.com/HeelHeight.html

https://www.hoofrehab.com/Breakover.html

LF radiograph: The pink line shows how the bony column should be aligned and ends where the toe should end. The purple line follows where it actually is. Note how the purple line drops back and down from where the pink line is. That is the broken back HPA. Blue X is the extra horizontal toe length that needed to be removed. Red line shows where the bottom of the foot needed to be - meaning the back half of the foot was much too low relative to the vertical height in the front half of the foot. That was a combination of the heels being underrun and the toe too long horizontally.

LF lateral: Green line is where the dorsal wall should be. This is NOT a trim line, it's only a visual to show how far forward the entire foot has run. Blue area is where the toe still needs to come back, A hard roll of the toe maybe the best way to do this as there isn't any extra sole depth available to play with. Orange line is where the heels should end up.

LF sole: Blue solid line is where to add more of the bevel/roll at the toe. Blue lines on the outer edge of the heels are where to  bevel the wall completely out of weight bearing. Use the bar-wall junction to create the heel buttress, leaving that as the highest point of the heels (orange squares). Preserve every millimeter of vertical height in this area. Add a rocker to the very back of the buttresses to help ease landings and mitigate the forward push on the heels.The yellow lines outline the current position and shape of the heel bulbs, which are pointy and squished out behind the foot. The dotted lime lines show where they should be once the foot gets brought back under the horse. Leave the soles, frogs and bars alone.

RF lateral radiograph: Same general comments as the LF, except that the broken back axis is worse, which is contributing to more arthritic changes developing .

RF lateral: This foot is a bit more underrun and flatter, with the toe being a bit longer. Same principles apply as on the LF, with more toe needing to be backed up.

RF sole: Same discussion as the LF. Definitely be extremely careful to preserve all the heel height as this foot needs more attention to that than the LF. Toe can come back a bit further than the LF. Again, leave the soles, frog and bars alone.

Boots and pads as needed for comfort. Make sure to add a good bevel onto the treads at the toes and the heels on any boots as no boot has enough of one straight out of the box.

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


Re: Confused about iron content

bakermouse
 

edit: the one in the mouse study is not synthetic and it does contain iron
--
Louise B, New Zealand, joined in 2021


Confused about iron content

bakermouse
 

Kia ora,

I have a question. There's a fairly new product on the market here, it's a probiotic that uses natural zeolite as a carrier. https://agribio.co.nz/product/biofix-equine/
I asked the supplier for a data sheet and they sent it to me. The iron content is 1%, if I convert that, it's at 10,000mg/kg, right? https://sciencing.com/convert-percentage-mgkg-8657962.html
The supplier recommends feeding up to 100g of their product a day to a 500kg horse. By my calculations, that will contain 1,000mg of iron.

I was alarmed about this, so I asked some questions. I was told the iron is not bio-available because of the zeolite's cation exchange. I asked about whether the gut environment could cause the iron to be released in the same way that changes in soil chemistry can. No answer yet.  

I went looking for some articles and I found some information about mice that said that a synthetic zeolite mopped up iron, so it might be good news (but does the synthetic one have iron in it?) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212648/

I'm trying hard to understand how much iron I am feeding my horses so that I can avoid feeds and mineral mixes high in iron, I've seen good improvements to their health as a result. But I don't know what to do when the label looks sky high in iron but the supplier tells me it's not bioavailable. We also have mineral mixes here that claim they are "iron free" but that have zeolite in them, so they actually have 160mg/kg of iron.

Help.
--
Louise B, New Zealand, joined in 2021


Re: New Subject: Welcome Karen ......Effects of High Protein Meal on Insulin Secretion

wacahootakj@...
 

In my previous post I listed a reference to a publication of a Ph.D dissertation written by Dr. Loos, University of Kentucky, 2018. I also attempted to post an abstract of a study she did  that was a part of her dissertation but it did not come through on my computer. So I will give a brief summary of that abstract. The study evaluated the effects of a high protein (31% protein) on insulin secretion in 6 normal horses and 6  age matched EMS horses (ACVIM Consensus criteria for EMS including hyperinsulinemia (oral Kayro Syrup test), obesity and/or regional adiposity, etc). Horses were given 2mg/kg of the 31% protein meal at 0 and 30 minutes (4mg/kg total) and glucose and insulin concentrations were measured over 4 hours. Elevations in glucose occurred in both groups and were not significantly different. Elevations in insulin area under the curve (AUC) was 9-fold elevated over the insulin AUC for normal horses. Complete information of the study are available in the dissertation available online. While the amount of meal intake was higher than the amount recommended by common high protein forage balancers (one forage balancer recommends 1-2 # per day per horse; 4mg/kg for a 900 # horse would be 3.6# ), it should still remind us that a meal high in protein ( certain amino acids) can serve to stimulate insulin secretion, more so in horses with insulin dysregulation than normal horses. 
--
Karen FL 2020


Re: no ecir post

Maxine McArthur
 

Daisy, I think it was a pretty quiet day yesterday. Are you receiving the Digest or individual messages? You can adjust how you receive messages in your Subscription tab. If you're receiving the Digest, there's a lag between when messages are posted and when you receive them via email. 
I check the group directly several times a day so I've elected not to receive messages via email at all. 
--
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

 


no ecir post

Daisy Shepherd
 

for past 24 hours i have only received one message from the ecir post.  i usually get about 6 to 10.  have i done something to my pc to cause this?  i cannot find anything i have turned off by accident. thank you daisy and tiko
--
-- 
Daisy, Tiko and Whisper
CO, April 2019
Case History:  https://ecir.groups.io/g/CaseHistory/files/Daisy%20and%20Tiko 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=90099&p=Name,,,20,2,0,0


Re: New Member

 

Hi Maria,

Welcome to the ECIR group!  It sounds like your vet has made a reasonable diagnosis of both insulin resistance and PPID and her recommendations of Prascend and controlled sugars are spot on.  What you will gain here is all about help formulating a safe diet which satisfies the horse’s needs.  With an insulin level above 200, she should be on our emergency diet which includes feeds that have been tested to be below 10% sugars and starches (s/s) or hay that has been soaked for one hour in cold water or 30 min in hot and then rinsed.  To this, you add flax oil, vitamin E and salt,  Don’t wait to locate the salt etc, before beginning the soaking.  She should not be out on pasture, even if it appears dead.  Once you have those details worked out, you can arrange to have your hay tested to see if it actually needs to be soaked and which minerals you would ideally add to ‘perfect’ the hay.  Many premixed supplements contain iron, which you should avoid.

The Prascend administration has cautions of its own.  Some horses are very sensitive to beginning Prascend and develop what we call the pergolide veil.  To avoid that we advise giving APF (Pro or otherwise) for a few days before starting and continuing until a few days after the prescribed dose is reached.  By which I mean, if your vet has prescribed one Prascend, you might have better luck with acceptance if you give 1/2 Prascend for a few days and then increase to one once she seems adapted.  (APF contains adaptogens which help her adapt to changes in hormone functioning.)  Another thing to keep in mind is that you will want to do regular ACTH testing to make sure you are giving her an adequate amount.  When you do that, there is no need to repeat the TRH stim test, just do the endogenous.

I don’t mean to be throwing all this at you at once but since you have a diagnosis and a drug to give, you may well be wondering how to get started and as well as how to avoid pitfalls.  Don’t hesitate to ask questions.

What follows is the ECIR group welcome which contains answers to many of your questions as well as many you didn’t know you had.  We are looking forward to seeing your case history and helping you make appropriate changes to your horse’s care.

 

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. 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. 


--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Invokana Fail?

riggslippert@...
 

I buy my Invokana from PricePro Pharmacy and it comes from the UK.  The package insert specifically states "This medicine does not require any special storage conditions".  Odd that the label contradicts others' findings.
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




Re: New Member

Sherry Morse
 

Hi Maria,

You'll get a full welcome message shortly but your mare's numbers have a firm diagnosis as both IR and PPID and in danger of laminitis.  Prascend is the medication needed to control PPID.  Getting ACTH under control may help with insulin numbers in some cases, but the real key with most IR horses is diet and exercise.  Full details will be coming but please check our website - https://www.ecirhorse.org/DDT+E-diet.php for information on the emergency diet and getting your hay tested so it can be appropriately mineral balanced.




New Member

Maria Swerig <mariaswerig@...>
 

My 18 yr old mare was just diagnosed, “Cushingoid Horse, sensitive to sugar”.  

Vet is prescribing Prascend.  She stated we can control high insulin with diet changes.
Mare goes lame once a year since 2012.  Recent radiographs confirmed laminitis.
Recent Labs:
Insulin over 200
TRH prevalue 54
TRH postvalue 909

Anyone familiar with Prascend?  Also, need the name of a good mineral supplement
Other suggestions are welcome.

Thank you!


--
Maria In Wisconsin 2021


Re: Abnormal Shedding question

Nancy & Vinnie & Summer
 

* clarification...he had an abnormal shed last August, and then put on an abnormally dense/long coat.
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Abnormal Shedding question

Nancy & Vinnie & Summer
 

Hey all, for a non PPID horse what would be a reason for abnormally increased shedding?

Vinnie started dropping coat about 15 days ago and the areas body clipped in his neck and chest and hips ooks not bald but very thin.

This is not a normal thing for Vinnie.  Could this be because he is feeling better? If you recall he had an abnormal shed in Aug too which an abnormally dense coat.

What mineral could he be lacking? What could he be getting in excess?

Could this be related to EMS? We think he is not PPID based in acth, but I have asked my vet if we should do a TRH stim to verify.  His June acth number was 24 and Dec was 20 (but he was on pergolide 0.50mg)

CH needs invokana but updated otherwise.

Thx Nancy 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: Zinc,copper for high iron

 

Thanks, Linda. I’ve learned to manage my difficult mare. Another good option is Uckele Poly Copper Pellets and Poly Zinc Pellets until the horse is accustomed to minerals. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Zinc,copper for high iron

Starshine Ranch
 

Hi Cass,
Good luck with the zinc and copper... good news is, I have a friend whose horses actually eat it out of a mineral feeder... but mine would not touch it or their supplements if I added it.  I still have the bags of it that I bought form California Trace.  You might check the California Trace Plus (no added iron)... it's expensive but there is quite a bit of zinc and copper in the regular dose and you can double it and still not get a huge amount of selenium.  Just a thought.
--
Linda in CA  2020  Midnight and Ostara


Re: Case Histories: What You Need To Know - Thu, 02/04/2021 #cal-notice

Sherry Morse
 

Hi Mel,

What I did for mine was put a note in that says "*weighed at vet -890" next to what his weight tape measurement was for the next day because I wanted to get a comparison.  FWIW my weight tape consistently comes up as 20lbs more than the vet scale so I have a note on that as well.  I also carry that expectation with me now when I weigh the other horses with the tape but of course the only way to know if it's consistently off with them would be to get one of them on a scale too.




Re: Zinc,copper for high iron

Lorismorgans
 


Re: Case Histories: What You Need To Know - Thu, 02/04/2021 #cal-notice

Mel V
 

On weight, all of mine are from an actual scale, at the vet clinic, which column is preferred?  I often go to the clinic for diagnostics/xrays and it is a handy way to get an accurate weight, the scale is right at the entrance.
--
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Mel%20and%20Bali
Updated Photos: https://drive.google.com/open?id=1YsoydAZGCqcWneSIfxh4dr2SBcXlMrFM  
https://ecir.groups.io/g/CaseHistory/album?id=241764


Case Histories: What You Need To Know - Thu, 02/04/2021 #cal-notice

main@ECIR.groups.io Calendar <noreply@...>
 

Case Histories: What You Need To Know

When:
Thursday, 4 February 2021

Description:

Your equine's Case History is the most important step to be completed upon joining the ECIR Group. It is critical for obtaining timely and specific advice from the support team.   

 

If you are a long time member, migrated from Yahoo, please be aware there are changes in how information is to be properly posted.  We also have a new case history form. If your case history does not contain the IR Calculator Table please transfer all your information on to the new form. The new uploading rules and instructions are located at the bottom of the case history form

 

We take the importance of accurate information very seriously. The information in our posts and case histories is of tremendous value to all our members. To help protect the data and your privacy only members of the main ECIR Group are granted access to the Case History Group.  If you are concerned about privacy you need only give your first name and general location.  The use of pseudonyms to keep your equine professionals anonymous is encouraged. Please review the ECIR Group Terms of Use and Privacy Policy

 

Don't delay posting or updating your case history. 

Missing information it can be added as you obtain it. The faster your case history is completed with what you currently know, the faster you will receive the best support from the support team. 

 

Please take the time to update your Case History.  An up-to-date case history is invaluable when an equine emergency crops up. Accurate documentation of management changes, the equine's responses, blood work results and links to the equine's photo album not only helps the ECIR Group gain the trust and respect of science-based equine professionals but can be used by vets who are on the ground trying to help your horse. Your Case History is the best way to effectively monitor and illustrate the results in PPID and IR management changes. 

 

Please leave all your information uploaded. When the time comes that you or your equine no longer need the advice of the ECIR Group, please leave your case history folder intact. Your information will be used in the future to confirm or re-shape ECIR protocols and help other members learn.  This is the best way to “give back” to the ECIR for the help you and your horse have received. 

 

Photos go in the Case History Photo Section.  Please help the Support Team work as efficiently as possible. Read How to Make a Photo Album for the rules and follow the Naming Pattern for photos so the Support Team can quickly locate the photos they need to see.  

 

Thank you for your cooperation, 

The Owners and Support Team of the ECIR Group

 


New subject :Welcome to Karen

Trisha DePietro
 

Hi Karen.  thanks for your recent post regarding the research study connected to our discussion of high protein effects on horses. I see that you have a signature in place but I don't see where you have received our official welcome letter! So, here is some really helpful information to have on hand if you ever have a question or concern about your horses. Embedded in this protocol are links to various supporting documents and information. And there is LOTS of information to read here! So, welcome again, and 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. 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.

 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


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