-- I read that not to give salt to horses that are feed kelp. So I did some looking at the Purnia Outlast that I have been giving my Cushings mare, for her ulcers. She was scooped a couple of years ago and had ulcers. I have treated her twice with Ulcer guard since. So I have been feeding her the Outlast 1 c.  3 x a day as recommended on bag for maintance. I checked ingredients and found it is alfalfa based with seaweed. But surprised to see it also has molasses. So my question is should I discontinnue the Outlast. 
Denise Wa 2019

Welcome to the Laura! 
Many new members come to this group because they have a horse experiencing laminitis or Cushing's and then need advice on what they can do for their horse. The situation may need a response from this group for emergency advice. But we also sometimes have new members join the group because they simply want to learn what the ECIR group is about. It certainly has a lot to offer on a variety of subjects. Please let us know if you need advice for an equine or have a question to ask.

Laura, below you will find our information document that we provide to all new members. You can ask questions by replying to this message or create a new message/New Topic to ask a question. We suggest you use the "SEARCH" box initially if you aren't dealing with an emergency. You can search the messages (search box at top of each page) or you can click on the "Files" button (see on the left of this page) and search thru the files. The files are well organized so take a look at the structure first to save you some searching time. We have two additional sub-groups, ECHorsekeeping and ECHoof.  There is a paragraph below that provided information about how to move about and "Work" with this group.

Welcome again Laura

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 etiquette, what 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.

EXERCISE: The 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. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Thanks Sherry

I’ll try to do both and take note of the differences. She’s not on glucosamine, but was on MSM and Yucca. Those were added after her DDFT. I pulled her off both after reading through the files. I will update everything once the hay test comes back and her vitamins come in. 
--
Lora Bannan in Eastern Oregon
Vera - 2005 TWH mare
Joined 4/2021
Case History Vera https://ecir.groups.io/g/CaseHistory/files/Lora%20and%20Vera
Photos Vera https://ecir.groups.io/g/CaseHistory/album?id=263692 

Have you tried the Mad Barn Omneity? It's not formulated for metabolic types like the AminoTrace is but its a fantastic VM supplement and it's more economical.
--
Laura Heit - Ontario 2021

Hi Sherry and thank you. 

Inwill be taking more photos and trying add the rest of her information today. I have a weight tape, but can haul to a scale once my husband gets back with hay. She is currently not heavy, muscle loss over top line (which has never been great despite much work), with a fattier crest than she had before. She had been on the pasture with 30% alfalfa/orchard mix over the winter. Obviously I’ve pulled her off of that and am soaking Timothy. I had a bag of Timothy pellets on hand, so her supplements have been going in them. I’ll be picking up beet pulp today and switch to that. 
--
Lora Bannan in Eastern Oregon
Vera - 2005 TWH mare
Joined 4/2021
https://ecir.groups.io/g/CaseHistory/files/Lora%20and%20Vera

Thank you for your response. There isn’t a lot of history because she was just diagnosed. My vet called yesterday afternoon with the lab results, and I am ordering Pergolide today. I plan to take good and body pictures today. 

My farrier isn’t the one who did the trim and reverse shoe. The vet was adamant about having a farrier come in and do that with help of X-rays, and the clinic is nearly 2 hours from my home. I will review the files and go over them with my farrier. 

Thanks again!
--
Lora Bannan in Eastern Oregon
Vera - 2005 TWH mare
Joined 4/2021
https://ecir.groups.io/g/CaseHistory/files/Lora%20and%20Vera

Jennifer,
You need to test your hay (Wet Chemistry method) for a start. The bulk of what your horse eats is the hay. I recommend using https://equi-analytical.com/feed-and-forage-analysis/analytical-service-packages/
as this company's branch focuses on horses. The results of their tests are easy to read for equine diet balancing versus an analysis done for cattle. Do some searches of our files for "Diet Balancing" or "Hay Balancing".  You ideally would have a an experienced balancer do your diet balancing for you. You will need to provide them with the names of all added in supplements/feeds and the quantities by weight of those supplements. It is WELL worth the cost to get this done for you. You will learn a lot  about diet balancing from this process. I was very happy using Dr. Kathleen Gustafson. Dr. Eleanor Kellon also does balancing for customers of Uckele.com

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Hi Sherry,

I do not believe that she had a laminitic episode or any consistent lameness this past year. She is, however, a stoic draft and holds her cards close to her chest as the alpha mare in my herd. I am beginning my PPID / IR journey so wanted to ask if this is something that is associated with either as I have not seen it listed as a clinical sign. But give the risk of laminitis with PPID, I wondered. 

For a draft, Eva has wonderful hooves, balanced, strong and upright and she has been barefoot since I've had her (3 years). She did have laminitis before she moved here to the farm with me and was shod on all four when she arrived. The farrier suggested that the bruising was the result of pressure from mud being packed into her hooves … but that seems unlikely to me unless there is an underlying hoof issue. 

I will upload my case histories--- I have three recently diagnosed PPID horses- Eva the draft, Jordy a QH and Sophie a Fjord ---  and so my journey begins.

Thanks, Kristine

--
Kristine Webber
Mayne Island, BC Canada
Joined 2021

Hi Lora, 

There's not a lot of detail in your Case History to go on (if you could copy all this information you write above into the comments section of your CH that would help a bit), but I noticed she is not on pergolide for her Cushings disease?  More details on this would help.  If her Cushings is not treated, no dietary changes can prevent the laminitis that comes with it.

It sounds like you are also dealing with Equine Metabolic Syndrome (EMS, which is commonly referred to as IR, insulin resistance).  It's very common for active horses of breeds susceptible to EMS (including TWH) to develop laminitis or founder when the exercise stops, especially if they are put on pasture or the diet is too high in sugar and starches.  The safest thing to feed her now is soaked grass hay long with minerals balanced to the hay, so you are on the right path.  Don't forget salt (min 1 Tbsp/day, but free choice loose salt is a good idea, too), 1600-2000 IU vit E (capsules with oil in then, or vit E powder mixed with a tiny bit of oil), and 2-3 oz fresh ground (or stabilized) flaxseed.  The safest carrier for supplements is RSR beet pulp, or soaked "soy hull" pellets.

If you and your farrier don't think the shoes are helping, you can pull them.  We always advise using hoof boots instead, with pads for comfort.  This allows more frequent trim adjustments without having to reset shoes every time, and the solar support from the pads takes some pressure off the compromised lamellae, which in itself can provide a lot of relief to the horse.  Easy Boot Clouds or Soft Ride therapy boots are usually recommended here, but I have successfully used Equine Fusion riding boots with 12mm "soft" (green) and "medium" (black) Easycare pads cut to fit.  Any boot that allows room for a thick pad will work.

Your farrier has made a big improvement with the trim, but there is some fine-tuning to do still.  If you'd like specific advise, you can upload a full set of hoof photos, as described here:
https://ecir.groups.io/g/main/wiki

Scroll down to Photos and Hoof Evaluation Help)
When they are uploaded, start a new message and call it "Request for Markups".  The first set of markups are free.

Last thing: could you please add the link to your photo album to your signature, too:
https://ecir.groups.io/g/CaseHistory/album?id=263692
And hit enter after both links to turn them blue and make them active!

Thanks!

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

Hi Ann,

Generally after laminitis has occurred we recommend allowing at least 1/2 to 2/3 of a new hoof capsule to grow out before beginning ridden work.  All other exercise in hand or on a lunge line should err on the side of caution.  If you are seeing any hoof soreness after exercise, then it is too much too soon.  Increased digital pulses AFTER he has cooled down and his heart rate is back to normal are also worrying.  Hoof boots with thick soles and/or thick pads do help with concussion and if the sand paddock is fairly compacted then the boots will help with comfort. 

While checking temperatures is not the most reliable, if you are seeing a correlation with hoof temperature and pasture, then you are probably right that the pasture is increasing his insulin.  One issue with allowing Nahar continued mini-flareups on pasture is that it does continue to compromise the quality of the old lamellae, as well as the new lamellae in his hooves.   This could be setting him up for a more serious founder if the pasture ultimately proves to be too much for him, or when he gets his spring vaccinations, or any other trigger event.

It's really hard for humans to take our horses off pasture.   It can be hard to use a grazing muzzle, too, some horses in particular can be very difficult with it.  But founder is a life-threatening condition that is very expensive and painful, and takes a long time to resolve, so by preventing it from happening again you are doing the kindest thing.  One person's advise here was to look at a sealed muzzle as a source of freedom for the horse, allowing them to be on pasture with their buddies, rather than as a negative thing that restricts them.  Our attitude is important too.  If the sealed muzzle (a muzzle with the eating hole blocked,  but still allows the horse to drink and breathe comfortably) is a no-go, then finding a way to turnout in an area with no grass would be something to work towards.   Wooded paddocks or dry paddock or sand arenas are options.

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

Lora you have already made a good start on following the ECIR protocols. If you haven't already do go to the ECIRHorse.org website (link is in the information packet below) and read thru the information there also. Our new member information packet is below. Details about testing protocols (and feeding before the blood draws) is very important. 

Please understand that many manufactured feeds, pellets, supplements, etc, actually have ingredients or sugar/starch levels that are NOT safe for IR horses. Test all feeds. You can send the timothy hay pellets to be tested also. But be aware that pellets like any hay cutting can vary in sugar and starch levels. 

You are off to a great start here!  

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 etiquette, what 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.

EXERCISE: The 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. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Welcome to the group Karen!
I am attaching our new member information packet below. It is chock full of information. There are blue colored words which are clickable links. As you read thru the document you can click on links that will open /expand more in-depth information.

Do get started on your pony's case history. This health history is important. Our experienced moderators need details about your pony in order to give you safe, relevant advice. I know the case history document is long and may seem daunting. I found it easier to actually print a copy of it and begin filling it in with pencil notes as I gather the details.

Reading what your pony is being fed I would advise you just feed soaked GRASS hay, salt, vitamin E and ground flax seed only. NO lucerne  in any form as it is quite commonly a trigger for laminitis.  All the details about the safe emergency diet is in ate DIET paragraph below.

Bute doesn't help laminitic feet but if you are using it be sure to taper off  when stopping, do not withdraw it abruptly. 

We do recommend having blood tests done but do use the ECIR protocols for the day of the blood draw.

We have members in Australia who can give you further advice about safe feeds, blood tests, etc. I am glad you found this group, it has helped so many equines and owners.

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 etiquette, what 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.

EXERCISE: The 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. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Hi Gail,

Mineral Oil, Sulfur, Zinc State, Glycerin, Cade Oil (rectified)

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Here’s a link to MTG, Gail.
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Hello. I'm new here and have spent the past few hours reading and trying to input all my information. Please let me know if there is something missing. I will get more photos and add them tomorrow, but I do have her Xrays uploaded.

Vera is a 16yo TWH mare that I started training for endurance in 2016. We successfully completed several rides over the next 3 years until she tore her LF deep flexor tendon in May of 2019. Up to that time, she was a hard keeper, mostly on pasture, with orchard and alfalfa during the winter and at rides. Last summer I started bringing her back, but experienced intermittent lameness. Two vet visits resulted in passes lameness exams and no hoof pain. Unfortunately no Xrays were done, I should've pushed for that. I let her rest most of the summer hoping that would help. She gained weight and developed a crest last summer. A couple months ago she presented extremely lame on her RF. No heat, increased digital pulse, or reaction to hoof testers. It didn't resolve and she started showing lameness on both front feet. Vet visit with Idaho Equine West on 4/26 showed chronic laminitis in both front with worse rotation on RF. The vet called a farrier to trim and shoe with radiograph assistance and put her in pads and reverse shoes. She has been on 2g Bute for 4 days, 1g the past 3 days. She is now in a dry lot run with soaked Timothy hay. She is slightly off, but is definitely a stoic mare. We are picking up another load of hay tomorrow, and will send off samples for testing on Tuesday. I've ordered Uckele VM to supplement until we get hay testing back. I also have access to blue grass "hay" which has been harvested for seed and then baled. I can pick some up and send a sample in for testing next week. 

What else do I need to do? We go back to the vet in 3 weeks. Should I ask for more bloodwork? My farrier, who is amazing with lameness issues, is NOT happy with the reverse shoes and pads. I'm not sure what to do. Thanks!!!
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Lora Bannan
Vera - 2005 TWH mare
Joined 4/2021
https://ecir.groups.io/g/CaseHistory/files/Lora%20and%20Vera

Hello. Hoping for some advice as we have been trying a few things to help our shetland pony and every time he seems to be improving he goes downhill again. We have had experience dealing with a previous shetland who foundered and knew how to get a handle on it quickly and get it under control. We are having no luck at all here.

We moved to a new property 12 month ago, and he experienced a bit of trouble from the richer grass here (had never foundered previously) so we had some fenced off areas where he could be near our other equines but with a mostly hay diet. It was a cold summer and we didn't really notice that he hadn't fully moulted until the end of summer when he got really sweaty and had a bad bout of laminitis that has not really ended. After trying all our usual tricks (no grass, soaking hay, regular gentle walks), and getting his feet trimmed by someone other than ourselves, we had the vet visit.

He diagnosed Cushings because of his long coat and laminitis and fatty deposits above his eyes. No actual tests were done, diagnosis was on the basis of symptoms. That was about 6 weeks ago. Since then he has been on Pergolide 1/2 tab per day day, increasing to 1 tab per day when 1/2 didn't change anything, and since that hasn't made much difference, some Periactin as well (4 tabs per day). We are still soaking hay. We had also been feeding him a mash of lucerne chaff, oaten chaff and 'zero' pellets (Australian brand suitable for founder ponies). We found out that Oaten Chaff is high in sugar, and lucerne isn't so we cut the oaten right back, he seemed to improve, but now back here we started. We tried throwing beet pulp in the mix, but he didn't like that. He has been on Bute most days - just when we start easing it off he goes backwards again. His feet are still very sore, particularly his front feet.

All advice appreciated. We don't know what else to do to help him and hate to see him like this.
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Karen Bevis in Tas Australia, 2021