Hi Kirsten. 

Im on the road otherwise I would do a search on cinnamon. My recollection is that regardless of type it has not worked in horses. It did not effect Beau’s glucose. 

I will have to leave the explanation of vinegar to Dr Kellon. I do not believe iron overload played a role but can be corrected. 
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA

Such good questions! I'll be following this to see what the experts have to say.
Now that I'm on this IR ride I've been wondering if I'll ever be able to leave home again.  Even the thought of being away for 1 night gives me the vapors!
I think finding hay under 10% would calm my nerves somewhat, but I'm having trouble doing that so I worry that if I didn't soak for a day things would fall apart quickly. 

--
Heather F
Minnesota
2020
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Ty
https://ecir.groups.io/g/CaseHistory/album?id=248884&p=Created,,,20,2,0,0

Hi Emma,

I couldn't find iron levels for Speedi-Beet or Kwik Beet, but many members use Speedi-Beet without issue. Maybe your trimmer has equine nutrition background, though, and has the skinny. Do you know the iron levels for each?

In any case,we do recommend rinsing,soaking,and rinsing beet pulp,for best results with our compromised horses.

Going to case history now. Thanks for changing the links!

--

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

Thank you all. LInks should be live now. I will update photos later this evening. Tom has been trimmed since the last x-rays were taken.  My trimmer and I have discussed boots but as he is comfortable walking on tarmac we have decided not to boot him as the trimmer suggests this will be better for the foot and sole development. He is currently walking out freely with no sign of discomfort.

2019 bloods.  These were taken pm. His last meal would have been about 7am (Happy Hoof).  His hay was soaked. He would have finished his hay by midday.
Karo syrup test. This was taken am. His last meal would have been the morning before and he had hay overnight (not soaked) but this would have all gone before midnight probably (sorry it was a long time ago and my notes aren't that detailed).

2020 bloods. Bloods were taken around 4-5pm.  His last meal (beet pulp etc) was at 9am. He then had an "easy to eat" haynet which he usually finishes by about 12pm.  He still had hay in a trickle net up until when the bloods were taken. This was the same for the Karo syrup test too.

I haven't had the hay tested as supplier keeps changing - not ideal but the hay is provided by the yard.
I am not rinsing the sugar beet at the moment.  It is the quick soak beet (ready in 10 mins).  I was using Speedibeet but my trimmer said to move to Kwik Beet which is lower in iron. Have been mixing the two but only a day or two left of the speedibeet.

Thanks
Emma
--
Emma M in East Sussex, UK 2020
Case History for Tom: https://ecir.groups.io/g/CaseHistory/files/Emma and Tom
Photo Album for Tom: https://ecir.groups.io/g/CaseHistory/album?id=249458

Cindy, thank you so much for all the info!!

my donkey was able to maintain a normal temp with the Banamine. 

1800 fever of 102.6
1900 fever 101.9
2400 99.3
0400 98.7

he is still off quite a bit in the front feet but better than yesterday (he’s also was on Banamine and previous was only on bute)
the cloud boots definitely help. 

the strange thing is there is no digital pulse and no heat in the feet. I even have a temp gun, his feet are the same temp as his old pony friend. 
perhaps the heat an elevated pulse stage of laminitis has passed?
but to be honesty I never really felt a lot of heat or a pulse. I’m an EMT so I’m use to being able to find a pulse lol. 

i did some research on Nutrena, I was mislead thinking it was the best choice for my pony, being that its names “safe choice” but I see the NSC is quite high!
inwill just be sticking with the triple crown senior and triple crown complete.

is the soaked beet pulp better to give the donkey to give meds and supplements rather than the triple crown senior handful?

They hay net to soak the hay is a great idea!
can the hay be fed wet or damp or does it have to be totally dry?

The vet is coming out this afternoon.
i assume we will do imaging on his feet, test for potamic since we had fever with laminitis, but I’m sure this is more of a metabolic issue.
so he may even want to test that again. I’ll make sure to get a game plan for getting him off the nsaids.
i have been giving probiotics and surcralfate to help protect his GI system, but I know they are so hard on his liver and kidneys too. I actually lost a mini to bute toxicity years ago. So I would definitely like like off as soon as possible

i fully believe that in top of cushings and hypothyroidism, he is insulin resistant. it just makes total sense. I will work on getting him outside in his dry lot with his boots today.

i can’t thank you enough for all the information!
 Im praying I can get him through this and get him on the right track with medications and diet.

not sure if I mentioned but my pony who has cushings is completely non symptomatic. But he can also benefit from the changes I’m doing for the donkey.
for a 40 year old the vet just rated him a 5 on the weigh chart, and the donkey a 7. So the donkey is quite obese! 

As soon as I am home to my computer, I will work on his case study.


--
Kelsey Hovi from PA 2020

The ODTB cubes are balanced to themselves so that if they were the only source of feed then only salt, flax and vit E need to be added.  If they are not the only feed in your horse's diet, the additional hay or feed will require mineral balancing and supplementation.  The ODTB cubes will not add any minerals that you need to balance your hay.  So yes, if you are also feeding hay you will need to add minerals.  If you have a hay test with major and trace minerals, it's well worth paying a balancer to find the most appropriate mineral mix out there, or have them design a custom supplement for your hay.


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

Thanks Nancy!  So is it the official position of ECIR that vinegar does not have the same effect in horses that it does in people?  Or do you think Beau was so iron overloaded that nothing would help? 

For cinnamon, I believe the effect is on glucose, not insulin, and that it's important to note that the effect on glucose is seen from the much cheaper and more widely available "cassia" cinnamon.  But "cassia" cinnamon, also known as Chinese cinnamon—or probably what you’re getting at the store, if it just says cinnamon—contains a compound called coumarin, which may be toxic to the liver in high enough doses."  Ceylon or vernum cinnamon doesn't have the toxin, but neither does it have the effect on blood sugar in humans.

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

I know dietary changes have an immediate effect on lowering insulin, but is there a cumulative effect seen over time as well?   For example, I've been soaking hay for about 6 weeks now.  If I continue to soak, could his insulin get progressively lower?  And, if I stopped soaking tomorrow (ie, if I went away for a week and didn't have anyone to soak hay for him) would Shaku's insulin go right back to where it was before I started soaking hay, or would it jump up partway then climb more slowly back to where it was?  And if insulin didn't rebound all the way immediately, how long would it take to return to his 'unsoaked hay' baseline?  What about glucose?

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

You do know that’s not correct. unfed  horses do not give you correct insulin levels.
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

-- update!!!!!
he was not good tonight!!
runnjnh a fever of 102.6 and was laying down grinding his teeth.
heart rate and respiratory rate was elevated, blood sugar was 116. 

was much improved after Banamine was given, he got up and ate hay for about an hour: he’s eating drinking peeing and pooping normally. Vet will be our tomorrow to see if there’s an infection going on and to do some imaging of his feet.

also we will be discussing the results of all the blood work. 

anyone ever dealt with fever and laminitis!?!
im son worried about my poor donkey ! 

Kelsey Hovi from PA 2020

Hi Kirsten and all --

I've had some experience with my diabetic and very high insulin boy Beau before he passed.  I was feeding 1 cup 2xs per day.  We were doing this to help jump start his mineral absorption.  No matter what form and how much Mag we gave him, he did not absorb well. To me this was a big piece of the puzzle as to why we could not bring his hyperinsulinemia under control.

We never saw a change in insulin and glucose with adding 2 cups of vinegar per day.  His diet was squeaky clean; his PPID under control: he was iron overloaded.

In addition, to speak to Clare's question -- Cinnamon did not have effect either. This is true not only for my horse when he was diabetic,  but also majority of horses on ECIR who have tried it.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA

Ok ...so do you still add stuff like minerals or a forage Balencer to your Ontario Dehy Timothy Balance Cubes/Stabul One mixture?? I’m guessing I would still need to add something like a balancer to my ODTB cubes since I’m only feeding a small amount of it to achieve proper nutritional requirements ?? I was considering trying the Vermont Blend and mixing with the ODTB cubes ??
Thanks in advance
Michele & Schimpie

--
Michele Goldberg
Bernville, Pa
joined 5/19/2016

The vet wanted the insulin result without any raise from feed, that’s how she’s always had her levels checked. 
--
Clare in NS, Canada 2020
Cory; IR/EMS 2000 ASB mare

Hi Clare

Welcome to the group! I'm sending you our welcome letter in its own post/thread so that I don't clog up the original thread's discussion.

From your "fasted!" comment, I think you may have read now that ECIR's recommendation is not to test for insulin fasted but to have hay access for the horse overnight before the blood draw and the same day up to the test (and if not, draw blood after the first meal of the day keeping hay in front of the horse up to the test). Full details on testing on our website https://www.ecirhorse.org/DDT+E-diagnosis.php.

Thank you for having your signature in place with your location. Could we trouble you to also add the month and year that you joined. For convenience, here is the list to edit subscription where you can update your signature: https://ecir.groups.io/g/main/editsub

Below is the full welcome letter with the 4 main sections on Diagnosis, Diet, Trim + Exercise. If you fill up a case history for your mare, you will be able to get specific help on your case more easily. There is a short note from our files:
Cinnamon is no longer routinely recommended. It had been hoped to improve insulin sensitivity, but instead it may lower blood sugar (glucose) without lowering insulin levels. Since most IR horses have glucose in the normal ranges, cinnamon sometimes lowers it too much. For that reason, the ECIR Group doesn't use it routinely. If you have a horse that is a true diabetic - high glucose - then cinnamon may be helpful. https://ecir.groups.io/g/main/message/245150

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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.

 
--

Thank you Sherry!  The abbreviations are a real hoot. I confused myself when I was writing my post LOL. That's all I really wanted to know, if it was IR safe. 
--
Heather F
Minnesota
2020
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Ty
https://ecir.groups.io/g/CaseHistory/album?id=248884&p=Created,,,20,2,0,0

Dear Kelsey

Welcome to the group! You have received some good advice already.

1) I see you are using cloud boots - my own experience is that they work well. I assume your Donkey is more comfortable in them than without. There is no need to lock him up in the stall and he can be given access to the joining dry lot with his boots on. If he is willing to move around freely himself, it is fine to let him and better for him probably.

2) You asked about soaking hay. I find using filling an appropriate size holed hay net with hay, and putting the whole thing into a container of water to soak works well. Soak 1 hour and drain well, when it is time to drain, you can lift the whole hay net up and hang it somewhere to drain. More hay soaking ideas can be found in our Files section here: https://ecir.groups.io/g/main/files/5%20Core%20Diet/1.%20Hay%20Information/Hay%20Soaking/Hay%20Soak%20Report.pdf

3) You can read about the emergency diet below in the full welcome letter but hay soaking and Sherry's advice on using Rinse Soak Rinse or the "Balance Cubes" is part of that.

4) You mentioned your donkey is positive for cushings and you will start pergolide soon. You can read our Pergolide 101 article in the files found here: https://ecir.groups.io/g/main/filessearch?o=0&q=pergolide+titrate
Take note that we usually advise to start on a small dose and gradually work your way up to your targeted full dose. Also read this post by Lavinia and she mentions together with other tips on handling and storing the medicine "
The Prascend is designed to be split into halves but not quarters so your vet is correct that splitting the pills into 1/4's isn't advised. To do ,25mg doses, take 1/2 of a pill, dissolve it in 6-10ml of water in a small syringe. Shake well then administer 1/2 the contents of the syringe. Refrigerate the rest for the following day." https://ecir.groups.io/g/main/message/201704

5) (Although not the focus here) For the 40 year old blind pony, the RSR beet and soaked cubes would not be a bad choice to mix with his Triple Crown, instead of Nutrena. Nutrena products I recall all seem to be high ESC + starch.

Here's the full welcome letter and please take the time to go through it. Let us know if you have questions, I know it's a lot of information you are getting so step by step!

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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.

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Hi Emma

Welcome to the group! Thank you for filling up your CH and uploading your rads.

As Sherry has mentioned, if you could let us know whether he was fasted for the tests or whether he had hay in front of him (no grain) for the 4 hours leading up to his test please. I agree he does look thin soled on the fronts. Is he wearing any boots? I didn't see this mentioned in your CH. Boots and pads could help his comfort and protect what sole there is while it grows. He may be more willing to move freely and that load and unload can then promote circulation and sole growth. Even then it takes time but without the constant assault on his thin soles, you would have a better chance. The RH also looks a little broken back but it looks like his foot is not fully on the block so he may be leaning back partially. For hoof photos please look at our guide on the angles that are helpful. For ground level pictures (like dorsal and lateral), your camera should actually be on the ground so that the lens is aligned with the hoof rather than at a height pointing at a downward angle https://ecir.groups.io/g/main/wiki/1472

Below is our full welcome letter which has a lot of details on our protocol of Diagnosis, Diet, Trim and Exercise. A few preliminary comments while you take the time to go through it - It doesn't look like your hay was tested and Forageplus in the UK can help you with that as well as custom balancing. Are you rinsing and soaking (with excess water which is then drained away) and then rinsing your beet (RSR)? I see you feed quite a lot of beet at 1.6kg dry (which usually means before it has been soaked), is that figure correct? Anyhow beet can have a lot of surface iron on it if not RSR -ed which can throw the mineral levels in your overall feeding out of whack and this can also affect foot health.

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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.

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