Hi, Barbara.
I'm so sorry you and your mare are going through this. ECIR volunteers and moderators will respond as soon as they see your post. The crew is from all over the globe, so try to breathe while we catch up with your time zone. You'll get a detailed formal welcome letter that will give you a lot of information. In the meantime, can you fill in some details? How old is your mare? What is the suspected cause of her laminitis? What is you mare's regular diet? Do you have copies of the digital X-rays taken at the vet hospital? If not, can you get them? Have you had any diagnostic testing done to confirm her metabolic status? Do you have copies of the lab results? More details will be a big help.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Hi, Kim. If you don't balance your hay and instead use a generic balancer, you would supplement the lesser amount of Vitamin C, 1000 mg/day. If your horse's diet is balanced by a trained balancer or if you carefully balance it yourself, then you have a tightly balanced diet, and you can supplement 2500 mg/day Vitamin C. 

As for N-acetyl-cysteine, a search of messages will tell you that it is a precursor to glutathione, an anti-oxidant. This article from NIH suggests it may be helpful for a number of conditions, including airway diseases like chronic bronchitis and asthma. 
https://ecir.groups.io/g/main/message/221511
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241507/

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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Jannalee, I bought plain Vit C powder from the bodybuilding shop I use for many of my other supplements. It is a white crystalline powder, and 1000mg weighed on my gram scale only fills 1/4 teaspoon. I put it the feed. I think I got the NAC from the same shop. You could try a similar outlet. 
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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

 

I forgot to mention that we live in Las Vegas & it’s been over 110 degrees since last Thursday. 
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Beth & Flame & Diana

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  

I rode Flame from 8-8:30am this morning. It was a light to moderate work out & he was sweaty but not excessively hot after. I cooled him down, sponged him off & rinsed his mouth out really well after syringing in his daily Metformin/magnesium/j herb/ chasteberry liquid combo (he usually drools & won’t eat/drink for about 30 minutes after if I don’t rinse his mouth). At 10am my BO texted me letting me know that another boarded noticed Flame standing in his pen breathing hard. They moved from his 3/4 shaded pen into a stall with a fan & all seemed well. This evening @ 8:20pm the BO noticed that Flame’s respirations were increased again. She noticed that he’s not drinking a lot & wants me to start him on electrolytes. Flame currently gets 4 tablespoons of loose iodized salt sprinkled on his hay after it’s soaked every day in the summer. He also has 24/7 access to a white salt block, which he doesn’t seem lick very much. He was body clipped 7/9 but is now definitely not as short as he was then. Running electricity & a fan out to his pen is not an option. Flame has had summers where he’s needed to be moved into a stall with a fan. Last year he did not need to be moved. Any suggestions on safe electrolytes or anything else I can do for him? Thanks in advance!
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Beth & Flame & Diana

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana  

I’m a new member. I’m located in Scottsdale Arizona. My Arabians mare was s currently at Chaparrall Vet Hospital. She’s been there 3 days and has had her second set of X-rays taken today. They are treating her as if she has IR because of her acute condition. The second set of x-rays so more rotation and as you know I’m extremely concerned. This has seemed to come out of nowhere 😪. 

They plan to put her in a clog shoe tomorrow. Do you have any suggestions?

Please help! I feel so helpless 

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Barbara S Arizona 2020

Pellets are also great to put in the muck bucket/wheel barrow as it absorbs the odour. Also use pellets in the dry ports potty (5 gallon Paul with toilet lid and seat on it). 

good for kitty litter as well. 
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Judy and Bugsy

Regina, Saskatchewan, Canada

Feb. 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Judy%20and%20Bugsy
https://ecir.groups.io/g/CaseHistory/album?id=243358

 

How do you know if Vit C is tightly mineral balanced?  

Also, with is N-acetyl cysteine?

Thank you
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Kim R, Lafayette, CA  2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee

I have preemptively put Ziya (IR) on the emergency diet as I am worried about fall rise and in the 2 months since her diagnosis other changes had no effect. She is not currently showing any signs of laminitis. Is this an ok way to manage/encourage her weight and insulin to go down? 
I am soaking hay but it is already low/safe, is it still ok to do so? (Analysis in case folder) 
Is there a resource or calculator for optimum weight? Because she is only 5 and started showing symptoms at 4 I am unsure what her weight should be due to her continued growth.
Thanks!
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Lauren A in Northern CO, joined Aug. 2020
Case History - https://ecir.groups.io/g/CaseHistory/files/Lauren%20and%20Ziya/Ziya%20Case%20History.docx.pdf

Thanks Martha!

we are currently in a heat wave here... by no means as hot as it gets in the US in some areas but still a cooler for us. Nights are cooler which gives everyone a relief thank goodness.

Yes makes sense about keeping her warm and my plan is to add socks to begin with when temps dip to below 10C at night then add from there the wraps and blankets.  We are also planning to insulate her her stall in the outdoor shelter this year as well.  

Her increased crest, should pads and runny eyes have me concerned.  Tonight she seemed a bit slower on our wal and makes we wonder if she is a bit foot sore.  I checked for boot rubs and her vet wrapped heels look on but maybe some discomfort from the previous day when her boots were rubbing a bit with the smouldering heat.

Thanks again for your comments as they are much appreciated.

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Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


Storm

photos

 

Hi Joe,  
Excessive drinking and urination is frequently a sign that his insulin is not well controlled.  I see that you are feeding Purina products.  These have never been found to be suitable for IR horses, regardless of the name they apply to the package.  I note that you’ve cut back considerably on what you feed of that but there’s no reason to feed any.  

It seems that your hay has not been balanced.  I would have it tested as we recommend and then find someone to balance it.  It’s amazing how much difference it can make to feed a horse a perfectly balanced diet, especially as metabolically challenged horses are particularly sensitive to this.

You have two entries for salt on the same date for different amounts, both further described as ‘free choice’.  It’s really important that he get an adequate amount of salt and generally free choice won’t get him in the ball park.  If I find my horses won’t eat the salt in a carrier, I put a smaller amount in the carrier and the rest on their hay.  With time, I can acclimate them to eating more and they begin to like the taste.  

I have a question about the Prascend he’s getting.  Why was he started on Prascend without first testing his ACTH?  You don’t have a PPID diagnosis listed for him and his more recent test is remarkably low for a horse with PPID.  If a horse has elevated insulin as a result of PPID, controlling the PPID with pergolide will often decrease the insulin but if the does not have PPID, I don’t believe pergolide will help.   
--

Hi Heather,
I’m sorry no one has replied.  I recall your original post but I felt certain that someone else could answer it better.  I’ll give you my thoughts and maybe that will inspire someone to step in an give you a better answer.
First of all, winter laminitis is not a true laminitis but a sensitivity to cold which occurs in horses that have been laminitic in the past.  I’m not aware of anything you can do to prevent this other than taking great care to keep her warm, not an easy job in the north.  There is lots of discussion here about that phenomenon and what people have done to alleviate it.  You’ve probably read them all but, if not, please search.  

However, the increase in neck tension is another matter.  I would follow Dr. Kellon’s advice and increase the pergolide, if your vet agrees, regardless of where you notice the puffiness appearing.  I have no experience with invokana so I don’t know if that dose is adjustable or whether doing so might help.  
--

Not sure about the Phytoquench, Nancy. Dr Kellon might have to chime in.
We don't get Uckele products here so I'm not familiar with them. 
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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

 

Sample mishandling is always possible. I say that based on my own recent personal mistakes that prevented us from getting accurate, representative test results for both insulin and ACTH. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Hello,

I am reposting this to see if I can get some suggestions as to how to proceed.  I have updated my case history too.  I am concerned about my mare and the fall rise.  See below my original post.

as it is the fall rise currently I am wondering about what to do for my mare Riosa. She was tested last fall with normal ACTH but as the fall went on she got more and more spooky and her fat deposits and crest kept growing despite tight balanced diet. We had a bought of AWFUL winter laminitis at the end of February.  I had her insulin tested and it was over 500.  We added in prascend to see if it would help and the insulin dropped to just over 400 pmol/l.  We tried metformin but it didn’t work.  At the end of May we started Ivonoka and when we tested her insulin over a month later it had dropped to just over 200 pmol/l which was fantastic news.

She is continuing to do well and her fat deposits are almost all gone except for her crest and rump areas. Her udder is almost non existent now too.  We are doing handwalking and she is moving sound at the walk and at these trot (we only do a few little stretches of trots on our walks).  

Dr. Kellon had said to monitor Rio’s udder as that might give me signed as to if I should increase pergolide as she doesn’t test positive with fall ACTH.  Her udder is good but I noticed today that I thought her crest is perhaps increasing as well as before she would get a puffy area on the underside of her neck.  This puffiness had gone down but it has also reappeared.  Could these be signs her insulin has increased and if so would the fall rise perhaps be driving it up.  She is on 1mg prascend and I wonder should I increase the pergolide to see if her crest and puffy neck goes down?

I asked my vet to come pull insulin but she has not given me an appointment yet and I fear that I might be chasing the rise if I don’t act sooner than later?

I am terrified of going through laminitis again this winter.

We are getting cooler weather now with the fall and some nights are around 10C with a few dips below 10C.  For those nights should I be wrapping and adding socks to her boots?  I have not been blanketing her as I want her to grow as much winter coat as she can for winter.

Looking forward to hearing your feedback and thoughts on my questions.  

Thanks!

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


Storm

photos

 

My wife's 10 year old EMS/IR gelding Mustang, Shiloh  has been drinking and urinating A Lot! for the about the past 6 weeks or so.   I read in the 'overview brochure' that this is a sign of Advanced EMS and PPID.
I guess I'm  confused/concerned with the arrival of a new 'advanced ems symtom' as I was thinking we were making progress.     Any Ideas on what might be going on ?    Looking for Feedback, possible paths to explore.

Background:
He was sore and lame with Laminitis some in 2018-2019, but Over the past year on dry lot with tight diet control and new vet/farrier he has lost over 200 lbs and is at what I would consider pretty much ideal weight (~870 lbs on weight tape  at 14 hands), and he's been comfortable and 'sound' for 9-10 months, athough we are proceeding cautiously with exercise at this point.   

DVM first impression is that he is just drinking a lot due to the heat, but I'm not sure about that. 
 
His only ACTH Test was in January of this year and it was 18.9 pg/ml.   (w/overnight fasting)
His Insulin at that time was 35Ulu/mi and Glucose was 98  mg/dl (w/overnight Fasting)

His latest Bloodwork:  Insulin: 21.58,  Glucose:93  (non-fasting.  although he did not have 100% constant access to hay and he did eat 1/3 lb of ration balancer about 1.5 hours prior to the blood draw)...
I know these numbers still indicate uncompensated IR, but hoping to get in the safer zone as able to increase exercise.

Daily Medications:
Metformin  (DVM is likely going to take him off this at next visit)
1 scoop Thyro-L
Prescend 1 tablet
 
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Joe S. in TX 2020
https://ecir.groups.io/g/CaseHistory/files/Joe%20and%20Shiloh

P.S. I'm not an expert doing the conversion from pmol/L. I used an online calculator, here, which gave the same results as another converter, here.  
2.8 pmol/L is close to 12.72 pg/ml.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .

Hi, Reta. 

My gut reaction --with no more basis than "if it walks like a duck..."-- is to return to this comment by Dr Kellon:
"I know his ACTH is testing well within normal but the distribution of muscle loss is highly suspicious first and foremost for uncontrolled PPID."
https://ecir.groups.io/g/main/message/251966   If he were mine, I'd be going over the submission of his blood work through IDEXX and trialing increased pergolide (with your vet's advice and consent). 

Your latest ACTH results are perplexing. Is pergolide dosing information in your Case History accurate? To have a lower ACTH in late July than in early May, without a dosage change, isn't something I've seen with my two PPID mares. Truthfully I never saw an ACTH that low ever in any of my three mares, including before they were diagnosed with PPID. 
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Cheryl, it sounds to me as though your vet and your pharmacy are saying pretty much the same thing.  2.0 mg of Prascend is equivalent to 2.6 mg compounded pergolide as each mg of Prascend is equivalent to 1.3 mg compounded pergolide.  2.1 mg of Prascend is 2.73 mg of compounded, not 3.0 mg but close.  The pharmacy is saying 2 mg of Prascend is equivalent to 3 mg compounded, not 2.6, but close.  I would go with the 3.0 mg compounded, which seems very close to what your vet suggested so I’m not sure why the vet is disagreeing.  Some pharmacies will prepare the dose to be the exact equivalent of 2 Prascend but I don’t think it matters if you go just a bit higher if they’d prefer to work in whole mgs.
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