Date   

Re: Isoxsuprine

Shevawn Romine
 

Scared to ask….but is that venogram a recommended test,  and what would a result of “no blood flow” indicate?    


--
Cassie and Shevawn
03/2015   Gordon, TX
CH folder:  https://ecir.groups.io/g/CaseHistory/files/Shevawn%20and%20Cassie 
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=76832 


Re: Horse recently diagnosed with IR - help

Sherry Morse
 

Hi Melodie,

We prefer to see insulin levels below 10 as 80 is in fact very high.  You can plug your glucose and insulin numbers into the IR Calculator - https://www.ecirhorse.org/ir-calculator-leptin.php and you'll see that Monte comes up as "Uncompensated IR" with his current numbers.  That plus the subclinical laminitis is a good indicator he needs tighter diet control to get his numbers down to where they need to be.



Re: Horse recently diagnosed with IR - help

melodie miller
 

I forgot, one more question.
My vet said he will do another blood test/evaluation in May.  (This time I will ask him to use the Cornell labs, I didn't know enough last time.)
He said his insulin wasn't that high (80) and he sees much higer.
But isn't 6 months too long to retest? What is the protocol?

Thank You again,

Melodie
--
Melodie Miller, Earleville Maryland, Nov 2019
https://ecir.groups.io/g/CaseHistory/files/Melodie%20and%20Montserrat 
https://ecir.groups.io/g/CaseHistory/album?id=207657


Re: Horse recently diagnosed with IR - help

melodie miller
 

Bonnie,

Thank you for responding so quickly.
I have 2 horses, my mare is "put together" much differently than Monty and has a lot of TB. I would, at some point, like to get them on the same balanced diet, though I may have to feed her a little more.  It would be hard to feed them different hay. I will be sure to increase his hay. I've been making sure they eat it all before I put more out because I don't want to over feed.  Now that it's getting colder I'm sure 20-25 lbs will be the normal.

The hay being low in DE and high in protein, - is this a problem? Can this issue be worked out in the mineral balancing?
I have a barn full of hay for the season.  I could maybe sell it but trying to replace it with good low sugar/starch would likely be a challenge. Hay in this area has been hard to come by. Most of this hay has little to no alfalfa and he has had a much larger alfalfa mix in the past (even straight alfalfa in the trailer) with no issues.

Even before this happened I noticed that the Poulin grain I was feeding has the wrong Omega 3 -6 ratio (was already adding flax seed to counter that) and I need to feed at least 2 lbs for the optimum vitamins.  No way can I feed Monty 2 lbs and even my mare seems to do just fine on 1 lb. so I am glad to switch  both to a good mineral-balanced diet and if my mare needs more energy (she is my hunter/jumper) I can address it then.

My other big issue is exercise! I was just getting him back to good exercise.  He has some coffin joint arthritis, my trainer had him on bute. I got tired of it, took him off the bute in September and took a few steps back to "train" him to get him off his forehand.  He is just coming back to harder work, and doing GREAT, including a 2 hour paper chase with no bute! and this happens.    But very soon I will be down to riding Wed, Sat, Sun, and holidays and I'm worried about that.  What do other people do in the winter?  If I didn't have to work, then DST wouldn't be an issue.
Please excuse my rant.. I'm just worried about him. He is, like most horses, a good boy!

Just an FYI:
My farrier noticed that he had a bout of laminitis between (front) shoe cycles.  I actually thought him incorrect because I've been riding him daily and he never took a wrong step.  I am VERY tuned into his front-end sensitivity due to the arthritis issue and the very specific work I have been doing with him.    But I called the vet right away and... you know the rest of the story. (We had a drought here then rain, and we think that may have been the final trigger because he was fine all summer on grass. Of course, free choice grass is no longer an option and I'm already trying to work out what to do next spring)

Again, thank you for your help and for supporting this site. I have been pouring over this site for days now.

-Melodie





--
Melodie Miller, Earleville Maryland, Nov 2019
https://ecir.groups.io/g/CaseHistory/filessearch?q=Melodie+and+Montserrat
https://ecir.groups.io/g/CaseHistory/album?id=207657


Re: High Manganese

Eleanor Kellon, VMD
 
Edited

Manganese toxicity has not been described in horses but that may be because they're not looking in the right place or studying it long term. In the human brain, manganese excess results in iron overload because the manganese is interfering with iron binding to its regulatory proteins so the brain allows more free iron than it should. https://www.ncbi.nlm.nih.gov/pubmed/30152072 . The vulnerable  neurons causing the movement disorder are dopaminergic, just like the ones damaged in  PPID horses. I have also seen horses with high manganese intakes that have low blood ferritin but high serum iron and high transferrin saturation, exactly what you would expect if the same thing that happens in the brain happens on a bodywide basis.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Vet says lethargy can be caused by too much pergolide

Eleanor Kellon, VMD
 

Lynn,

 It actually could be either one! However, if you have noticed lethargy to coincide with ACTH too high in the past, and improve with pergolide, it may be more likely it is the uncontrolled PPID causing it. Best way to try to figure this out is to hold at a dose of pergolide for 3 to 4  weeks, not lethargy or not, retest ACTH. Also be supercritical of foot comfort, e.g. trotting on hard vs soft surfaces, since "lethargy" may actually be reluctance because of pain.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Horse recently diagnosed with IR - help

Sherry Morse
 

Hi Melodie,

I wanted to add my observation to Lorna's - your guy has what appears to be a very distinct crest in the pictures you posted, in addition to what could be fat pockets (although those are harder to distinguish in pictures with a a full winter coat).  Welcome to the group though, you're in the right place for help.

As far as the amount of hay being fed - is 15 pounds a definite or just an estimate?  If it's an estimate you want to weigh what he's getting.  We recommend feeding at 2% of ideal weight or 1.5% of current weight (whichever is greater) until ideal weight is achieved.  That would be 24 lbs for your guy based on 1200lbs and would include hay as well as any grain, beet pulp, etc.  We don't recommend IR horses being turned out on grass but he can be in a dry lot with part of his hay ration for the day.



Re: Horse recently diagnosed with IR - help

Eleanor Kellon, VMD
 

P.S.  The ultimate test of how much you should be feeding him is his body condition score. If he is holding at a good weight on what you are feeding, don't change the amount.

As already mentioned, alfalfa can be problematic for many EMS horses. So can "balancers" fed in 1+  lb amounts. No more animal crackers!
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Horse recently diagnosed with IR - help

Eleanor Kellon, VMD
 

Hi Melodie,

Thanks for taking the time to get your CH info accessible. It really helps! Given his age, breed and an October laminitis I would suggest speaking with your vet about putting a TRH stimulation test on the schedule for him. There's a very good chance he is an early PPID horse.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


Re: Isoxsuprine

Lorna Cane
 

Jessica, you said, "........jiaogulan!  As soon as I found the good dosage, she started to walk better and be more comfortable "

And I just have to say how lucky Sonara is to be in your family!
You have worked so hard, struggling  through issues that a couple of years ago seemed insurmountable to you . We know you felt like giving up sometimes, but you never did.
And look at the two of you now!
I so hope you get to follow your dream of someday creating  a rehabilitation facility for  our compromised horses.





Lorna Cane
Ontario, Canada
2002


 


Re: High Manganese

jessica skene
 

How interesting!!
does manganese can be too high au cause toxicity? Or is it just a matter of balancing mineral ratio and all?
--
Jessica Skene  - Abitibi, Québec, Canada
Sonara => Canadian X QH mare , 11 years old, historic of founder and suspicion of IR

october 2017

Link to case history: https://ecir.groups.io/g/CaseHistory/files/Jessica%20Skene%20and%20Sonara/SonaraCaseHistory.pdf
Link to album: https://ecir.groups.io/g/CaseHistory/album?id=10295&p=Name,,,20,1,0,0
Link to hay analysis: https://ecir.groups.io/g/CaseHistory/files/Jessica%20Skene%20and%20Sonara/analysedefoin.pdf


Re: Isoxsuprine

jessica skene
 

My vet told me he could sale me some isox but as they where no proof of efficiency he was not comfortable recommending it to me, especially at this price!
but I am happy I followed the protocole here as it really helped my mare to take jiaogulan! As soon as I found the good dosage, she started to walk better and be more comfortable
--
Jessica Skene  - Abitibi, Québec, Canada
Sonara => Canadian X QH mare , 11 years old, historic of founder and suspicion of IR

october 2017

Link to case history: https://ecir.groups.io/g/CaseHistory/files/Jessica%20Skene%20and%20Sonara/SonaraCaseHistory.pdf
Link to album: https://ecir.groups.io/g/CaseHistory/album?id=10295&p=Name,,,20,1,0,0
Link to hay analysis: https://ecir.groups.io/g/CaseHistory/files/Jessica%20Skene%20and%20Sonara/analysedefoin.pdf


Re: Beet pulp shreds vs pellets

Deb Walker
 

Yes Martha...Scotty has NO molars left...he can chew up the soaked beet pulp shreds and the soaked ODTBC. That is his diet.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Re: Isoxsuprine

Deb Walker
 

My horse was on Isoxuprine before he foundered completely, with both coffin bones near coming out his hooves. When he was at the UW-Madison (WI) hospital (now 2 years ago) they kept him and did a test to see if he had circulation in his legs/hooves. He did. He was 35 +/- at that time...and still had circulation. In fact, they were not expecting such a good result. The vets there also kind of pooh poohed Isoxuprine...but who's to say? He had very good circulation and is still with me today because the doctors there and the farriers there saved his life. I've been following protocol here for almost a year now, and he is still alive and well. I've taken him off jiogulan for the time being; he doesn't seem to have an issue with circulation. I may start him up again over the winter...time will tell.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Re: Horse recently diagnosed with IR - help

Lorna Cane
 

P.S. Melodie, I meant to say , it may be the angle, but I also see signs of a crest in the photos of your handsome boy, higher up along his neck  than you mentioned.

--

Lorna Cane
Ontario, Canada
2002


 


Re: Horse recently diagnosed with IR - help

 

I wanted to add that 15 lbs of hay just can't be enough for a 16.2 hand warmblood. The Digestable Energy of this hay seems a bit low while the protein is quite high.
However, it would be a good idea to switch him to a tested low esc/starch ALL Grass hay if possible. Many IR horses cannot tolerate alfalfa in their diets. My IR horse became sore footed from just a small amount found mixed into his grass hay. And by the way my 14.3 hand Arab cross gets 20 lbs of grass hay per day.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Horse recently diagnosed with IR - help

 

Hello Melodie,
I'm glad you found this group. We really needed your horse's case history file accessible and in your signature before we put thru your first posts with the questions you would probably have. 

First an organizational item. Photos and any type of .jpg or .jpeg file cannot be loaded into  case history folders. Only documents like Word documents (.doc) or Adobe documents (.pdf) can be uploaded into case history file folders.

Within the Case History Group we have a sub-group called files which is where documents and folders for documents (like you case history folder) are stored. See the "Files" sub-group in the column on the left side of this page.

Above that is the "Photos" sub-group is just above the Files. Within the "Photos" sub-group you can create you own photo folder (album) for your horse's pics. If someone sends you a scanned document (which appears as like a photo (.jpg) you can store it inside of your album. Remember to name you photo album/folder in the same way as your case history folder, your first name and horse name.

In the "Main" group we have a "Wiki" which is fully functioning. "How-To" help is right at your finger tips in the Wiki. How to create folders, how to reorganize files, move your files, change or add to your signature, etc. It's all right there.

I have attached our New Member post below. It is long and detailed and can be a bit intimidating at first but just begin reading at the top and follow the steps we require of new members. We want to help you but we do require you provide us with the details about your horse's health and history so that our moderators can offer you safe advice.

Your horse has experienced laminitis and I see you wrote that you have him on the emergency diet. Is he still going out on grass? Grass isn't safe for him at this point given his test results and the laminitis. Have you gone to our web site yet 
https://www.ecirhorse.org/
and read the DDT&E? Also use the "MAIN" files area to do searches, for example: type "diet balancing" into the "Search box" at the top right of each page and you will find info about diet balancing and a link to the list of diet balancers that we suggest. You will have to contact each balancer (or maybe just one) and ask them for a price for balancing and what they provide with their balancing. Taking action on getting a diet plan for your horse is REALLY worth the initial cost. I learned a lot and it finally got me moving forward with a real plan that helped my horse.

When You have a question try searching the files and/or Wiki then post a message with your question if you couldn't find what you need within our extensive files. 

By the way I lived in Maryland for about 30 years before retiring to Michigan. 

Welcome Aboard!

Welcome to the group! 

The ECIR 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 etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and 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.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Re: Horse recently diagnosed with IR - help

Lorna Cane
 

Hi Melodie,
Welcome. You will receive a formal welcome,full of ideas for you shortly. But I just wanted to say our Files contain a list of diet Balancers,as you indicated. Scroll down to the 6th entry.
I also wondered if 15 pounds of hay....yes,sugar and starch numbers are good....is enoughfor a horse his size? Even with the beet pulp?
Speaking of beet pulp,can you enter in his CH how much by weight he is getting? I'm not sure what a quart weighs.
Thanks.
--

Lorna Cane
Ontario, Canada
2002


 


Vet says lethargy can be caused by too much pergolide

grandmalynn44
 

 Bodie was on 6 mgs. of cp pergolide when I had his ACTH tested in late October.  The result came back 54.45 range 9-35.  I was hoping for much lower results since he had been on 3.0 in July when I began to increase his dose in preparation for the seasonal rise.  The vet noticed this high result but suggested not increasing dose since it was beginning the down slope of the seasonal rise and to watch his symptoms.  I kept him on 6.0 mgs for a couple of weeks than lowered to 5.0 mgs, the new prescription I had requested before I saw the ACTH results.  I have ridden him several times and his energy is not his usual.  The last time he stopped several times for no apparent reason while I was leading him to saddle up. His energy level is definitely down so I requested raising his dose to 6 mgs. again.  My vet agreed to the increase but said the lethargy could be related to the dose being too high now that the seasonal rise was ending.  I don’t think this is a side effect of too much pergolide which is what she said could be the cause but I would like more input from the group.  This vet has been very cooperative so I don’t want to undermine our relationship by questioning her suggestion in this case. Just want more information. 
Thanks
Lynn McKechnie

N. California, May, 2011

Mica:  https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Mica  
Bodie:  https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Bodie


Re: Advice for re-homing a PPID horse

sunygirl06@...
 

I am so sorry that you have this difficult decision!

I personally have instructed my family that if something were to happen to me, that I want Sunny put down. I have a lot of time and money invested in her. She is/was my 1st horse, is my lesson horse for my kids, drives, been-there-done-that.
She's comfortable and sassy at 20 years young, but I know that nobody else would be able to keep her in that condition nor would I expect them to invest the time or money that I have. Her health and condition are always on my mind, chores are more than just pitching hay, and are ever changing with new hay, increasing pergolide dosages, etc. 

I am young so I most definitely expect to outlive her, but before I would pass her and her problems to another I will have her euthanized. No matter how much my lesson girls love her, I love her more!

Good luck with your decision.
--
Amber Lauer
September 2016, Black Creek, WI

Sunny Case History https://ecir.groups.io/g/CaseHistory/files/Amber%20and%20Sunny/Sunny%20Case%20History.pdf