I've been tapering her off the concentrates and alfalfa as she's held weight (already cut in half). She didn't respond to the first few things I tried, though hoping once we get her system straightened out she'll do better on safer feeds. I got a little desperate in needing to keep any weight I had on her--she was looking bad earlier this year, and not finishing a lot of things.

Given how quickly she gained once I gave in and added the alfalfa I suspect she will probably need some over the winter to keep her ladylike curves. Should I look in to adding some phos and probably mag? Would alf pellets be a better option? (problem is she may not eat them before they turn into cold goo and she will then tip her bucket and bye-bye AZCC)

In an ideal world, yes, we'd be on teff and one of the safe feeds from the chart but I have to work with what I have and can afford and can get the barn to do. They will do slow feed bale nets (which is how I keep my EMS mare), which is a blessing. I might be able to get LMF feeds; I'll look into it.

I can run IR tests when retesting ACTH, but really not concerned about it with this horse. Even when young and at the height of her easy keeper days she never developed the usual issues (and when at a show barn in her youth she was cracked out on sweet feed, straight alfalfa, corn, red cell etc). She's had a number of opportunities to devolve into catastrophic metabolic issues and hasn't (enterolith surgery w/ salmonella infection, 2000; crashed into barbed wire, numerous lacerations and hematomas, lots of sedation to get her patched up, etc, 2008; snakebite just above ankle, leg swelled to the point of losing skin, lots of steroids... etc--2010 maybe?). We watched her like a hawk for issues and fully expected at least some level of laminitis, but in the latter two incidents she wasn't even lame despite having front leg injuries; no pulses, no heat. No colic, either (even with the enteroliths--paranoid vet caught them after losing another horse in the barn on the table to enteroliths). She just likes to give me heart attacks with her apparent death wish (and a couple of choke episodes juuuuust bad enough to need an emergency call when she bolted soaked feed).

Tough cookie who I expect is going to drive me batty until she passes in her sleep, probably at 40. Trim before last I had to lunge her just to get her feet done. And by lunge I mean stand in the middle of the round pen while she ran for 15 minutes by herself. Last trim (day after The Vet Poked Her With A Needle) she wouldn't let me catch her. <insert variety of emojis here!>
--
Sara
Prophecy - 31 yo Morgan - PPID
Missy - 6yo Morgan - probably EMS
San Diego, CA
2019

Hello Sara,

Welcome to the group! 

You are already miles ahead of many people in your knowledge and understanding of what is needed - kudos to you. Thank-you for the signature and case history for Prophecy - so helpful :)

You can either use APF/j-herb or not for starting the Prascend - your choice. No way to tell beforehand whether it will be needed or not, unfortunately, so suggest you use your own gut feeling to determine whether to use it or not. If you are on the fence, and the finances allow, start the APF a day or two before starting the Prascend. You should only need one bottle to get over any potential hump.

The best scenario is always to test the hay, then custom balance. However, that isn't always a realistic option. AZCC is a good 2nd best option. If the hay tends to come from the same general location, testing a few batches will give you an idea of what the mineral profile tends to be so you can assess whether the AZCC is a good fit or not. Once you get the PPID controlled, it should be easier to put and keep weight on your girl.

It looks like you had Prophecy's ACTH tested but not insulin/glucose/leptin - is that correct? It would be a good idea to have the additional tests run to see whether there are also issues with IR. Even if she has never had problems before, the PPID can influence that aspect. Even if IR is not an issue, the Elk Grove Senior and the Purina Ultium are both not the best choices as feeds as the mineral content is not at all well balanced plus they contain ingredients that make them totally unsuitable for an IR horse. Your area tends to have high calcium in all the hay so adding alfalfa on top of that is compounding the potential problem. Probably best to stop that.

The remainder of this message contains our Official Welcome, with tons of links and general info. It can be a bit overwhelming so storing it away somewhere easy to access for future reference might be helpful. Let us know if there's anything else we can help with.

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 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.

Hi!
I hope I'm getting everything uploaded right--as a PHCP trimmer I refer folks to ECIR constantly and am just now getting on here seriously myself, though I have lurked previously.

My 31 year old Morgan mare has just been diagnosed with PPID. Not surprising, I was expecting it, and am looking forward to seeing her get back to herself; she's been not quite right all summer. Feet are in good shape. Levels were 175 from Cornell (normal 9-35 pg/mL). Prascend just arrived so she starts it today.

I can order APF or j-herb and get it in the next couple of days, or should I see how she does first? She's a tough cookie (has kicked death in the teeth more than once) and I wouldn't be surprised if she does okay. However she IS 31 and I did just fight to get a good hundred pounds on her this summer so I do not want to lose it going in to winter. Her teeth are in remarkable shape for her age, no loss, down to the last bit of grinding but she eats well.

Thanks Dr. Clougher for the fab PHCP webinar last month :) got me to call my vet. And the fab presentation last year at the conference which got me to realize my youngster is probably EMS... you tagged it, soon as she stopped growing, the weight packed on. I'll start her history and post about her as soon as I get my old lady sorted out.

QUESTIONS:
-APF/j-herb when titrating on Prascend: just do it, or see how the horse does first?

-I board, and hay testing is going to drive me batty. If I have to, I will, but since the mare's never blown an abscess much less been footsore (I've owned her 20 years, she got me in to barefoot trimming in 2006, she's got some pathologies but I'm pretty sure part of it is from coffin bone demineralization--I look forward to tightening WL coming in with the Prascend but I doubt it'll ever be perfect), I'd rather focus my efforts on what I can control better. I feed AZ Copper Complete and have for years but am happy to start custom mixing, if I can get a ballpark to shoot for. I am thinking it might be wise to do that for my EMS mare given that I'm adding magnesium for her anyway (she is happier if she has more than AZCC provides). We also have hard well water. Would custom mixing be a better option given that I can't control the hay or realistically am I safer going with AZCC?

I have taken the NRC Plus course but life threw me a huge curveball partway through and I realistically need to re-do at least the mathematically inclined bits, as well as take the test. Math is NOT my friend and I never trust my answers (I have a talent to do the same exact calculation, on a calculator, multiple times, and get different answers) so I would love some help.

--
Sara
Prophecy - 31 yo Morgan - PPID
Missy - 6yo Morgan - probably EMS
San Diego, CA
2019

www.drkellon.com 
EC Owner 2001

www.drkellon.com 
EC Owner 2001

www.drkellon.com 
EC Owner 2001

Hello,

This email message is a notification to let you know that the following files have been uploaded to the Files area of the main@ECIR.groups.io group.

• /6 Diet Balancing/HAY BALANCING.pdf

Uploaded By: Eleanor Kellon, VMD <drkellon@...>

Description:
Where to get help with diet/mineral balancing

Cheers,
The Groups.io Team

Lorna Cane
Ontario, Canada
2002

Foxtail has been a problem where I live for a long time but I am usually able to find grass hay that is mostly free of it. Because it is a grass, it is hard to eliminate without killing or damaging the entire crop.  Because it comes in later, I try to buy first cutting which is normally foxtail free but tends to have other weeds.

There is another grass becoming a problem here now - some call it squirrel tail but my vet says its a type of millet.  The seed heads are dense and has tiny hairs on each seed that create ulcers in the horses's mouths.  We began having it in our own field last year; it seems to like the wetter places. Luckily for us, it is very easy to pull but we only have a couple acres. My long-time hay grower has been redoing his fields more often because of the foxtail but he said he hasn't had many complaints about the millet and that his horses have no problem with it. One of mine did ok with it but I have a mare that is missing a couple of teeth and she was full of ulcers throughout her mouth, especially around the base of each tooth. Maybe horses with an odd chewing pattern or in need of balancing are more susceptible to problems with the millet anyway.
--
Jill, Khari & Jetty in Idaho

NRC 2010

https://ecir.groups.io/g/CaseHistory/files/Jill%20and%20Khari 

Hi,
I have balanced my hay based on the NRC Course.  I'm looking for sources to purchase Phosphorus, Copper, Zinc, Iodine.

I would also like to know amount of Methionine and Biotin horses should have.  I didn't see recommendations in the NRC list (may have missed it?).  

Thank you

--
- Julie Thomas
September 2018, Seabeck, WA
Case Histories: https://ecir.groups.io/g/CaseHistory/files/Julie-Ike-Sparky  .
Ike Photos: https://ecir.groups.io/g/CaseHistory/album?id=73042  .
Sparky Photos: https://ecir.groups.io/g/CaseHistory/album?id=73044  .

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 

2.5 weeks ago my horse stopped eating well.  We were 12 days into Pergoloide so I mistakenly assumed it was due to Pergoloide veil.  

However, several days later my horse started drooling excessively.   I felt around in his mouth and felt a notable size welt on his cheek inside his mouth.   It felt like a wart.   My veterinarian examined him and discovered he had several ulcers due to sharp grass stuck in his cheek, under his tongue and in between several teeth.  He had a huge clump under his tongue and an abscess.  

According to a quick Google search on horse eating hay with foxtail produced:   “ Horse owners should check hay for the presence of foxtails before feeding it to their animals. Mouth ulcers, also called hay blisters, can be caused when horses ingest foxtail (Setaria species). Foxtail seedheads are green to light green in color, and resemble a bottle brush or a fox tail.”
--
- Jennifer Haunschild
Sept 2019, Edmond, OK
Space Cowboy - 12.1h Welsh Pony:  PPID 

Space Cowboy Case History:  https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Space%20Cowboy