Date   

Need Input on Management of RecentlyDiagnosed PPID Mare

Mary Gills
 

I would greatly appreciate input for management of my mare who was recently diagnosed with PPID.  I have posted my case history.  My mare is currently on 1.5 mg of Prescend and I am thinking that I should increase her dose. 
Do you want pictures on all horses as part of their basic case history or only for specific issues?  I've been a member of the main group for many years but I'm not sure how to find out what year I joined. Thank you in advance for your help. 

https://ecir.groups.io/g/CaseHistory/files/Summer%20Blush%20Case%20History

--
Mary Gills
Steamboat Springs, CO


Re: Liquid Pergolide

Kathy Thomas
 

Thanks, Linda!


--
Kathy 2017 and Donna

Harrowsmith, Ontario

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Donna


Re: #file-notice #file-notice

Lesley Bludworth
 

Kirsten,
Thank you for the thorough explanation, I am afraid she is in the 9-month group.  
I am so thankful she did not penetrate her soles
I hope her insulin is better on the metformin and diet.
Diet alone certainly did not do it.  
Is it safe to have her exercise via swimming at this time?
I found an equine aquatic center not too far from here.


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Kirsten Rasmussen <kirstenrasmussen3@...>
Sent: Monday, August 15, 2022 10:15:52 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] #file-notice
 
Lesley,

Pain improves within 24-72 hours of an insulin reduction, whether by diet or medication, and can continue to improve with time.  I've seen an immediate reduction in pain in my own horse within 36 hours, and gradual improvement over the following several weeks for minor laminitic flareups caught early.  More serious or prolonged acute laminitis can cause a lot more damage and take a lot longer to recover from.  No matter what, you have to get the insulin under control to stop the damage and pain.  Only then can they recover. 

If insulin is brought down to a safe level, but they are still in a lot of pain then the lingering pain is due to damage to the hoof.  All you can do about that is get the hooves trimmed correctly to promote healthy growth and reduce stress on the damaged lamellae, and support them with pads in boots until a healthy hoof capsule grows in, which takes about 6-9 months assuming there are no additional laminitic events that damage the new growth.  You should see an exponential  improvement in pain levels over those 6-9 months.  Abscesses are commonly a part of this healing process though and can be more painful than the acute laminitis. 

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

--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Re: Question on hay analysis

Kimberly
 

Thanks Nancy and Lavinia, I only posted as I have discussed this and NIRS vs Wet Chemistry with the lab alot over the years.  They have always advised to  use the 3rd column, which is usually higher, so I assumed that was correct.  What you say makes perfect sense in that how you feed is what really matters.  I just did what they recommended based on my questions to them about how important the results are for IR horses.  I guess now I will have a bit more wiggle room.  Thank you for the clarification and I hope my comment did not confuse anyone.  BTW, Mouse will be going to VA Tech on Thursday so I will update as I have more info.  Kimberly 
--
Kimberly joined 7.17.2018 Virginia
https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse
https://ecir.groups.io/g/CaseHistory/album?id=275222



Re: Sloughing Pix Posted

Nancy & Vinnie & Summer
 

What worked for me related to proud flesh when I had to deal with Vinnie's medial sinking with the hoof wall prolapse and decompression, was pressure wrapping with elastikon and gauze soaked with homemade Dakins Solution.

What we did was soak the non stick gauze in the solution,, drain a little before applying around the affected area, and then apply mild pressure when wrapping with elastikon.   This helped the tissue cornify and helps keep the area a little antiseptic.   I had to change the wrap every two days until the tissue cornified.

I would apply cotton wrapping and then vetwrap around the foot to keep debris out.

I don't know if this would be helpful here, but I thought I would share.
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: Invokana vs Steglatro

Nancy & Vinnie & Summer
 

Hi Beth

I get my pea protein here, based on a recommendation from Dr K.   BulkSupplements.com Pea Protein Isolate - Pea Protein Powder - Vegan Protein Powder - Plant Protein Powder - Unflavored Protein Powder - Plant Based Protein Supplement (1 Kilogram - 2.2 lbs) https://a.co/d/9gLp1w0

Also here are a couple articles from Dr K in case you missed them:

https://ecir.groups.io/g/main/topic/92424610#280689

https://ecir.groups.io/g/main/message/278423?p=%2C%2C%2C20%2C0%2C0%2C0%3A%3ACreated%2C%2CPea+protein%2C20%2C2%2C0%2C91629078

I will be doing labs again this week, so will post when I have the results.

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: #file-notice #file-notice

Kirsten Rasmussen
 

Lesley,

Pain improves within 24-72 hours of an insulin reduction, whether by diet or medication, and can continue to improve with time.  I've seen an immediate reduction in pain in my own horse within 36 hours, and gradual improvement over the following several weeks for minor laminitic flareups caught early.  More serious or prolonged acute laminitis can cause a lot more damage and take a lot longer to recover from.  No matter what, you have to get the insulin under control to stop the damage and pain.  Only then can they recover. 

If insulin is brought down to a safe level, but they are still in a lot of pain then the lingering pain is due to damage to the hoof.  All you can do about that is get the hooves trimmed correctly to promote healthy growth and reduce stress on the damaged lamellae, and support them with pads in boots until a healthy hoof capsule grows in, which takes about 6-9 months assuming there are no additional laminitic events that damage the new growth.  You should see an exponential  improvement in pain levels over those 6-9 months.  Abscesses are commonly a part of this healing process though and can be more painful than the acute laminitis. 

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


Re: Re-test?

 

Hi Colleen.  I did not know that she had been trailered for her blood testing.  Experience has shown us hat can definitely skew the results.  
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


Re: #file-notice #file-notice

Kirsten Rasmussen
 

Toni,

Keep in mind that too magnesium in any form can also cause loose stools.  Only add it if your hay analysis shows that Mg is deficient. 

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


Re: recent tender footed - latest insulin up - please advise on medications

Sherry Morse
 

Hi Jenny,

With that additional information I would say you could trial the Metformin (planning on redoing bloodwork 7 - 10 days after starting) and see if it helps with the insulin number as well as the tenderness.  If you see an improvement you have your answer as to how sensitive he is to changes in insulin.




Re: recent tender footed - latest insulin up - please advise on medications

Jenny Heishman
 

Hi Sherry,

Thanks so much for your quick reply. 
I understand that laminitis occurs around insulin levels of 80.  I thought that there could be changes in the laminae at 50? 
The reason why I am writing in for advice, is that my horse is showing hoof sensitivity and higher insulin results.  The hoof sensitivity has just come on.  He has been in glue ons since last October.  I often have the shoes off for a day before getting the next set glued on and he has never shown this tenderness.  In addition to witnessing that....he is showing other behaviors that he did back before living on the track and before the glue on shoes.  Such as seeking softer ground when riding out.  Choosing to walk rather than trot.  This is with his glue on shoes back on.  I would never take him out without anything on his hooves - that's been the case for the past three years.  He also has a pair of easy boot gloves with the thin pads.  I trim myself under the guidance of Jodie Jenson, who is a long time ECIR member, and a very good trimmer.  She is coming on Wednesday, so I can get photos and post them....but I really don't think it's a mechanical hoof issue.

My vet said that the normal ACTH for August is below 20.  So that is why his value of 34.8 look high to me.  Thank you for the link to the weekly ACTH levels - that's super helpful and I will forward to my vet.

Thank you for letting me know that Metformin is the first medication of choice.
There is a string of hot wire on our track that is quite low.  I clip grasses regularly to keep them low and unavailable to him.  It is only a 100 foot long track with a 30' by 40' sand loafing area, so I do have my eye on the whole area.  I would say that from time to time, he is able to get a piece of grass.  But, I think it's unfair that this would be cited as the cause.  Honestly, his bloodwork results don't back that up either.  There was no dramatic lowering in his insulin numbers when he went from a taped muzzle in a pasture - where he was always able to partially rub some of the tape away and get grass....much, much more grass than he is able to very minimally get to now.  The track living started December 2021.  You can see his insulin numbers before that in the case history.  I think he is a puzzling case and I'm certainly scratching my head (and throwing my best at it)


--
Jenny Heishman and Rico  
Bainbridge Island, WA   June 2018
https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico
https://ecir.groups.io/g/CaseHistory/album?id=60437


Re: Re-test?

colleen.m.morrissey@...
 


Re: Re-test?

colleen.m.morrissey@...
 

Thank you Kirsten.  Isabella's vet agrees we should re-test. He said it could be an error but also stress can spike glucose. For the next test, I will schedule the blood draw at home instead of trailering her to the clinic and have sent to Cornell. 
--
Colleen M in CA 2022


Re: recent tender footed - latest insulin up - please advise on medications

Sherry Morse
 

Hi Jenny,

His insulin results are high, but not high enough that he should be experiencing laminitis right now.  I do agree with running the TRH stim test next spring but wouldn't be surprised if it came back normal as he's in line with what we expect at this time of year.  https://ecir.groups.io/g/main/files/Blood%20Testing%20for%20IR%20and%20PPID/Blood%20Testing%20for%20Cushings%20-%20PPID/Seasonal%20Influences%20on%20ACTH/Liphook%20-%20Seasonal-Changes-in-ACTH-Secretion2.pdf has a weekly list - we're in week 34 now so you can see he's not out of the adjusted range at all.

Is he tender while wearing the shoes or was he barefoot and tender and then you put shoes back on him?  I'm not real clear on that.  If he's barefoot and tender have you tried putting boots on him to see how he is with them?

Before going to Metformin (which is the first medication choice) you may want to confirm he absolutely can't be getting any grass under the fence of the track and also share pics of the current trim to see if there's something there that might be leading to the tenderness.  




recent tender footed - latest insulin up - please advise on medications

Jenny Heishman
 

Hello all,

My gelding, Rico, 11yo Paso Fino/Rocky Mountain, lives on a dry track since December 2021.  I was hoping that this grass-free environment would bring his insulin values down to normal, but unfortunately, that's not what we are experiencing.

He eats weighed and soaked hay 1 hour cold water (hay test in file....tested both soaked and unsoaked sample)
Balanced minerals served in R/S/R beet pulp
Jioagulan 2 teaspns/day
He's wearing easy care glue on shoes - four week cycle then trim and re-glue.  This last cycle, when I removed the glue ons, I noticed that he was tender footed (had not seen this in previous removals of shoes)  I then noticed some other "tender footed" behaviors, called the vet to run bloodwork and his insulin came back higher than our last test in the end of March.  Please see case history for bloodwork history - four tests in the past two years....none of them with normal insulin.

Current bloodwork on 8/4/22:
     ACTH - 34.8 pg/mL (Normal <20 in Aug)
     Insulin - 56.03 uIU/mL
     Glucose - 98 mg/dL

Previous Bloodwork 3/23/22:
     ACTH - 15.2 pg/mL (Normal <15 in March)
     Insulin - 48.62 uIU/mL
     Glucose - 110 mg/dL

My vet here is suggesting medication, either Metformin or steglatro.  I have asked here before about putting him on Metformin and it was recommended to save it for an emergency, like an active laminitis episode.  What do you all think now?  It's really worrisome to see/feel the slight changes in him with his tender hooves.  Places on the trail that he usually trots off, he is now walking on the ivy plants on the sides.  He has been under the most exercise ever....especially leading up to this....and moving/feeling great until late July.

Vet also says, " PPID is still lower on the list given his age, but his ACTH has never technically been normal with the most recent updated reference ranges and insulin dysregulation/laminitis is sometimes the only clinical sign, especially if early onset. Next blood-work I'd recommend a TRH Stim test."  
Would you agree?

Thank you for sharing any suggestions/thoughts you may have.



--
Jenny Heishman and Rico  
Bainbridge Island, WA   June 2018
https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico
https://ecir.groups.io/g/CaseHistory/album?id=60437


Re: Invokana vs Steglatro

 

Thank you for the replies. Nancy, what does the pea protein isolate do? Where do you get it and how much do you feed? Even with the l-carnitine I have not been able to get much of a change in Flames triglyceride numbers. Does anyone know when Dr. Kellon will be “back”? I’m definitely still interested in hearing and understanding about what happens internally with triglyceride levels that high.
--
Beth & Flame dx 2013 & Diana dx 2020

NV Oct 2013

Flame Case History

Flame Pictures

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




Re: Liquid Pergolide

Starshine Ranch
 

Hi Cathy,
I've been using Avrio but I am going to switch to Precision Pharmacy in Bakersfield.  I think they have a location somewhere else as well that might be closer to you.
--
Linda in Grass Valley, CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara


Re: Sloughing Pix Posted

Nicolle Dupont
 

Hi Martha,

I checked our tack store's website and it apprears they carry the Schreiner's.  I am just waiting for them to open at 8:30 to grab some before I head out.

Thank you.
--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/files/Nicolle%20and%20Elsa
https://ecir.groups.io/g/CaseHistory/album?id=276759


Re: Sloughing Pix Posted

 

Nicolle, after looking at the photos, I think you might well find it useful.  You could call the company to ask.  I found them very approachable.  When I first bought it, it was a niche item at my tack shop but now you can get it many places, including across Canada, they state.  It forms a light film across the wound and keeps bugs away.  I don’t know what the carrier is but it might contain alcohol.  My mare never reacted to it but some horses do so keep yourself out of harm’s way while applying it.  They may have thoughts on the bedsore as well.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


Now: Message Posting Etiquette - Keeping ECIR User Friendly - 08/15/2022 #cal-notice

Group Notification <noreply@...>
 

Message Posting Etiquette - Keeping ECIR User Friendly

When:
08/15/2022

View Event

Description:
Message Posting Etiquette

This is a high volume group that can be difficult to follow. Help make it easier for everyone by following the Message Posting Guidelines below:
1) Sign your posts. This is a very large group.  Whenever posting a message, identify yourself and your equine by using your full ECIR Signature with your first name, location, the date you joined and the links to your Case History folder and Photo Album. The volunteers need all this information to provide quality responses and suggestions for local support, vendors, vets and hoof care. 
 
2) Be clear in your posts. If you need to quote a line this is most easily done using the web to reply (not from email). Once you have the message you want to reply to on your screen, copy the text you want quoted, then paste it into the reply message composer.  Highlight the text you are quoting and then click on the quotation marks in the toolbar.  
3) Be considerate of the Support Team. They volunteer to help members in their spare time. Many have full time jobs. Unless you are in an emergency read the Start Here Files and check the archives to see if your question has been answered before.  Many new member's questions are answered there.
4) Discussion should always take place on the forums so all members can learn from the conversation and the support team can help clear up confusion.  
5)  Try not to hijack threads.  Start a New Message or change the subject line to discuss issues not covered by the subject line.
6) Don't immediately re-post.  Give “missing” posts a few hours before reposting. For unanswered messages, be patient. A lack of response is not personal or a reflection on you in any way. With so many posts some do get missed. Unless in an emergency situation, wait roughly 48 hours before re-posting and edit the subject line with "2nd Try". 
7) Off-topic but horse-related discussions: ECIR Horsekeeping Forum provides a place to discuss issues involving non-PPID/EMS horses, general horse keeping practices, other equine health issues, alternative therapies and any equine related philosophical debates.
8) All discussion about horses with PPID and EMS takes place in the ECIR Forum. Hoof related discussion for horses that do not have PPID/EMS takes place in the ECIR Hoof Forum
 Thank you for your cooperation.
 
- The ECIR Group support Team