Date   

Re: ACTH results Dr Kellon please

Eleanor Kellon, VMD
 

It's reasonable to go to 6 mg first, at least for 4 or 5 days and definitely use up the Prascend! Too expensive not to.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: How to say "thank-you". Please help.

Joy
 


Re: Hogan Greatly Improved on Metformin

ferne fedeli
 

I need to retest my Icelandic, Magic, soon, but his insulin came down quickly on Metformin too.  It seemed to be stabilizing, so I took him off the Metformin and the next test, his insulin went up a bit, so I put him back on it.  I grind it up and put it in his food dish with his other supplements, Stabul1 & ODTB cubes, and he eats it up just fine (I make SURE that there isn't any white showing!!!).  I can't really say it is continuing to help because I haven't retested, but plan to next month.
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


Re: Seasonal Rise questions for Bullitt and Kate

Sarah Orlofske
 

Thank you so much Kristen for the help with the syringe ideas. I will try to give it a shot! Because they are minis I probably use a smaller syringe so that may be part of the problem. I have been making a very watery homemade applesauce with no sugar added to load the syringe after dissolving the Prascend inside with a little water first. Anything thick like baby food seems to clogs up the small syringes. I will try experimenting. I am just trying to get a handle on how to get the powder in without powder or applesauce running all over. 

I definitely agree with syringing! I was so scared of it at first but worked on both horses to train them to it and now it is super easy and better than wondering if they will get sick of a treat at some random moment or if they dropped it got it all. Thank you again for your help! 
--
Sarah O. 
Rudolph, WI
2020


Re: trh stim?

Eleanor Kellon, VMD
 

TRH stimulation goes back to the 1990s but was originally done measuring cortisol. When that proved to have too many false positives, the next suggested test was combined TRH stimulation and dexamethasone suppression, also measuring cortisol . After that the dex suppression test had a reign as the "best" test until dethroned by ACTH and now TRH stimulation again but measuring ACTH.

We still don't know what it means if baseline ACTH normalizes but stimulated does not, especially if the horse is not symptomatic in any way. Andy Durham's paper released just this year looked at TRH stimulation tests before and after treatment and found most improved but were not normal. Unfortunately, they had no information on clinical status or dose of pergolide, and only gave a range and median for pre TRH levels so we have no way to specifically look at horses that were normal before the test.

The big question is does a positive test but with normal baseline mean you should increase dose? If they are also symptomatic, I'd say yes. If they are not, I don't know.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Seasonal Rise questions for Bullitt and Kate

Kirsten Rasmussen
 

I should add that others mix the powder in water or baby food in a tiny cup, then suck it up into the syringe.  Both methods work.

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


Re: Update on Isaac

Mialisa@...
 

Stabul 1 from Chewy is on back order for the fenugreek and peppermint. they have banana, but as we have never tried this before I am hesitant to buy it. Sometimes I think it is a sign from above when I keep hitting walls not to move forward with this.

We did give the Jiaogulan this morning and Isaac ate it out of my hand, but still refused the supplements. I will continue this for a few more days before trying as Amber suggested and pouring them over his hay. Or I can start syringing it.
Thank You!!!
--
Rene` in WI 2021
CaseHistory@ECIR.groups.io | Album
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Re: Seasonal Rise questions for Bullitt and Kate

Kirsten Rasmussen
 

Hi Sarah, I personally find capsules filled with powder easier to give.  I have to syringe meds in.  Hiding Prascend or capsules in a treat got old really fast for my horse.  When I syringe in capsules, I open the capsule carefully by slowly unscrewing it and tap the powder from each half of the capsule into a 5cc syringe preloaded with 2-3cc baby food.  Some powder sticks in the capsule but it's a minute amount.  Then I top up the syringe with another 1-2cc baby food.  My horse loves it, no more battles.

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


Re: ACTH results Dr Kellon please

Suzy Berkowitz
 

I ordered 7mg cp capsules from mixlab and should be here tomorrow. Scout has had no issues with the 1mg increases in the past, do you think the 2mg increase would cause any? I still have prascend left if you think going to 6mg for a few days would be the way to do the increase. I also ordered apf which should be here Thursday, just in case. Thank you for your help
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Re: Update on Isaac

Mialisa@...
 


Re: Peanut has stopped eating her hay / Now Welcome Colleen

Bobbie Day
 

Hello Colleen,
Although you were replying to Alice regarding Peanut, it appears that this is your first time posting so that triggers your welcome message!
So, we want to officially welcome you to the group, you are probably aware of the message that we send to all new members and includes many, many useful links.
When time allows, please give this a read and let us know if you have any questions of your own. I am guessing you have an IR/PPID or EMS horse that has brought you here? It would be a great idea to also get a case history done on your horse or equines so if that time comes when you need help, we will have that information available. Now on to your message!

Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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: EMS 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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

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



Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: Banamine/Gabapentin/Pentoxifylline

Sharon Bice
 

I think Alicia Harlov is in Penn, no in Mass… But I’m sure she knows people near by. She has a great list - you can ask her for it by friending her on facebook or emailing her. She can also help via photos etc to at least make sure you get the best help nearby. Her website is thehumblehoof.com

Sharon Bice

--
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:
https://ecir.groups.io/g/CaseHistory/files/Taillight%20Case%20History

Taillight's Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=257590


Question re: blood work

HBRancher
 

Dr Kellon

Per my vets advice - I have been giving Vandy 1/2 tab Prascend since June 18.  She has also been on a Bute trial since then - starting with 2g twice/day & now down to 1g at nite only. She responded great & has gotten better every day despite lowering the Bute. She is in her Glove boots & showing no signs of lameness. 

I have scheduled a vet farm call for Vandy this Thursday. What blood work do you recommend?

 

Thanks

Mary & Vandy

--
Mary
May 2022,  Holden, Louisiana
Case History: https://ecir.groups.io/g/CaseHistory/files/Mary%20and%20Vandy  .
Vandy's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275053  .


Re: Peanut has stopped eating her hay

colleenulbricht@...
 

When our horse stopped eating her hay, we thought she was stressed or just being picky.  A few weeks later, she developed a huge swelling on the side of her face from a tooth root abscess.  Her teeth had been floated and examined closely by the vet twice at that point but the break in her tooth was below the gumline and couldn't be seen without xrays.  Are you noticing any unusual odor from her mouth or do you ever see any discharge from her nose?  It doesn't have to be consistent to indicate a problem.  I would seriously consider some dental xrays to make sure she doesn't have any changes around any of her roots or any bony changes in her jaws.
--
Colleen U in St. Louis, MO 2022


Re: Flame’s latest labs

Eleanor Kellon, VMD
 

Since he was due for his next dose, you have a worst case scenario on the results. Cornell also runs high on insulin. If he will eat it, I'd like to increase his BP to 4 lbs and add an extra pound of cubes to each feeding. Keep Invokana dose the same. Make sure he is eating at least 2 oz of salt with his food and have it available free choice.

Have you been checking his urine? Were triglycerides tested in May? When was the May sample pulled relative to his last dose?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Heaves, Heat & Testing

TERRI JENNINGS
 

The combination of Spirulina, elecampane, j herb and euphrasia got Beefy off of his inhalers.  He was using albuterol and fluticazkne inhalers 2-3 times a day before we started treating him with herbs. I dropped the j herb when we found out he had PPID but he is still not needing his inhalers even in the heat, and insane pollen amounts.  I do not know if elecampane and euphrasia are safe for IR horses.  When Beefy was dependent on the inhalers I did notice that the fluticazone worked much better than the albuterol. Again, I’m not sure it’s safe for horses with IR

--
Terri Jennings with Mr. Beefy, Finn, Elliott and Teeny (over the rainbow)
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Beefy
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Elliott/Elliott%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Finn/Finn%20Case%20History.pdf


Joined 2019


Re: How to say "thank-you". Please help.

Karen Anderson
 

I was happy to vote!  And grateful to show support!

Dr. Kellon has not only helped educate me, but now my vet (to whom I forward some of Dr. K's messages) is more receptive to being proactive in terms of increasing the dose of compounded pergolide based on the horse's clinical signs. 

--
Karen and Fhinland in Maryland

Case Study:   https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Fhinland


Hogan Greatly Improved on Metformin

Robin
 

Hogan's Insulin is down to 24.32 (baseline) in a 10-40 reference interval. This is a HUGE improvement! Just a week prior it was 73.51 and in January it exceeded 200! And his lower insulin directly correlates with his soundness improving.

I find this interesting because he was on Metformin a few years ago for a laminitic flare up, but there was no change. So, I'm quite surprised (but so thrilled) that it is working now. I thought I'd give it a shot before trying Invokana and so happy I did.

Can Hogan remain on Metformin? Has anyone experienced that it can maintain insulin levels long term (with diet to support of course)? How often should insulin levels be rechecked?

--
Robin

Aiken, SC 2022

https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan  
https://ecir.groups.io/g/CaseHistory/album?id=275012


Re: Banamine/Gabapentin/Pentoxifylline

Cecile Johnson
 

Try Progressive Hoofcare Practitioners.  The website is Progressivehoofcare.org.  I found them through this group.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

As I said, The American Farriers Association website was one of the resources I tried. The worst farrier I found was listed there — Charlie was lame for two months after the guy did an overly aggressive trim. I will never trust that site again.


I will check out Go Horse. 

Fortunately I was able to get Charlie into Daisy Haven Farm which was referred by this group, and I will be transporting him there today.
--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/files/Alysoun%20and%20Charlie
https://ecir.groups.io/g/CaseHistory/album?id=275965 

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