Date   

Re: Ertuglifozin v. Metformin

Maxine McArthur
 

Michelle, I would discuss your concerns with your vet, as they are allowed to trial pergolide/Prascend based on symptoms even if the test is equivocal. My mare tested only at the top of the normal range but her anhydrosis, lethargy, poor coat and skin issues without any other obvious cause prompted us to try her on medication and she improved, so my vet is quite happy to keep her medicated now. 

--
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

 


Re: Intro

Cindy Q
 
Edited

Hello Jane

Welcome to the group! 

As Arabs are prone to insulin resistance and further this guy is positive PPID, it is recommended to feed according to our feed guidelines (details below in the 2nd section of our Welcome letter covering Diagnosis, Diet, Trim + Exercise (if horse is comfortable). We recommend not to feed alfalfa as it has been found to make some equines footy. 

Any reason why you feed copper and not zinc? We recommend iron: copper: zinc: manganese in the overall diet be 4:1:3:3 for metabolic horses. If you are feeding these minerals separately, please note that with a hay test (recommended 603 wet chemical method from Equine Analytical) you could get free mineral balancing from Uckele by Dr Kellon using Uckele products. They sell both poly copper and poly zinc separately. If you are not able to get a hay test for your specific hay, some members get by using regional averages for where the hay is grown (poorer 2nd choice but sometimes necessary).

For a carrier for supplements, there are safer choices than Haystack Special Blend. See our file Safe Bagged Feeds here: 
https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds

Your post seems to have been cut off and a case history is a great place where you can consolidate all relevant information on your PPID gelding. Lucky horse to land with you.

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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





Re: feeding before blood draw

 

Hi, Lynda.
Yes, both are acceptable options for feeding before blood draws. The reason for the different options is that some EMS horses can have hay in front of them 24 hrs a day and not get fat. Far more need to be on calorie-restricted diets. Whichever works for your equines, we must avoid testing insulin right after breaking an overnight fast because that is followed by an insulin surge.

To answer your question about Loomis Vet, you need a little background. Different labs use different testing equipment for insulin and ACTH. We’ve found that the results aren’t always identical from lab to lab. Those discrepancies can be critical to a fragile equine with uncontrolled EMS and/or PPID. As an example, Cornell uses equipment that can dial in very high insulin results accurately. I don't have enough information about Max and Ginger to say much more. Case histories would help. My own experience sending blood samples from a single blood draw to Cornell and a different lab was that the different lab reported results within the "reference range," but the Cornell results showed elevations that required action. 

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


Re: Ertuglifozin v. Metformin

misglen
 

Hmm, that makes sense.  What a shame, when its a very useful alternative test.  My gut instinct is that Max is early PPID, as nothing else explains his abnormal sweating which only started this autumn,and his late coat shedding for the last year or two.  And as Dr Kellon said above, the insulin is high, but its not hugely high.  I just don't trust the ACTH test results, but what am I supposed to do, its really frustrating.
--
Michelle & Max
Yarra Valley, Victoria, Australia
Thank you
Joined 2022
https://ecir.groups.io/g/CaseHistory/files/Michelle%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=277108


Re: feeding before blood draw

Lynda, Max & Ginger
 

Hi,
I also have baseline ACTH, Insulin & Glucose testing coming right up and get a bit confused about the timing of food before the blood is drawn.  Sherry's reply to Daisy indicates the horse should eat normal breakfast early enough so they are finished eating 4 hours before the Vet arrives, but recently someone posted that they'd fed breakfast and then kept food in front of the horse for 4 hours until the vet arrived.    Are both acceptable options? 

On a related note, I am using a different Vet this time because I question if my usual one is always able to get back to their office to spin down, freeze, and send out as quickly as necessary.  However, this vet does not send labs to Cornell, It's a large practice, Loomis Basin Equine Medical Center, and they do their own processing for the things they don't send to UC Davis.  Will that be OK?  

As always, thanks for your help.
--
Lynda M
Northern CA
Jan 2022


Re: Jiaogulan

 

Lesley,
That’s right, as an estimate for starting.  You still need to check to see if tongue and gums get pinker in about an hour. Once you get the dose right, it’s not a terrible idea to check every so often. It’s really easy to see the effect on pink-skinned horses. It’s harder with horses with dark skin and gums. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Ertuglifozin v. Metformin

Maxine McArthur
 

Michelle, as far as I know it's not a laboratory issue with the TRH stim--it's the fact that vets have to buy an entire very expensive vial of the material, which they may not use all of, and therefore it's a huge loss for them. They can't afford to do it, at least that's per my vet. Unless they pass on the expense to the owner. She did say that Charles Sturt Uni at Wagga might be able to do it but I would probably need to take the horse there, and she wasn't sure. That's why I asked you to let me know if you find any vet in Victoria who does it. 

--
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

 


Re: Jiaogulan

Lesley Bludworth
 

Cass, so if it is mixed with everything else, double the dose?


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Dawn Hernandez <BHSEquine@...>
Sent: Sunday, July 31, 2022 6:01:06 PM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Jiaogulan
 
Thanks Cass!

I did read to monitor the tongue and gums. That's been added to my cheat sheet that I keep at the barn. 
Thank you for the explanation of why the 20min prior to normal feeding. 

--
Dawn Marie & Dalli
Eliot, ME
https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Dalli
https://ecir.groups.io/g/CaseHistory/album?id=271623



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


Re: Jiaogulan

Dawn & Dalli
 

Thanks Cass!

I did read to monitor the tongue and gums. That's been added to my cheat sheet that I keep at the barn. 
Thank you for the explanation of why the 20min prior to normal feeding. 

--
Dawn Marie & Dalli
Eliot, ME
https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Dalli
https://ecir.groups.io/g/CaseHistory/album?id=271623



Re: Jiaogulan

 

Dawn, we introduce Jiaogulan teaspoon by half a teaspoon, increasing the dose until we see the effect we're looking for: pinker tongue and gums about an hour after the dose. If you were asking why to give it 20 minutes before feed, it's to enhance it's absorption without mixing it with a lot of feed. It's a very small amount! 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Ertuglifozin v. Metformin

misglen
 

PS it’s in my Case History but I forgot to add in above, I was giving him 3\4 cup of stabilised RBO fir a week or two  along with the Lupinpak…. Too much far from what I know now 
--
Michelle & Max
Yarra Valley, Victoria, Australia
Thank you
Joined 2022
https://ecir.groups.io/g/CaseHistory/files/Michelle%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=277108


Re: Ertuglifozin v. Metformin

misglen
 

Hi Kristen the bloods were taken for the insulin test before I started the emergency diet.  My vet is coming back tomorrow to re-check Max so perhaps I should get another insulin test done to see if the level has come down? 


if anyone knows a lab in Australia that will do a TRH test I’d love the details so I could get one done… we seem to be on a backwater in that regard!
--
Michelle & Max
Yarra Valley, Victoria, Australia
Thank you
Joined 2022
https://ecir.groups.io/g/CaseHistory/files/Michelle%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=277108


Re: Ertuglifozin v. Metformin

misglen
 

Thank you Dr Kellon, he was tested for PPID first, I’ve uploaded the test result in his Case History, it was negative at 23.3 so my vet then did the insulin test. Unfortunately he hasn’t been able to find a lab here in Australia that does the TRH test, as I asked for that to be done also?
--
Michelle & Max
Yarra Valley, Victoria, Australia
Thank you
Joined 2022
https://ecir.groups.io/g/CaseHistory/files/Michelle%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=277108


Re: Jiaogulan

Lesley Bludworth
 

Wow, Nice to know, thanks for sharing.  I suspect I have SAD also, will give it a try


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Martha McSherry via groups.io <mmcsherry@...>
Sent: Sunday, July 31, 2022 2:08:06 PM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Jiaogulan
 
Well, here’s another one.  A few years ago, I’d read so many recommendations for using jiaogulan I decided to try it myself.  I find it incredibly energizing.  I have seasonal affective disorder so I’ve had to stop using it in June when the days are noticeably longer and sometimes I forget to start it up again in the fall but just got the bottle out again.  I’m sure I’m not the only one but I was impressed.  My only concern is whether my fingernails might grow faster than they already do.  
--
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
 

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


Re: Jiaogulan

 

Well, here’s another one.  A few years ago, I’d read so many recommendations for using jiaogulan I decided to try it myself.  I find it incredibly energizing.  I have seasonal affective disorder so I’ve had to stop using it in June when the days are noticeably longer and sometimes I forget to start it up again in the fall but just got the bottle out again.  I’m sure I’m not the only one but I was impressed.  My only concern is whether my fingernails might grow faster than they already do.  
--
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: Intro

Lesley Bludworth
 

Jane,
Super lucky horse to have been rescued by younger!
Nice to hear about A2M.


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Jane M <scandiajane@...>
Sent: Sunday, July 31, 2022 8:18:34 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: [ECIR] Intro
 
I rescued a lame, neglected 24yo Arab gelding April 2021. Removed shoes (feet trimmed), vet exam, vaccines, dental and rads. PPID diagnosed; Prascend prescribed. First year owned: added about 125# to his frame, free feed timothy plus supplements, occasional alfalfa; feet trimmed every 3-6 wks depending on growth (season); daily turnout with grazing muzzle. Lameness continues. Nerve blocks finally determined lameness caused by inflammation at right shoulder, not feet (thin reactive soles when bought). Equioxx prescribed. Two A2M injections to date into shoulder joint; third planned mid Aug. Sound on straightaway. My goal is to do whatever possible to keep him comfortable the rest of his days. Current daily diet: 8# hay (third ea tim, alf, orchard grass) 2x/day; haystack special blend, Renew Gold, Tight Joints Plus, copper, turmeric, salt soaked,
--
Jane M in WA state, 2022

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


Re: Pergolide and Bute

Starshine Ranch
 

Thank you both!
--
Linda in Grass Valley, CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara


Re: Ertuglifozin v. Metformin

Maxine McArthur
 

<Do a TRH stimulation test, if available>


Michelle, if your vet does do a TRH stim please let us know the details, as it is not available here.
--
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

 


Re: Jiaogulan

Dawn & Dalli
 

First, thank you for this thread. Very informative and came at the right time for me.

I've just ordered the Uckele Jiaogulan for Dalli. I've been going through the archives and have read to introduce it slowly and to feed 20 minutes before any feed. Why is that? Also, I thought I read that you could add it to the feed, but you would need to double the dose. 


--
Dawn Marie & Dalli
Eliot, ME
https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Dalli
https://ecir.groups.io/g/CaseHistory/album?id=271623



Re: Hind end stiffness, forehand soreness

Mikaela Tapuska
 

Thank you Sherry! I will do that.
--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255

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