Date   

Re: Now VIt. E (was But E)

Kirsten Rasmussen
 

I'll just add that you can buy vitamin E powder and mix in the oil yourself.  I think this is one of the more economical options.  There are lots of brands selling powdered vit E for horses.   My Best Horse is one source.

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


Re: Bradley Bloodwork

Sherry Morse
 

Hi Maureen,

Given Bradley's high insulin now I would be looking at starting him on Pergolide for the elevated ACTH and Metformin to get his insulin down (this is dosed at 30mg/kg twice a day).  You should recheck insulin 7 - 10 days after starting Metformin to see if it's effective for him.  You also need to get his diet changed which includes no more pasture unless he's in a completely sealed muzzle (this will allow him to drink water but we don't recommend they're turned out longer than 4 hours with a sealed muzzle).  

Why is your vet recommending thyroid medicine?  It will help jump start weight loss if needed but will not bring down insulin levels by itself. 

Without knowing what his insulin was over the winter we can't guess why he was laminitic but were he mine going forward I would always keep him warm when the weather is cold rather than chancing a laminitic event.




Re: Xrays and trim photos

Kirsten Rasmussen
 


Hydration for recumbent horse (was Re: [ECIR] Solar Penetration)

Sherry Morse
 

Nicolle,

Are you salting her hay?  Putting salt in a mash for her? Dosing her with salt to encourage her to drink? (To do that you can mix 1 oz of salt with 1-2 oz of kaolin pectin and administer with a dose syringe).  Horses will usually reject food with salt in it if they're not used to it being added already so dosing might be the best way to get salt into her to get her to drink.  You do NOT want to use electrolytes in a dehydrated horse as that will cause other problems.

If needed you can have the vet do IV fluids as well but were she mine and I was not seeing improvement with the NSAIDs I would wean her off of them to avoid further kidney damage from something that isn't helping her pain level. You can read about that here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf  Possible alternatives for pain relief include Devil's Claw and you can read about switching to that here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Pain%20control,%20switching%20from%20Bute%20to%20Phyto-Quench.pdf




Re: Vitamin E

Eleanor Kellon, VMD
 

I don't think it would solidify in the refrigerator but never tried it! I'll try to find out.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Morgan Mare Diagnosed with EMS and PPID

Sherry Morse
 

Hi Lori,

Getting a full case history completed would be very helpful for us so all the information on Abbey is in one place.  The pain could be due to insulin still being elevated as well as the lack of sole depth and slightly long toes (although as Lavinia said there are just minor fixes to her trim needed).  Is she sore in boots?  If so, have you experimented with pads to find the ones that she likes best?  Could you post a full set of hoof pictures?  If you get those posted and request a trim markup from Lavinia at least 10 days prior to the next farrier visit she can provide you markups showing where the trim can be tightened up.

As far as testing - you can retest 3 weeks after being on the target dose of pergolide to see if it's working.  However, the caveat with that is trying to run a TRH Stim test at this time of year can yield unreliable results so you need to focus on her insulin number more than anything.  Normally you would also want to rerun insulin at the same time as you checked ACTH to see if that has come down with the diet change as well.  

If you are going to start her on Metformin (and unless you have bloodwork showing her insulin has greatly reduced as she's lost weight I would recommend that) you want to test the insulin prior to starting and then after 7-10 days on Metformin.  If the pre-start bloodwork comes back much lower than the initial 115 reading you could then decide to stop it and keep it as a back up if she has another event.  

Have you started her on Devil's Claw or Phytoquench with Devil's claw to see if that helps?  Again, the key here is removing the cause of the pain which is elevated insulin.  Diet can help with that as can pergolide if elevated ACTH is driving up insulin but for a level that high I'd get her on Metformin ASAP.




Re: Hyperthyroidism and other questions regarding blood tests

Sherry Morse
 

Hi Liz,

What form of pergolide are you using (capsules/in oil/powder)?  If this were my horse going into the rise I would be upping his dose to at least 3mg of pergolide now.  As his glucose number was normal I wouldn't think the insulin was a mis-count but it's certainly no longer indicative of him being IR.  Have you had his Vitamin E level checked?  Had a neuro evaluation done?  Feet crossing when they walk and loss of muscle makes me think of motor neuron disease, not thyroid or PPID.  





Re: Bradley Bloodwork

 
Edited

Hi Maureen,

Welcome to the ECIR group.  A new ECIR group member making the first post is sent a formal welcome which contains lots of good information.  We focus on diagnosis, diet, trim and exercise in both resolving and preventing IR related issues.  I realize you are not at all new and this is not your first post but we couldn’t find any record of your having been sent an ECIR welcome.  If in fact you have, no matter, as this letter is updated frequently and everyone can use a refresher.  I edited your message to make the link to your case history live.  I did not edit your signature itself so you will need to do that.  Just press return and then save after the link to turn it blue and make it live.

While winter laminitis could certainly be causing Bradley issues, it quite possible he could also be experiencing “regular” metabolic laminitis.  His insulin is definitely high enough for that to be the issue.  We don’t advise putting insulin resistant horses on any sort of pasture unless wearing a sealed muzzle.  The fact that he’s sensitive to higher carb hay means it’s very likely he will not be able to tolerate grass.  Dead grass and grass roots dug up by the horse can be quite high in sugars.

Chastetree Berry powder does nothing to decrease ACTH.  It has been used successfully to help regulate coat growth.  Some people use both CTB and pergolide but we don’t recommend that because research has noted that the CTB might well diminish the effectiveness of the pergolide.

The emergency diet we recommend and describe below calls for magnesium.  Once your hay has been mineral tested, you may find that it contains adequate Mg.  Thyroid medication is used to jumpstart weight loss.  If Bradley is overweight, which I did not note, it’s fine to use to help get the weight off but it does nothing to lower insulin.  In fact, abnormal thyroid results are most often the result of euthyroid sick syndrome and will resolve once the other metabolic factors are under better control.

High ACTH can exacerbate high insulin in many horses.  Winter laminitis is not metabolic, other than that it occurs more frequently in horses which have suffered laminitis, so I don’t think ACTH would be responsible for winter laminitis.  However, getting it under control might well help to bring the insulin down.  While I would definitely put him on pergolide if he were mine, the ACTH (as tested) is not alarmingly high.  The goal is to keep the ACTH in the high teens or low 20’s.

If you have X-rays to share, please post them so we can give you trim guidance.  I would highly recommend having your current hay tested, using wet chemistry techniques, and having the minerals in the hay balanced appropriately.  Aside from needing enough of each mineral, those need to be in appropriate ratios to be the most effective.  While a mineral balance low ESC+starch hay is beneficial for all horses, it is crucial to the good health of metabolically challenged individuals.  What follows is our welcome letter.

 

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. 

with coat growth.  Some people use both CTB and pergolide but we don’t recommend that because research has noted that the CTB might well diminish the effectiveness of the pergolide.

The emergency diet we recommend and describe below calls for magnesium.  Once your hay has been mineral tested, you may find that it contains adequate Mg.  Thyroid medication is used to jumpstart weight loss.  If Bradley is overweight, which I did not note, it’s fine to use to help get the weight off but it does nothing to lower insulin.  In fact, abnormal thyroid results are most often the result of euthyroid sick syndrome and will resolve once the other metabolic factors are under better control.

High ACTH can exacerbate high insulin in many horses.  Winter laminitis is not metabolic, other than that it occurs more frequently in horses which have suffered laminitis, so I don’t think ACTH would be responsible for winter laminitis.  However, getting it under control might well help to bring the insulin down.  While I would definitely put him on pergolide if he were mine, the ACTH (as tested) is not alarmingly high.

If you have X-rays to share, please post them so we can give you trim guidance.  I would highly recommend having your current hay tested, using wet chemistry techniques, and having the minerals in the hay balanced appropriately.  Aside from needing enough of each mineral, those need to be in appropriate ratios to be the most effective.  While a mineral balance low ESC+starch hay is beneficial for all horses, it is crucial to the good health of metabolically challenged individuals.  What follows is our welcome letter.

 

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. 

 
--
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: Solar Penetration

Lesley Fraser
 

Unfortunately, no Lyme tests are 100% accurate, and a negative result isn’t necessarily the same as not having Lyme. To complicate things further, there are dozens of different species of Lyme bacteria, and none of the tests can cover them all. To complicate things a bit more, there are several tick-borne infections other than Lyme, and they might need to be addressed separately. Hopefully none of them are in the mix, though.

--
Lesley and over the bridge Omar,
11-2012, Sutherland, UK

Omar - Case History


Bradley Bloodwork

Maureen
 
Edited

Hello,

Bradley was diagnosed as insulin resistant in 2015 and has been under control since his original episode of laminitis that year.  In spring 2020 I moved to the mountains of North Central Washington State and Bradley was able to be turned out on pasture.  The weather here is cold with daytime highs below freezing from November - February and I have been struggling to manage winter laminitis.  In February 2021, he had a severe bout after a few nights of 20 degrees below zero.  I learned about boots, leg wraps, laminox and phytoquench here and he improved as the weather warmed.  

This past winter I got ahead of the cold and started him on laminox, phytoquench, APF and ALCAR in December.  In early January we had about 5 consecutive nights of 20 below zero and he was fine without a blanket, leg wraps or boots.  I took him off the supplements at the end of January and by mid February he was laminitic.  I got him back on the supplements, blanket, leg wraps and boots right away and he bounced back pretty fast.  

I did bloodwork last week and the ACTH is high as well as insulin.  My vet wants to start with Chastetree Berry, magnesium and thyroid medication.  I would like to start him on pergolide.  Could the high ACTH have something to do with the winter laminitis in February?

Thank you,
Maureen
North Central Washington State
2015?
https://ecir.groups.io/g/CaseHistory/files/Maureen%20and%20Bradley


Re: Start Chicy back on pergolide Dr Kello please

Qhgirl
 

An added notation. I had wanted to test her bloodwork before putting her on pergolide. she was just trimmed this Monday  (my trimmer did not want to trim her with her foal for some reason) and her feet were in bad shape. She developed white line disease snd thrush while At the hospital for 8 weeks and the stuff they put on her feet dried them out snd the walls just broke off.   My new trimmer came Monday and removed more and thinks he got it all - he follows Pete Ramey and I have hopes he will take good care of her. She is sore footed after the trim as I expected she would be after all she has been through so I put her back in boots on all 4s for the time being. So I am not sure if she is just sore footed from trim or having reaction to season rise. I wanted to do bloodwork before starting pergolide as a frame of reference but did not want yo do bloodwork so quick after this trim since she appears to have some pain after the trim. Was hoping she would be better a week after trim, pull blood and start her on pergolide the same day.

-- Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Morgan Mare Diagnosed with EMS and PPID

abberdoo@...
 

Thank you Nancy & Sherry, appreciate your support.   I am starting to wonder if I should be increasing her dose of pergolide reading through what some other recommendations were for far lower results.  I just got the capsules from my vet, it says they are 1.1 mg, I still have the powder as well, the vet told me to give her one capsule and 1/2 scoop of the powder for a couple of weeks... and then I don't know what.  She is still so very sore and doesn't seem to be getting any better, so could it be she needs a higher dose?   Also, the vet said we should test her again in 2 to 3 months, but if we wait that long how do we even know if it's working?   She has been on it for a month and other than her losing weight because of her new diet I see no improvement in the amount of pain, it seems worse.  Would it hurt to bump her up to 2mg?   Or 1 of the capsules and a full scoop of the powder?  

Her results about a month ago::
Pre TRH Response at 25 pg/mL and post at 305.  Her Insulin was at 115.59 uIU/mL.  Prescribed  "a heaping scoop" of "Cushings Powder" (the label says 1- 5ml level scoop contains Pergolide 1mg and Cyproheptadine 180mg),    
--
Lori J in NC 2022

Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 


Start Chicy back on pergolide Dr Kello please

Qhgirl
 

Hello,
with the season rise I know I need to start Chicy back on pergolide. She has been off it for 3 months. I took her off 30 days before 320 days so she could produce milk. She baked her baby 360 days. Pep is 1 month old today. Too young to wean. 

I did discussed going back on pergolide with the repro vet snd she told me to put Chicy back on pergolide any time with no concern about her not lactating. She said the concern is for a pregnant mare to produce milk at foaling time. If a mare is already lactating they can be put on pergolide and will continue to produce milk for the baby.  Do you agree with this statement?

I have purchased milk replacer and foal creep feed. I am fixing up a place for creep feeding and will have ready tomorrow. Will only use the milk replacer powder if Chicy dries up. But will start the foal pellets tomorrow to get him used to eating in the creep feed area we are building tomorrow. Would like to start her on pergolide tomorrow as well  

I asked the repro vet if for some reason Chicy lost her milk if I could leave Pep with her. She said no because she would reject him because he would try to nurse and it would cause her pain snd would no
longer tolerate him being with her so I should separate her. I spoke to a breeder friend of mine and he disagreed. Said leave him with mom and allow him to creep feed milk replacer snd eat foal pellets and Chicy would allow him to share her hay snd still be his mom since they have a bond  

I want to be prepared. Just need more information as we cross this milestone. If you feel she will dry up how long do you think it will take for that to happen?

Thanks again as we forge forward. 
--
Janet and Chicy
Chester SC
09/17/2021
https://ecir.groups.io/g/CaseHistory/files/Janet%20and%20Chicy
https://ecir.groups.io/g/CaseHistory/album?id=268334


Re: Help with Mineral Balancing?

Trisha DePietro
 

Hi Lucy. Here is a link to folks that can assist with mineral balancing...  https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf     --
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: New to EMS

Trisha DePietro
 

Hi Emma. Your first post here causes a welcome letter to be sent to you.Its not just a welcome letter, it actually contains highlights of our protocol for Diagnosis, diet, trim and exercise. Embeded in each topic are blue links that will take you deeper into the subject matter. 
Answering your question about "how long" is so hard to determine. It 'depends' is the best answer. As you fill out your case history, and share with us, his current weight, feeding, etc....and his hoof xrays...we will be able to tell you more information, but overall, it takes about 9 months to a year for a full hoof capsule to grow out.  That growth is dependent on proper diet, proper trim, proper diagnosis and proper exercise if he is comfortable. So,your horse is still not sound, which could mean you have not touched on the actual root problem...does he have Cushings ( PPID)?  If it is a pure EMS situation, what is his diet? All of that info goes into your case History. What is his current weight? What are you feeding him?  Here is a link to information from Dr. Kellon about feeding the EMS horse when they are back to normal https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Feeding%20Recovered%20Laminitics%20When%20Back%20in%20Work.pdf --

So lots of questions for you now, but once you get your case history up  and any pictures of his feet, etc.  We will be able to guide you better. here is the welcome letter.

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. 

 
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Solar Penetration

Nicolle Dupont
 

Forgot to add that this area has not had lyme disease diagnosed in livestock.

Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 5:04 PM Nicolle Dupont via groups.io <nicolle8383=gmail.com@groups.io> wrote:
Hello Dr. Kellon,


I am at a loss at why she continues to worsen.  I posted case history and photos from today which show right sole with greater penetration than three days ago.  She has been on soaked hay for 2 months, supplements, NSAIDs, just started anti-biotics Apo Sulfatrim to prevent any bone infection.  We decided against the Doxy as her kidney numbers were getting bad from the dehydration and NSAIDs.  Lyme blood test results should be available next week.  She doesn't drink as much as she should as she does not move around and it has been quite warm here.

Between the edema and kidney issues I am not sure she will make it until the blood test are back.  I need a Hail Mary to stop this progression.  Should I switch her to the Doxy?
  
Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 3:27 PM Nicolle Dupont via groups.io <nicolle8383=gmail.com@groups.io> wrote:
Hi,

She had not moved for 36 hours (not more than 2 inches with her feet) and it is very warm during the day 93 F.  I thought that had caused the edema.


Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 2:02 PM Eleanor Kellon, VMD <drkellon@...> wrote:
The ventral edema means your vet should be searching for an infection causing a SIR - systemic inflammatory response - as the root of all this.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


Re: Solar Penetration

Nicolle Dupont
 

Hello Dr. Kellon,


I am at a loss at why she continues to worsen.  I posted case history and photos from today which show right sole with greater penetration than three days ago.  She has been on soaked hay for 2 months, supplements, NSAIDs, just started anti-biotics Apo Sulfatrim to prevent any bone infection.  We decided against the Doxy as her kidney numbers were getting bad from the dehydration and NSAIDs.  Lyme blood test results should be available next week.  She doesn't drink as much as she should as she does not move around and it has been quite warm here.

Between the edema and kidney issues I am not sure she will make it until the blood test are back.  I need a Hail Mary to stop this progression.  Should I switch her to the Doxy?
  
Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 3:27 PM Nicolle Dupont via groups.io <nicolle8383=gmail.com@groups.io> wrote:
Hi,

She had not moved for 36 hours (not more than 2 inches with her feet) and it is very warm during the day 93 F.  I thought that had caused the edema.


Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 2:02 PM Eleanor Kellon, VMD <drkellon@...> wrote:
The ventral edema means your vet should be searching for an infection causing a SIR - systemic inflammatory response - as the root of all this.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


Re: Solar Penetration

Nicolle Dupont
 

Hi,

She had not moved for 36 hours (not more than 2 inches with her feet) and it is very warm during the day 93 F.  I thought that had caused the edema.


Regards,

Nicolle Dupont
1831 Parkcrest Ave.
Kamloops, BC  V2B 4W8
Cell:  250-644-4002
Fax:  855-288-9410


On Wed, Jul 20, 2022 at 2:02 PM Eleanor Kellon, VMD <drkellon@...> wrote:
The ventral edema means your vet should be searching for an infection causing a SIR - systemic inflammatory response - as the root of all this.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Nicolle D in BC Canada 2022
https://ecir.groups.io/g/CaseHistory/album?id=276759


Help with Mineral Balancing?

Lucy Butler
 
Edited

Hi Folks,

I have a newly diagnosed PPID/EMS Morgan mare - she is an early case with mild symptoms, but I am trying to take proactive steps to her treatment.  I've got her started on pergolide (and APF and following the ECIR titration schedule to help avoid the possibility of a veil), and I just received results of hay testing (#603) from Equi-Analytical.  My next step is mineral balancing.  I reached out to Uckele to request a custom mineral blend, but customer service responded that they are no longer offering the service due to rising costs.  Can anyone help me with some basic information or another avenue for help with mineral balancing? I have added the analysis report in my case history file folder.

Thank you!

Lucy Butler & Rowan
--
Lucy Butler
Rhode Island, USA
Joined 2022
Rowan Case History: https://ecir.groups.io/g/CaseHistory/files/Lucy%20and%20Rowan
 

 


Hyperthyroidism and other questions regarding blood tests

Liz7033@...
 

Hi,
Dante was retested after 4 week of not being on kelp products.  HIs thyroid numbers were worse!  T3 - 251 (range 30-80),  Free T4- 7.39 (1.2-1.8) T4 - 5.73 (1-3). Before these test results, the vet did ultrasound his thyroid. And thought it looked normal, but noted that he doesn't look at many thyroids. 1) I'm looking for suggestions on what my next step is.  Hyperthyroidism is rare and I don't even know what questions to ask.

Dante's ACTH came back at 37.3.  He has been on 2.2 pergolide.  I can't seem to get his ACTH out of the thirties. 2) Do I go to 3 mg or much higher?  3) Could this be effecting his thyroid?

His insulin was 4.0 uIU/mL.  He had plenty of food in front of him the night before, had his "grain" at 4 am was turned out on pasture by 5 am.   Blood work at 11, before any other procedures. He might not be eating enough, but he is eating. 4) Any reason for this low of insulin, since I do not believe he was fasting.

He is schedule for a stomach scope tomorrow with a 14 hr fasting before.  5) Is there a reason he shouldn't be fasted  based on his insulin numbers?

Overall, he is looks tired, but at the same time he is ready to go for a walk.  Losing more muscle on top line, but at time maybe a slight belly. The most disturbing thing, is at times he completely zones out doesn't seem to know where his feet are, his feet cross when he walks,   Almost like he is a sleepy drunk.  After less than two minutes of this he is back to his normal self. I don't know how often he does it, but I'm beginning to see it more. 

Any insights would be greatly appreciated.

-


Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
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