Lynn,

Such sad news, I'm sorry you had to let Mica go.  Thank you for your kind offer, I'm sure it will help another horse.

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

To be more specific, I'm looking at distribution of fat in terms of crest size, deposits behind scapulas, the feeling of flesh/fat over the ribs, the filling around the "waist" ie area where hind leg joins to barrel, and fat pads around the tail head, and I'm thinking about how much they would need to lose to come down 1-2 grades on the BCS. 
--
Cassandra in NM 2022
https://ecir.groups.io/g/CaseHistory/files/Cassandra%20and%20Beshlakai%20-%20Negra

https://ecir.groups.io/g/CaseHistory/album?id=277489

https://ecir.groups.io/g/CaseHistory/album?id=277702

Hello Jean

Welcome to the group! 

Below I'll be sharing our welcome letter that Dr Kellon referred to.

1) Put her onto the emergency diet (linked below and on this page: https://www.ecirhorse.com/DDT+E-diet.php - you need to scroll to the bottom half for the details). Soaked and well drained grass hay for an hour is part of it but there's more. Although you are feeding a small amount of alfalfa as a carrier, please cut that out (as mentioned below that it is not recommended for most). Suitable carriers are mentioned below under the DIET section.

2) As for testing your hay, we recommend Equi Analytical/EA. https://equi-analytical.com/ - they also cover how you can take a hay sample (https://equi-analytical.com/feed-and-forage-analysis/taking-a-sample/):
- Hay probe - more accurate. You can borrow from your local county agri office sometimes or local coop: https://ecir.groups.io/g/main/message/235368 
- hand grabbing samples - you can get by and it's better than not testing: https://ecir.groups.io/g/main/message/198634
- You want the 603 (trainer) test - this uses wet chemical method (more accurate) for every item.

3) Diagnosis/ testing your mare. This is actually in the first section of our DDT/E protocols below. We recommend to test for non-fasting Insulin, glucose and also for endogenous ACTH. At 13, your mare is worth testing for the last one (which is for cushings/PPID).

4) Dry lot/ enrichment: Some random ideas for you and you don't have to explore all at once! Rome wasn't built in a day.
- you could put a buddy in with her for part of the day. Someone not rowdy. https://ecir.groups.io/g/main/message/274397 
- Split her soaked hay into 2 or 3 slow feed nets at opposite corners.
- Bonnie Snodgrass has great luck with an "Action Hoe" that is apparently quite easy to get in the US: https://ecir.groups.io/g/main/message/274397 - this may be a good way to easily maintain your lot/remove the bits of grass that grow back.
- If you describe your dry lot here, members may be able to chime in with ideas how you could improve it balancing with cost effective ideas. Eg. maybe a layer of gravel/sand. Personally I have found these work best if you put some kind of landscaping/textile fabric down below as it will save you renewal costs by keeping the gravel/sand in place. I had to convert 750 square feet and it seems to be about 69 square metres.

5) Thyro-L can help jump start weight loss but it is not suggested for long term. Usually once IR is under control any thyroid issues will resolve.  We usually recommend weaning off of it as it will not help with insulin levels. Weaning recommendation from Dr Kellon: https://ecir.groups.io/g/main/message/265797 

Hang in there, you are in the right place and there are some things you can definitely work on right away. Ask us if you have questions!

Here is the real dirt/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 etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and 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.

EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

--

I have now also read through some suggestiins for others on here due to the seasonal rise. It looks like I should have Jokers insulin tested again. It was very high before when I tested it last time.  Maybe I should be giving him Metformin during the seasonal rise time or possibly all the time??? I know after his last blood test I was hoping that an increase in activity would help lower his insulin without needing meds, but if the meds are needed to keep his feet truly comfortable for work that is fine. 

Could someone advise on this medication and remind me the potential problems of using and adminstiring it. 
Thanks!!
--
Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Thanks Bobbie!! It takes a village and it is "undoubtedly" Dr Kellon and this group that has made all the difference..  I am truly so grateful.  Words can't really express how blessed we feel that we found you all. 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

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

Oh my gosh Nancy, he looks amazing!
Glad they’re both doing so well. What a great mom you are❤️
--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
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

Hi All, 
Joker has been doing well, I got him back in work doing walk, trot and canter. When we started to canter he seemed to act like he had ulcers. We got him scoped and have been treating him with gastrogaurd and sulcralfate for a month. At about the same time we started his ulcer treatment, we also got him started on a track system. We had round up killed the grass, but there was still some brown grass on the track and a few areas of somewhat greener spots. He was turned out with a partner on the track system for about a week. At this point he was starting to seem like he did not want to walk as forward and was seeming less comfortable. He was not lame, but not seeming 100%. I started him on APF again in addition to his normal IR diet. I also removed him from the track and put him back in his regular dry lot. I did the round up again and put limestone down on the track before letting joker back on the track. Joker has not been ridden again until yesterday.

Yesterday, I rode Joker at the walk and some at the trot. He seemed sound and happy. Today he was a little slower than normal and not wanting to trot pleasantly. He was not lame, but I could again tell he was not feeling 100%. I checked his digital pulse in his feet and his fronts were slightly elevated. 

I realize that he must need more recovery time and will be giving him that time. 

A few questions.

How much APF should I be giving him? Do I continue to give the intense work/recovery amount or just a maintenance amount. 

Joker has not been wanting to eat his phytoquench, so I have removed that from his diet. When he was doing well with his riding, I thought it would be fine to discontinue its use. Now with his relapse I am wondering if he should be getting the devils claw that was in the phytoquench. If so, I will provide the devils claw in capsules. Is it best to split the devils claw dose in his AM and PM feeds or all once a day? 

Additionally, Joker is supposed to go back for his ulcer scope recheck. Do I need to be concerned about fasting him right now? Should I give him a double dose of APF while he is fasting? 
--
Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Hi, I've been monitoring their weight pretty carefully for a few years, in dialogue with a couple of vets (who honestly haven't had much to contribute re weight estimates).  Also I asked about ideal weight when I posted my case history a couple of weeks ago, and Kirsten or Sherry answered with some thoughts that confirmed my thinking on the matter.  However I know there's a lot of grey area and even a small bit of measuring done wrong then put into the weight calculator can produce quite variable results.  So I'm open to suggestions.  Thanks!
--
Cassandra in NM 2022
https://ecir.groups.io/g/CaseHistory/files/Cassandra%20and%20Beshlakai%20-%20Negra

https://ecir.groups.io/g/CaseHistory/album?id=277489

https://ecir.groups.io/g/CaseHistory/album?id=277702

Hi Dr Kellon and all, I just wanted to send a quick update about Vinnie and have a couple questions.

I don't have a new set of labs yet, trying to get that coordinated for this week.

Vinnie is doing GREAT! He is probably the soundest he has been in years.  We have been playing a little with liberty work in the arena and he is just loving it. Offering trot and canter and overall super playful and happy.

Now for my questions:

I increased Vinnie's pergolide from 6.6 mg to 9mg over the last month or so.  I feel like he needs another bump for the remainder of the rise because he seems to be growing coat at a rate where I could probably clip him every 3 weeks. He is still having some skin issues that do improve with a clipped coat, so I am not sure if that is from sweat or bugs or ??  He just recently had a swollen eye lid that resolved with some antibiotic eye cream with a little hydrocortisone.  He is still extremely hypersensitive to bugs.  His water consumption has stabilized but I am filling 2 5 gallon buckets twice a day. That is in addition to his main water trough. And just in the last week, he has been a little more lethargic than usual.  Based in these symptoms should I increase by a half or full mg of pergolide? And should I consider splitting the dose up to see if he is one of those horses that does better on a split dose?

My second question is about diet and invokana with the increased work load.  He is currently on 225mg daily and his current diet seems to be managing his weight.  Labs will tell us if TG/insulin are managed.  I feel like in the last week with the increased activity that he may need something to boost his energy levels.  It is just a hunch based on some of his behaviors after work.  He seems to be napping more than he did in the past after work and a little slower to recover. But i also wonder, could this be he needs a bump in pergolide?

Here is a small video of the other night:
https://youtu.be/EFeVLpm6SZQ


Ps.. Summer is doing absolutely fantastic too after her ovariectomy in June. No more issues with colics etc,  and she definitely has been easier to manage related to her IR.

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

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

Hi Angela,

I did see your message and thought I had replied - sorry, as it seems I didn't.

I'll get something up for you in time for that appointment.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

H Angela,

If you haven't seen an acknowledgement you should ask again.  Lavinia, who does the markups, does not always see every post.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

--Hi Kirsten,

I have a question.  I did as you said and started a new topic with the title of Request hoof markups for Gracie.  I added the new photos and stated her next trim is September 5th.   I did this 4 days ago and haven't heard anything.  I am wondering how I know that I am on the list for the markups? Do you guys send me a message?

Thanks for all your help!

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132

Thank you Dr Kellon,
She was scoped prior and after extensive gastrogard treatment. Her ulcer symptoms are flank, girth area sensitivity, overly girthy, cranky, nervous. Always helped by first ranitidine,  then the gastrogard treatment. She only had gr. 1, but she is a typical Chestnut Arab mare. Very sensitive. 
Visceral was the first product that helped get her off the ulcer meds. Whenever i had tried to dc the Visceral,  symptoms returned. She's been med free for almost a year now.
I've been giving her 2 heaping scoops GUT for 2 weeks now and she's doing well.
Thank you, 
I've been giving
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham

Also, If I am reading it correctly, ODTBC contain 830 calories per pound.  An average 1,000 lb horse needs 15,000 calories per day to maintain weight. ( take that number with a big grain of salt) , so a typical horse needs 18 pounds of ODTBC as it's only source of nutrition.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Bonnie,

Yes, GUT is fine long term but how are you diagnosing ulcers and regression of ulcers?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

 Where are you getting your ideal weights?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Lori, I believe the ratio is done to provide those who are using cubes as a substitute for long stem hay understand how much to feed. If you horse requires 18 lbs of long stem hay and you were going to substitute balance cubes, you only need to use 75% of the 18 lbs.  Meaning 13.5 lbs of cubes would equal the calories of 18 lbs of typical grass hay. 
The cubes have beet pulp in them in addition to the timothy and vit/minerals. Beet pulp has the same amount of caloric energy as oats, and so the cubes are a higher source of calories than long stem hay.
BUT....if your horse is only getting 13.5 lbs of cubes, and they eat them fairly quickly, then they are left with nothing for periods of time , which can lead to wood chewing, etc. People who only use cubes have to figure out how to stretch out the cubes.

If you want to substitute balance cubes for some of their hay, then figure out how much hay you're are substituting and multiply that by 75%. If you are just adding them to your horse's regular diet of 18 lbs of hay, you need to add the extra calories they receive from the cubes and determine if it's too much. 


--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Yes, assuming all samples were handled correctly.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Am I right to think at least the horse is not PPID? 
If ACTH is low because cortisol is high, but ACTH in PPID horses does not respond to high cortisol as it is produced by the medial lobe, then this horse is not PPID is this correct?
--
María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album