She is really suffering right now and it has been 4 days. Makes me sick and breaks my heart to see her like this.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album

Hi, 
here is all of zinc supplements with zinc chelate. What is better chelate or zinc oxide? Where do you buy zinc supplement without other minerals?

Thank you
--
Marie Volsicka
Mid Europe
2021

Got it ! Thanks! 

If I remember correctly, she had breakfast the morning of testing last time. 
--
Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

She can have dinner the night before but nothing but hay day of testing. If she doesn't run out overnight, test anytime. Otherwise, wait 4 hours after she first gets hay.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thank you.

Just to be completely clear, The day before only breakfast and hay then no dinner?
or she can have dinner the day before? 
Also, 4 hrs after the morning feeding of hay if she runs out overnight?  

Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

The coupon code is ECIR.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

 Feed hay only night before and up to time of test.  If she runs out overnight, wait 4 hours after the morning feeding. No exercise or shipping.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi, can't remember the code for Uckele for the % off for being a member of this group.Thought I did

Thanks!
--
Bonnie with Racham (over the rainbow) from Southern California, Nov/2016

Case History
Racham's Photos 
Ω 

 

Hi, thanks for your reply. That test was from Aug before I started soaking her hay. She has lost weight now and her crest is better as well. 
I will be retesting her this week.

Ive been reading how best to test but I’m confused.
Do I feed her as usual and keep hay in front of her? I basically have soaked hay in front of her in slow feeder hay nets outside in my ring or in her stall so I don’t spike her insulin.
Is there an amount of time I should wait after her breakfast to test her? 

or don’t feed breakfast? 

I’m confused  

I know she’s not laminitic as of the middle of Oct because she had an MRI on both front feet and there was no indication of it.

--
Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

Jenn,

If she has an insulin of 80 she's not doing well. It's a miracle she's not already laminitic although since she's a pony she probably is without you noticing the more subtle signs. IR ponies that make it through pregnancy don't go into it obese, inactive and with insulins of 80.  Pregnancy induces IR in all mares. I wouldn't consider breeding her unless she was normal weight and had a normal insulin. Even then you risk laminitis. If that's a risk you are willing to take with her well being, no one is going to convince you otherwise. Yes, they have different nutritional requirements.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001ou

Also, I will be trying to get her under control before I breed her.

I did speak with several vets about this and the feeling seems to be to try and be on top of her hay and food before and during and that if we never bred IR ponies, we wouldn’t be breeding many ponies. 
--Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

Hi, I will be getting her tested again next week. Her latest Insulin Baseline Equine was 80.00 uIU/ml but she has since lost a little weight and crest is better so I’m going to retest to see where she is at. 

I won’t be exercising her during pregnancy because NBC wants her to have time off due to a lateral soft tissue injury in her RF. 
Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

Hi, thank you for the responses so far. I will try and upload what I can. 

I’ve got to tell you though, this is not a user friendly site. It’s tough to navigate for sure. I’ll try to get it done  

Jenn
Pixie   (IR & Cushionoid)
Grace (IR)
SE PA 2021

Hi Kandace, 

Once we have diagnosed pergolide, we have found its best to keep ACTH at or below the middle of the normal range, even through the seasonal rise.  PPID horses seem to do better with this really tight control on ACTH.  Your bloodwork shows a value of 27 pg/ml in mid-August, which is already above that middle-of-the-range max we recommend.  Guaranteed it went higher still into the seasonal rise, unless you increased the pergolide at that time.  Insulin was already high then, and it likely climbed higher as well.  Did you test in September, too?  Your Case History only goes to Aug 29.

You might want to talk to your vet about switching to compounded pergolide.  You can justify it because it will be easier to give 1 pill a day (and there are huge cost savings).  Island Pharmacy on Vancouver Island is fantastic and highly recommended here.  Keep some Prascend on hand for dose increases, if/when it needs to be adjusted.

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

Hello Jenn,

Welcome to the group! 

Sounds like you have been doing some reading - which is great. We are going to need a case history for your girl to be able to answer your questions more fully. You should be receiving a message shortly with the link to the case history sub-group where you can upload the form, once you have a chance to fill it out.

Once you have created a folder on the case history group, would you please upload the hay analysis you have so we can see what your hay actually needs for minerals. You are correct that a pregnant mare's needs will be different than those of a a non-pregnant one and will change as her pregnancy progresses. Also, her IR will become worse as her pregnancy progresses, so that will need to be tightly managed throughout to make the  process as safe as possible for both mare and foal. Correct supplementation won't stop, it will just need to be tweaked to make sure it covers the both the mare and foal's changing needs throughout the pregnancy. Need to stop the Purina Enrich balancer now as it's not safe to feed to an IR horse, esp. not at 2lbs per day to a pony. You can do a search of past messages for Heiro, but the bottom line is that it's a waste of your money. Here's one to get you started:

https://ecir.groups.io/g/main/message/261948?p=,,,20,0,0,0::Created,,HEIRO,20,2,0,80957224

Remission is just expensive magnesium, with some chromium added. Whether you need added magnesium and/or chromium or not will depend on your hay analysis. If you do, there are much more economical ways to add it. I can't seem to find an ingredient list for the Dumor hoof supplement but once you actually mineral balance the diet, you won't need a separate hoof supplement.

Why is your girl on Thyro-L? As primary hypothyroidism is extremely rare in equines, it is usually not needed nor recommended. Many times it is prescribed in the mistaken belief it will help lower insulin levels - it won't. It may help to jump start weight loss by inducing temporary hyperthyroidism but that is only a temporary effect as the body will compensate by lowering natural output.

The remainder of this message contains our Official Welcome. Grab a cup of your favorite beverage and have a read, then save it somewhere easy to access for future reference as there's a lot of info crammed into it.

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.

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

Hi Jessica, 

To answer your question:

If it is high insulin and she is back on soaked hay with no other triggers how long to wait before expecting to see improvement?

You should see reduction in pain within 2 days, and definitely within 1 week.  If that's not happening, then the problem is unlikely to be high insulin, OR the hay soaking isn't removing enough sugar.  I'd continue soaking until you get her last bloodwork back and then make a decision based on how elevated insulin was before you started soaking.  If it WAS  high, then you may also want to check insulin after 1 or 2 weeks of soaked hay to see if it has come down enough, or if you need to consider medication to bring it down further.

I find it easiest to hang a big plastic muck bucket on my digital luggage scale, then zero it out and load the bucket with hay until I have the desired weight.  After that, I transfer it into the hay nets which are fitted over a frame to hold them open and make them easy to load.  Way easier than hanging the net and trying to fill it to the correct weight.  My plastic muck bucket weighs 3.89 lbs so if I forget to zero the scale at least I know exactly how much to subtract.  Wet /damp nets are heavier than dry, obviously, and it can really throw off the weighing.

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

Hi Laura, 

Have you talked to your vet about switching to compounded pergolide?  It is the same medication but significantly more affordable.  You can increase doses at a fraction of the cost because the compounding pharmacy will make a capsule with whatever dose your vet prescribes for only a small increase in price for each dose increase.

The physical signs you are describing might mean you need a higher dose, but you should confirm that by rechecking ACTH as Sherry suggested.

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

Hi, I looked at the files and didn’t see an answer. 
Can you give me a safe diet for an IR pregnant mare? From before conception through weaning? I would imagine nutritional needs would be different in the different stages. Will I have to stop giving supplements? 

It’s for my 13.2 IR pony. 

She is currently doing well on soaked grass hay that tests after soaking at 10%, a handful of soaked and rinsed plain beet pulp (am/pm), 1lbs of Purina Enrich ration balancer (am/pm), scoop of Dumor foot supplement (am/pm) , 1 scoop (am) Heiro Supp, 1 scoop Remission (am/pm), 1 1/4 scoops (per day) thyroL

Jenn
Pixie  11.3 pony (IR & Cushionoid)
Grace 13.2 pony (IR)
SE PA 2021