Date   

Re: Vinnie and Invokana update 4/2022

Eleanor Kellon, VMD
 

I would wait for blood work to increase pergolide. You could try magnetic wraps like these https://www.sstack.com/dura-tech-magnetic-ankle-wraps-5-magnets/p/08738/ for his pasterns. The magnets really help some horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


New member

Sonja Hinds
 


--
Sonja Hinds
05/03/2022
central fl


Re: Hoof pain

Sherry Morse
 

Hi Lisa,

You can check ACTH again (and do check the study Dr. Kellon linked to) after 3 weeks on the pergolide.  Insulin should have been checked 7 - 10 days after starting on metformin to see if it was working.  If you didn't have that checked that prior to starting the pergolide you'll not be sure if the decrease is related to just the metformin but regardless you want to keep her diet as tight as possible.  I would NOT increase her hay as she still needs to lose weight.  As long as the dose of metformin is correct for her weight it should not be decreased.




Re: High ACTH and Insulin with Updated History

Sherry Morse
 

Jamie,

The dose for metformin is 30mg/kg twice daily.  You can read more about the use of the medication here: https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin

For Walker if the weight in your CH is correct his dose would be 13,550mg twice daily.  Less than that will not have the desired effect.




Re: Hoof pain

Eleanor Kellon, VMD
 

Lisa,

Your questions will be answered when you get your blood work results. Do you know about our TRH test study https://wp.me/p2WBdh-1iA ?

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New shedding protocol and worming

Elizabeth Kuzma
 

Thank you for your responses.  I had run a blood panel March 15th of this year since he was showing sheath swelling.  As far as I can tell his results seemed pretty good to me.  Do you happen to agree Dr. Kellon?  He always shed out previously, and right now his coat seems very copper and long and I have him balanced by a ECIR member.  He is currently on 2mg of prescend.  

Glucose:  97 mg/dl                                          reference level:  71-122
ACTH Baseline:  14.9  pg/mL                          reference level:   2-30
Insulin Baseline Equine :  26.34 uIU/mL          reference level:  10 - 40
Leptin Baseline:  11.92 ng/mL                           reference level:  1 - 10
T4 (Thyroxine) - Immulite 0.715 ug/dL               reference level:  1 - 3

--
Elizabeth
Aug. 2019, Patchogue, NY
Case History: https://ecir.groups.io/g/CaseHistory/files/Elizabeth%20and%20Onyx
Onyx's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=94258


Re: Help with Snowman

Eleanor Kellon, VMD
 

Jean,

The TC Senior also has to be stopped. If you send your hay analysis to kellon@... I'll see if we have a balancer to suit it. Which Source product are you using? There is a good chance he has abscesses which need to drain so he may get worse until that happens. I would order Numotizine poultice. Put a ball of it in the bottom of a large, heavy weight freezer bag and put the hoof in that before booting.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: High ACTH and Insulin with Updated History

Eleanor Kellon, VMD
 

Interesting pattern, Jamie. Most horses do worse on twice daily dosing but there's always room for individual differences in drug metabolism. Try 1 1/2  AM and PM.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Captain Drifter relapse

Eleanor Kellon, VMD
 

In addition to Kirsten's comments, 3 weeks is much too long to wait for results. Your vet's office needs to track them down for you or repeat it ASAP so you can know if he needs a change. How long has he been on metformin?  How long on Jiaogulan?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Smokey latest test

Eleanor Kellon, VMD
 

We haven't seen Invokana stop working.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: High ACTH and Insulin with Updated History

Jamie Miller
 

Thank you, Lavinia.  I'm sorry .. the equine podiatrist describe what he has as a dermitis or scratches, I guess. I have been using foot powder, wraps, diapers, and time out of boots but on soft footing that is in stalls and aisleway. And, (I'm sorry, again), he stated he couldn't take the toe back any further than what was in the radiographs and in the recommendations you provided.  I'll clean his feet really well and get some pictures tonight. His trim was April 19th.

Also, thank you for the link and information on Metformin.  I'll share that with my vet. I'm hopeful she'll know the correct dosing, but I'll look through the files for that information. 

Thank you. 
--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


Re: Vinnie and Invokana update 4/2022

Nancy & Vinnie & Summer
 

Just a quick update with some observations.  We are at 5.4mg Compounded. Day 2 of the increase dose we hit a littlw veil and decreased appetite, so I upped his APF.

We are at day 4 of the 5.4 mg and his appetite is fantastic. He is a little more sore in the LF but hard to say of it is foot or ringbone.  We have also been walking about 25 mins and of he offers a little trot I let him for a short period..less than 1 minute. ( my instinct says it is ringbone..but there are lots of factors and I don't want to overlook things.

Water consumption has slowed which is good. We have had some warmer days too. His pee spots are a little more manageable too.

Shedding a little bit too. He does have some scurfy spots on either side of his tail but I don't think this is worms. I think it could just be all related to cushings.

He tapes at about 985 tonight. He was holding at about 969 so the increase of weight is about the max I want him at.

I have managed to add one more cup of sw beet pulp to each feeding.

I'm tempted to go up another 1.2 mg of pergolide, but I am not sure if i should hold for now and maybe retest in 3 weeks and then decide if a bump is needed?

I also thought that if is acth went up by about ~50% in two months maybe the 50% increase of pergolide may be warranted?

What do you think? 
--
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


Re: High ACTH and Insulin with Updated History

Anthie Booras
 

That’s about the same price I pay to get my 1000 count 1000 mg Metformin from Costco pharmacy. Given the large quantity they usually don’t have it on hand but they get it in by the next day. 
--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/

https://ecir.groups.io/g/CaseHistory/album?id=269097


Re: High ACTH and Insulin with Updated History

Lavinia Fiscaletti
 

Sorry, I don't know what you mean by "dermitis"? Boots will always hold in some moisture. The biggest issue can be that you get some really stinky feet - the athlete's foot powder should keep that at bay. You can pull a sock over the foot, or wrap it in a baby diaper, if the dampness is really persistent and causing the soles/frogs/collateral grooves to remain too wet.

"The farrier stated that according to the xray guided trim, he can't take the toe back any further because of the "bone""

The trim mark-ups were based on the rads and showed what needed to happen, what could/should be done. If that didn't happen, then the trim still isn't correct. Attaching an appliance to a faulty trim is only a band-aid that encourages the trim to become worse as it prevents any kind of self-correction and makes it almost impossible to make adjustments in a timely fashion.

"He also stated that when he takes from one area, he has to consider other areas as well."

No offense, but that's what you do whenever you do any trimming.

Will look forward to seeing the new pix.

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


Re: High ACTH and Insulin with Updated History

Lavinia Fiscaletti
 

Hi Jamie,

You can get Metormin from any local pharmacy - it's a common human diabetes medication. However, the best price I've found is here:

https://www.farmvet.com/Metformin-HCL-Tablets

They usually ship out really quickly. I'd ask my vet if he would call in the script to Farm Vet for the longer term and maybe get a week's worth from your local pharmacy to get started while waiting for it to arrive.

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


Re: Help with Snowman

Bobbie Day
 

Hello Jean and welcome to the group, it looks like you joined in October but since this is your first post I will be including our welcome message.
Although Snowman's ACTH is within "Normal" Range to your vet, normal to us is in the high teens or low twenties at the most. And his insulin is high which is probably helping to drive his pain. 
A couple of things come to mind then I will post your welcome below, it is long and will require some time, but you will find it very, very helpful believe me. I would suggest keeping it to refer to , it really does cover a lot of information that new (and old) members can get a lot from. The blue links will take you even deeper into the subject, but if you still have questions please let us know.
First thing i want to mention is that NSAIDS doing nothing for neuropathic pain, laminitis in not an inflammatory, so these drugs will not help. If his trim is tight theis Lamin-Ox is recommended here as it will help with circulation.
The feed, Triple Crown Balancer is not on our safe feeds list but mostly because of the high protein, added iron, and the estimated starch and sugar is just under 14%, ideally we suggest nothing over 10% and sometimes that's even too high for sensitive horses. I am not familiar with Source Micronutrients, but as you can see from his insulin, something is driving it up and if it were me I would tighten his diet, put him on the emergency diet as outlined in the welcome message, get him off the banamine and continue to soak his hay. I will also include some links for additional reading but you can also do a search in our files and messages. 
https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Pain%20Relief%20Alternatives%20to%20Bute%20and%20Banamine.pdf
https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf
Also some reading regarding vaccinations. 
https://ecir.groups.io/g/main/files/Vaccinations/Vaccinations%20and%20Metabolically%20Challenged%20Horses.pdf

Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

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

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

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

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

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

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

 

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

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

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

 



--

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

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

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


Re: Hoof pain

Lisa
 

Hello,

Nira has been on 0.5 mg pergolide for the last two weeks after a TRH stimulation test showed positive. After about 4 days on it her appetite seemed to increase and she is way more pushy about getting her hay - prior to this she would patiently wait for her hay. I am going to get her blood work done in a couple of weeks, so I will have her insulin levels tested again at that time. I have never had her glucose levels checked. Is that something I should get done also? She is on Metformin since mid-March.

She is getting 15# of soaked grass hay a day, I split it into 5 meals and put it in slow feeder hay nets, she gets her last one at 8:30 - 9:00 PM. Her taped weight is around 990# now, which is getting close to what her summer in-work weight was with the same tape (970 or so, she would go as low as 950). She also gets a cup of beet pulp twice a day to carry her minerals and ground flax. As the weather has finally been starting to warm up here, she is outside in her dry lot more now, sometimes all day, and she can put on a rodeo some days when I let her out. Turns are still an issue for her and she is still in boots. Her laminitis started very end of January (right after getting cast in the snow for about an hour), so we are just hitting 3 months of hay soaking and wearing boots. 

Do I not worry about this change in her appetite? Should I increase her hay? Does she not need the Metformin (or need less than the 30 mg per kg of body weight twice a day) now that she is getting pergolide? Or is that something to consider after the next round of blood tests? 

I am always questioning and worrying if what I am doing is right. Thank you so much for your help!

--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Re: Captain Drifter relapse

Kirsten Rasmussen
 

Does he have bounding pulses?  I would soak the hay for a few days to see if it helps.  Maybe it's due to a bale that's higher in sugar/starch.

Could also be abscesses mobilizing although usually one hoof is worse than the others.  You could do some Epsom soaks to speed this up.

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


Re: High ACTH and Insulin with Updated History

 

Hi Jamie,
When I was using metformin, some years ago, I picked up the prescription, called in by my vet, at a nearby pharmacy.  It’s a human drug as well.
--
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


 
 


Help with Snowman

jean banville
 

Hello,
I am hoping for help and support regarding my 20yr old Welsh pony who has Cushings and is treated with 1 mg Prescend daily. He had his 1st laminitis 10/2021 and seemed to recover over the winter showing no lameness. 
Recently, following spring shots 4/4/22 he became lame again and he worsened to include back hooves as well. Labs drawn that day for ACTH (35)and insulin (200). Vet came out and did radiographs to guide trim. He was on Banamine 5mls orally for 5 days. He now has cloud boots on the front with rear boots on order. My hay has been tested and NSC is just under 10%. He gets Triple Crown 30% balancer 1 cup both AM and PM, 1mg Prescend AM, Vit E 1200, 1:2 scoop of Source Micronutients,  Laminox 1/2 scoop AM and PM, 1/2 cup soaked Triple Crown Senior Gold to carry supplements. I started soaking his hay ration today 10-12lbs per day.  His last trim was 4/29, no pain relief following trim. 
Thank you in advance for advice.
Best,
Jean and Snowman

 Jean B from NH
joined 10/27/21