Congratulations Rita.  You made my day.  Great work.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022

Congratulations, Rita!  You did all the hard work so you really deserve them.

To add photos, click on the link to your photo album in your signature and add your photos, using the “add photo” button.  You’ll need to be able to locate the photos on the device you are using to upload them.  The add photo button will bring up a browser to locate the photos or you can drag them in.  You did seem to make a new album which you can delete - or we can if you can’t find it again.
--

Thank you both!
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

https://ecir.groups.io/g/CaseHistory/album?id=94380

I have been waiting for this day! It's been 1 Year since my beloved Stetson was first diagnosed with laminitis and founder. Thank you so much for the helpful guidance by everyone in this group. You all saved my horse. My vets helped, but not as thoroughly as EC/IR Group did. I have my healthy, happy, active boy back! The knowledge provided by Dr. Kellon, Lavinia, and so many others has reframed my understanding of how to feed my horse without killing him in the process. 

On a side note: I wanted to upload some new photos, BUT, I can't seem to see how to do that. I have a new laptop (Apple MacBook Air) compared to when I created my album last year (old HP laptop). Even searching through the Wiki files didn't provide an easy solution. Shouldn't there be a button, or tab on the left frame to click on to upload new pictures into your album? And I may have accidentally created a new album, labeled the same as my original, but now I can't delete that. I'm usually quite tech savvy, but this has me stumped. Help...

--
Rita C. and Stetson (IR)
Aiken, South Carolina USA
June 2021

https://ecir.groups.io/g/CaseHistory/album?id=265166 

https://ecir.groups.io/g/CaseHistory/files/Rita%20C.%20and%20Stetson

Iodine is not a requirement on labels. Even the guarantees are minimums, not actual, except that calcium has to be minimum and maximum. What TC gave you is probably a "typical" amount - ballpark figure. The level in kelp is going to be variable.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thanks so much, Trisha and Lavinia. Lavinia, I am going to talk to Dr. Matt about pergolide when he comes next week for the health certificate visit. I’ve noticed that she hasn’t completely shedded out (it’s very subtle, just along her belly, but long hairs are still there) - just another symptom that has me nervous. Again, I really appreciate the guidance. Thank you both! 
--
Lucy Butler
Rhode Island, USA
Joined 2022
Rowan Case History: https://ecir.groups.io/g/CaseHistory/files/Lucy%20and%20Rowan

 

They will take your checking account number and do an e-check or if you have Zelle you can pay them with the app. 
--
Terri Jennings with Mr. Beefy, Finn, Elliott and Teeny (over the rainbow)
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Beefy
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Elliott/Elliott%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Finn/Finn%20Case%20History.pdf


Joined 2019

I did contact TC regarding the iodine in the two feeds I was using. Based on their numbers and my calculations, Dante was receiving up to 7.4 mg per day from TC feeds.  So nowhere near toxic. But what I don't know is 1) Did TC give me a guaranteed amount or a minimum amount, and 2) how much is too much iodine to influence the thyroid test at Cornell. I guess I get to call everybody back tomorrow.  

Thanks Cass - for sharing your story, so maybe Dante's test was Ok, (which I'm not sure I want).

I did not mean to infer that TC products had too high of levels of iodine.  But one thing I did find interesting is that the amount of iodine is not on TC bag nor on their website.  I had to call for the information after I saw kelp as an ingredient.  Is this a labeling loophole? Or is iodine not required to be shown? 

--


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
Case History

Thanks Maxine. Unfortunately I did not see your message until after the Vet came and took bloods. I am doubtful that he followed the protocols. 

The results came back with ACTH of 22.9 but if correct protocols were not followed who knows what her true reading is. I am still waiting on the insulin results from the blood taken.

It is rather frustrating that I have had 3 blood tests taken in recent months to try and understand what is going on and something is wrong each and every time! So I am still literally in the dark.

--

Hi Lucy,

Have a read here for some explanation of the EMS calculator results:

https://www.ecirhorse.org/DDT+E-diagnosis.php

Here is more info on what lab reference ranges are and why they aren't synonymous with "normal":

https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php

https://ecir.groups.io/g/main/message/275298

Her latest insulin result was solidly above the lab's reference range, and almost double what it was last Oct. That is a red flag that she could be heading for a crash, esp. as we head into the seasonal rise, when her ACTH will be rising again -  likely to higher levels than last year. Rising ACTH will drive insulin levels up as well and high insulin is what leads to laminitis.

Her ACTH result from last Oct was positive, so Rowan should have been started on pergolide, at least during the seasonal rise period.

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

Hi Terrie,

Did your trimmer give a reason for why she believes the frog is lacking blood supply? Her frogs are already being stimulated by the current pads in her boots because they (frogs) are level with her soles, so I don't really see the need for it. IMO, she probably won't appreciate having the constant pressure applied. If her boots are rotating, then I agree it's unlikely the frog support will remain in place. You could try taping the frog support+pad to her foot but that means there will be constant pressure across the frog and sole, instead of pressure-and-release. The frog and sole do not like constant pressure.

That bulge is laminar wedge, which is dead tissue, so removing some of it at each trim to gradually normalize the dorsal wall is not going to cause her any discomfort and would definitely make it easier to get boots to fit better.

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

Hi Gail,

Cornell offers glucose testing, it is just found on another part of the form as the test is classified under another lab category.

We no longer recommend testing Leptin, so save your money on that part and just get the insulin and glucose.

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

I asked my vet to come out and test Glucose, Insulin and Leptin, to be sent to Cornell per their collection and transport protocols.  She pointed out that they have no glucose test offered for EMS testing.   This is for a horse who does not have a case history on file.  He has a history of high insulin.  Something we did recently has brought his weight down, and he looks great, but I decided to do a baseline test to see where we are.  No glucose from Cornell?
--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .

Hi Lucy and welcome to the group. My role here is to give you our welcome letter which is chock full of information that you will need to help manage your horse. I would focus on our welcome letter information first. Especially, the diagnosis, diet, trim and exercise pieces.  This will give you a background of solid information, based on science, to help you understand what you might be looking at for the future and at present.  The IR calculator helps you to understand where your horse is on the spectrum of IR. However, Dr. Kellon will chime in on this as well, with a better explaination!  I'm glad that you found Lavinia and that you are open to prevention vs reacting to a serious episode of laminitis or worse. Please feel free to ask questions after reading through the material. 

 

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 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. 

 

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

Hi All,

I am new to the ECIR, but I am very fortunate to have Lavinia Fiscaletti as my trimmer.  My horse, Rowan, is an 18 year-old Morgan mare.  Lavinia has done a wonderful job guiding and educating me on how to keep her healthy as she ages.  Lavinia raised some concerns in the past about Rowan's weight, cresty neck and fat deposits, so I had ACTH and G/I tested in October, ACTH retested in December and G/I retested last month.  I plan to do ACTH again in September. My vet didn't seem too concerned about any of the results of these tests, but after talking with Lavinia and reading articles here, I am definitely wary.  I'm not dealing with any active laminitis, and Rowan is in regular work (about 18 miles a week of walk/trot trails), but she has some limited white line separation and the weight issues mentioned above.  I don't really understand the results of the EMS calculator other than it appears that I do have reason to take precautions.  It would be very helpful if someone could explain the calculator results to me or point me in the direction of a plain-English explanation. I intend to have an equi-analytical hay test & subsequent balancing done just as soon as we get our big purchase of hay made (hopefully in the next few weeks), but in the meantime, I'm looking to learn as much as possible about the signs and management of PPID and EMS and any other steps I can take to keep Rowan sound and healthy.  Thanks in advance. 
--
Lucy Butler
Rhode Island, USA
Joined 2022
Rowan Case History: https://ecir.groups.io/g/CaseHistory/files/Lucy%20and%20Rowan

 

Thanks so much Dr Kellon 🥰
--
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

Nancy,

Don't panic on that number. We'll work through ways to get it down and as long as Vinnie is happy and sound there is no reason to worry about it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001