Date   

Re: interpreting blood test results - ECIR Calculator

Hilary McGregor
 

Thanks Sherry. I think you did these calculations on her October 2020 results only?

My concern is that she has gotten significantly worse since then based on the Cornell results I just received. Now she's at high-risk for laminitis? 

Cornell March 2021
glucose 97 mg/dL
insulin 21.69 ulU/mL
G/I: 4.47
RISQI: 0.21
MIRG 8.4

I thought the ECIR calculator made the unit adjustments. That's where the numbers above are from.

Please correct me if I'm wrong.

Hilary


--
Hilary and Amika
Prince George, BC, Canada
Joined July 2019
Amika's Case History Folder
Amika's Photos Folder


Re: interpreting blood test results - ECIR Calculator

Sherry Morse
 

Hi Hilary,

It might help if you're comparing apples to apples:

Glucose: 4.4mmol/L is 80mg/dl
Insulin: 42 pmol/L is 6.0475 uIu/ml by http://www.endmemo.com/medical/unitconvert/Insulin.php (or 7 if you're simply dividing by 6 as directed on the diagnosis page).
G:I Ratio: 13.25
RISQ: .41
MIRG: 4.4

Using 7 for insulin still results in:
G:I Ratio: 11.43
RISQ: .38
MIRG: 4.9

The low insulin makes me wonder if something happened with the test results but let's take it as it is.

Normal G:I ratio is 10:1, lower ratio is increased risk of laminitis
RISQI under .32 correlates to increased risk of laminitis
MIRG over 5.6 correlates to increased risk of laminitis

So you're on the right track.




Re: Candy Update: Invokana on board Questions and Concerns re. symptoms and diet

Shawn Gould
 

Thanks to everyone for your thoughtful responses. I just called the lab and they still have the sample and can test for nitrates for $11! So between Nancy and I we will get a good number. My other question is regarding ACTH. Does anyone have a sense of which comes first, symptom abatement or a drop in lab numbers? I ask this because I’m wondering if after 3 weeks if there is no change in Candy’s PPID symptoms I should increase Prascend again by quarter tab? 

Thanks
--
Shawn and Candy
Dec 2020, Santa Cruz, CA
Candy Case History:  https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy
Candy Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=258140


Re: Easy and palatable supplements???

Lorna Cane
 

Hi Janine,

The Ontario Dehy Timothy Balance cubes,recommended by Kirsten,are wonderful. I always feed them dry, except for my 47-year-old mule,who had no teeth and liked them in a mush.


--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: interpreting blood test results - ECIR Calculator

Hilary McGregor
 

Thanks Nancy

So, the ECIR calculator is no longer providing any interpretation?

In October 2020, my mare Amika's non-fasted results eating 11% ESC dry hay were:

Guelph University Animal Health Lab
glucose 4.4 mmol/L
insulin 42 pmol/L
G/I: 13.01

Now, her non-fasted results eating same hay soaked are:

Cornell 
glucose 97 mg/dL
insulin 21.69 ulU/mL
G/I: 4.47

According to the link you sent me, a G/I ration of 10 or higher is normal. This puts her in a G/I ration below 10, which is IR and at risk for laminitis?? If anything, her body condition is better than in October and we thought they were doing really well. 

Can anyone please help me understand what could be going on here?

Many thanks,
Hilary

--
Hilary and Amika
Prince George, BC, Canada
Joined July 2019
Amika's Case History Folder
Amika's Photos Folder


Re: Easy and palatable supplements???

Kirsten Rasmussen
 
Edited

Hi Janine,

One easy way to make sure your mini gets a mineral balanced diet is to feed them exclusively the Triple Crown Naturals Timothy Balance cubes (aka Ontario Dehy Natural Balance cubes).  These are a mixture of beet pulp and hay with minerals added in the correct proportions.  All you need to add is salt, ground flax and vitamin E.  The hay cubes can be soaked to a mush, or steamed in a bucket with a little hot water and a lid until they crumble apart into a semi-dry mash for horses with dental issues.  Every batch is guaranteed to be under 10% ESC+starch (you won't find that guarantee on hay pellets, and despite their "typical" analysis online, several of our members have tested a few different brands of hay pellets and found higher sugar than was reported).  Also, the fact that the Naturals Timothy Balance cubes are already mineral balanced makes them easy to feed.  You could try introducing a few as a treat to see what your horse thinks, they might take a little getting used to but most horses like them.  They are also higher in calories than the same weight in hay so they might help put weight on your little guy. 

Of course there could be other reasons for his low weight so I second Candice's suggestion to work on a case history for him so we can better advise you!  If he is IR or PPID then all questions concerning his direct care are welcome here.  If not IR or PPID then we prefer it if you could join our Horse-keeping subgroup and post there instead.

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


Re: Lavinia mark ups please with laminar wedge advice 2nd try

Sherry Morse
 

Hi Jeanne,

Not Lavinia (obviously) but would you be able to retake the pictures on a clean flat surface with no backlighting?  I'm unable see the edges of the hoof in most of the pictures between the shadows and the dirt and to do markups on pictures like that is almost impossible as you need to guess where the hoof is vs. where the shadow starts. 




Re: use of uckele cbd pellets

Sherry Morse
 

Hi Daisy,

As I'm sure you've read here often enough, the trim is an essential part of our philosophy (DDT&E) and until the trim is correct you will have issues.  If you were to add current pictures and x-rays to Tiko's album we could offer you trim suggestions to help get Tiko on the right path.  I would suggest you take a look at the success that Lynn has had with Relevante (https://ecir.groups.io/g/CaseHistory/album?id=36909&p=pcreated,,,50,2,50,0) over the last few years if you think there's no way that Tiko can be helped just through corrective trimming. 




Lavinia mark ups please with laminar wedge advice 2nd try

Jeanne Q
 

Really needing some help here.  As for all, it has been a rough cold winter and hard on Glo.  She had been maintaining fairly well until the -20 to -30 degree weeks set in.  She is now very ouchy on the RF and doesnt want to put much weight on it at all anymore(toe first and hardly any weight on heel).  We finally! got her heel down better this last trim on 2/22.  I hoped that would help but there was not much change.  My farrier glued a composite shoe on with frog support and I was hopeful.  However, it had a heel wedge that I was leery about and Glo did not do well in that.  Took it off after two days.  Tried a boot with a depression in the pad to relieve P3 pressure.  No relief.  Tomorrow I try a reverse wedge.  She is walking toe to heel on the RF.
How can I best relieve the pressure of P3 with it so rotated? 
Anyone know of custom made boots? 

Lavinia, could you please do one more mark up for me.  I would be happy to pay for your services.  Farrier is coming Monday 3/8.  I feel like that dorsal laminar wedge needs to come off but to what degree?  We did one small resection last spring.  Maybe that is what is necessary.  Dont want to destroy what hoof wall integrity we have and also I worry about protection for what is left of P3.  Also, with P3 in such a severely rotated position how far back does that put her breakover?  Wondering because of the boots she is in cant be helping with that.

I have been rasping myself on the toe and heel but her foot is hard as rock so Im not sure Im doing much in between trims.

I know the rotation and bone loss is really really bad.  But Glo is still maintaining an upbeat attitude with a healthy appetite and a serious will to keep on........so I do.

Photos 3/1/21 Second page (in all RF photos she does not have weight on her heel.  She can fully straighten her leg, however.)
Xrays 12/18/20 First page
Last trim 2/22
Next trim 3/8 

Thanks so much!
--
Jeanne Q MN 2020
https://ecir.groups.io/g/CaseHistory/files/Jeanne%20&%20Glory
https://ecir.groups.io/g/CaseHistory/album?id=241360


Re: interpreting blood test results - ECIR Calculator

Nancy C
 

Hi Hilary

You can get an overview of what your numbers mean here: 

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

Scroll down.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


interpreting blood test results - ECIR Calculator

Hilary McGregor
 

Good morning

Just got new test results but the ECIR calculator is no longer providing an interpretation. This is for our gelding that I don't have a case history for yet. This is un-fasted blood test. How is he doing?

Insulin 33.51 ulU/ml
Glucose 93 mg/dL

G/I       2.78
RISQI  0.17
MIRG  11


--
Hilary and Amika
Prince George, BC, Canada
Joined July 2019
Amika's Case History Folder
Amika's Photos Folder


Re: Candy Update: Invokana on board Questions and Concerns re. symptoms and diet

Nancy & Vinnie & Summer
 


Re: Flea on Invokana

Eleanor Kellon, VMD
 

Any of your readings that just said greater than 200 could have been that high too.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Flea on Invokana

Jennifer Murphy
 

Just to follow up on this post, I finally received the insulin results. I was floored that he went from 88 to 375 in a few short weeks.  I've been hand feeding him the pills to be sure he's ingesting them and am hoping it doesn't take as long to work this time.  He's visibly sore, and we're in a cold snap that's definitely affecting him.  My vet was supposed to come out yesterday to retest blood, but it was well below zero with the wind chill, so I asked to postpone.  I've never seen Flea's insulin that high.  Does being on Invokana cause changes that would allow insulin to spike that high if it's discontinued?  I'm still trying to wrap my head around that incredible increase.
 
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Re: Candy Update: Invokana on board Questions and Concerns re. symptoms and diet

 

Nancy,
We're deep in the weeds, and we're heading OT for this thread. Further details, assuming I can answer your questions, belong in the Horsekeeping subgroup.

Total nitrogen is what is actually measured at a forage lab that reports Crude Protein. Total protein includes both true protein (organic compounds containing amino acids) and non-protein nitrogen, such as nitrates.  So Crude Protein is only an indirect calculation of actual protein in the hay. Total Nitrogen doesn't tell us anything about how much of the total nitrogen is from nitrates. A separate test is required to detect nitrates within certain ranges. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: Dr. K truths and myths about alfalfa

Sara Gooch
 

 

Thank you Bobbi!

 

Sent from Mail for Windows 10

 


Re: use of uckele cbd pellets

Nancy & Vinnie & Summer
 

I have used both the uckele formulations of hemp joint and hemp daily formulas.  They were both palatable and I think they helped with overall wellness and comfort. 
--
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: use of uckele cbd pellets

Daisy Shepherd
 

thank you. plan is to add hind shoes and progress slowly to work on negative palmer angles; i have had tiko for 3 years now always barefoot behind; tried him barefoot but soles  too thin; also had front wedges in shoes front only which made no difference. tried cavallo boots but he has big feet and boots at size 5 were like boxes and to try to use for dressage work was very difficult. vet plan is to add hind shoes and progress as needed with wedge support front and back for the negative angles. the cbd pellets are just to use until shoeing helps with comfort  or maybe equinox. i  am asking for recommendations.   thank you daisy and tiko
--
-- 
Daisy, Tiko and Whisper
CO, April 2019
Case History:  https://ecir.groups.io/g/CaseHistory/files/Daisy%20and%20Tiko 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=90099&p=Name,,,20,2,0,0


Re: Candy Update: Invokana on board Questions and Concerns re. symptoms and diet

Nancy & Vinnie & Summer
 

Thanks Cass, the Dairy one test for this same hay has a row for Nitrogen at 2.18 assuming %.  In the context of the info above which element is it?  I am confused by nitrate vs nitrogen and I am totally dumb when it comes to math. ;)

I bought some of this same hay too and have a test out on it including nitrates :) it is lovely grass so I hope it works out. 
--
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: Easy and palatable supplements???

Candice Piraino
 

HI Janine,

Before giving you any suggestions, I think its best to get a case history on your mini, so I don't give any ill advice. Please complete a case history for us with as much detail as possible. The following information is going to be overwhelming- but just take it one step at a time!

I will tell you if utilize the search function within messages for "taste tempter" you will get loads of suggestions! Many members have been in your shoes before with picky eaters! If he is IR or PPID, we do not recommend any alfalfa. We also want ESC + starch under 10% for almost all metabolics as well. Here is an approved list: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Acceptable%20commercial%20ration%20balancers/Acceptable%20Ration%20Balancers.pdf


In regards to quidding, please see this link here: https://ecir.groups.io/g/main/files/Dental%20Care/Dental%20Care%20and%20Issues%20by%20Stephen%20Galloway%20DVM.pdf

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. 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. 


--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History: https://ecir.groups.io/g/CaseHistory/files/Candice%20and%20Shark

Shark's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71507 

PHCP Barefoot Trimmer @ www.arkhavenfarm.com

 

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