Date   

Re: Ventral Line Edema and PPID

TERRI JENNINGS
 

Hi Nancy,
First of all, I have no experience with pigeon fever. But what you are describing in the last week sounds much like an episode Teeny had a few years ago around this time of year. She started out with a few hives on her barrel but later progressed to what my vet called a “shelf”. The swelling was over the entire underside of her body and the way it protruded from her barrel it looked like a shelf.  It extended from her chest all the way back to her udders. She was extremely itchy.  After ultrasounds, multiple blood draws, every test the vets could think of, exercise, topical treatments, antibiotics, etc.,  I still had a very unhappy and very swollen Teeny a month later with very little improvement.   I very reluctantly, after lots of coaxing from my vet, gave her dex for a few days and she had her first laminitic episode. Of course I felt terrible but the edema resolved, the itching resolved and luckily the laminitic episode was mild.  


I hope Summer feels better soon,

--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Re: Thoughts on this anyone?

Judy and Bugsy
 

Would the 'awesome farrier' be open to following hoof mark-ups done by someone else?
--

 

Judy and Bugsy

Regina, Saskatchewan, Canada

Feb. 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Judy%20and%20Bugsy
https://ecir.groups.io/g/CaseHistory/album?id=243358

 




Re: Interpreting IR Calculator Results

Debby Sharbaugh
 

Thanks!
--

-Debby

 

November 2017, Muckleford South, Victoria, Australia

 

Chicory Case History: https://ecir.groups.io/g/CaseHistory/files/Debby%20and%20Chicory

 

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=10826


Re: Interpreting IR Calculator Results

Sherry Morse
 

Hi Debby,

All the information you need to interpret the test results can be found here: https://www.ecirhorse.org/DDT+E-diagnosis.php but in a nutshell it looks like her IR is well controlled so keep up what you're doing.




Re: L-glutamine

Lamourah Perron
 

Hi Ktisten
I have her back in boots with socks, as her heels rub sometimes.
It is typical Spring weather in BC. So not to cold but her last bout the temps changed from very hot to cold.

I gave her a homeopathic remedy Aconite, 3 doses 20 minutes apart on the first day along with a hoof soak in Epsom salts and warm water to draw toxins. I  gave her a dose, 1/4 tablet of previcox. She bounced back quickly.

I am not sure yet as the cause. I will get to having her blood work done but we do not have a local vet and timing of appointments is unperdictable.  

My vet does not believe in fasting for blood work. I am also concerned about the sample being comprised as she is 2 hours away and will not guarantee a successful sample with ship times etc.

The only carrier I can for get for minerals is Thimothy hay pellets. I contacted the rep and was sent an analysis. See attached.

I do soak the Thimothy hay pellets as a carrier but when I clicker train  I do not. She get about a quart a day un soaked during training.

I cannot get beetpulp without molasses here. I was using Coolstance but my equine nutritionist said not to as it is to high in fat. I cannot get Triple Crown Thimothy Hay cubes either.

What are your thought on this article about feeding beetpulp with molasses?

https://rivasremedies.com/blog/feeding-your-horse-beet-pulp-the-myths-and-the-facts/

Would Metformin, or such be given without a blood test?

I am taking a workshop in Hoofcare from Hoof Geeks starting tomorrow.

Thank you for all you do.
Lamourah 






Sent from my Galaxy


-------- Original message --------
From: Kirsten Rasmussen <kirstenrasmussen3@...>
Date: 2021-06-08 9:57 AM (GMT-08:00)
To: main@ECIR.groups.io
Subject: Re: [ECIR] L-glutamine

Colder temperatures do increase insulin and cause laminitis-related pain, but can also increase pain due to damaged circulation that gets worse with colder temps.  Have you tried wool socks in her boots when it gets cooler?  If its related to circulation that should help.  If its related to increasing insulin, then the diet needs to be tightened up (if possible) or medications can be tried like Metformin.  Seeing a case history and any bloodwork results would help us advise you on this.

Do you test the soaked timothy pellets?  I wonder if you should try a safer carrier, like soy hull pellets or rinsed-soaked-rinsed beet pulp.  Or soaked Triple Crown Timothy Balance Cubes (these make a wonderful carrier for minerals when soaked to a damp mash), which are guaranteed to be less 10% ESC + starch.  Timothy pellets tend to be low in sugar but there are no guarantees unless you test each bag.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album
--
Lamourah Perron
British Columbia, Canada 2020


Interpreting IR Calculator Results

Debby Sharbaugh
 

Hi All, I recently had my mare (previously professionally diagnosed as both EMS and IR) retested for insulin, glucose and ACTH. All for the first time in a totally relaxed, non-stressed, non-fasted at home situation.  

ACTH very low (second time for this), so I am very happy and suspect she was initially misdiagnosed and spent a couple of years on unnecessary pergolide.

However, the IR calculator doesn't have the interpretation comments it used to have.  Could I please get some feedback on what these results indicate?

Input  Insulin: 8 ulU/mL Glucose:4.8  mmol/L
Calculator results:
G/I Ratio: 10.80
RISQI Calculation: 0.35
MIRG Calculation: 4.8

Thanks!
--

-Debby

 

November 2017, Muckleford South, Victoria, Australia

 

Chicory Case History: https://ecir.groups.io/g/CaseHistory/files/Debby%20and%20Chicory

 

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=10826


Quarter Horses and IR

gypsylassie
 

Hi all,   Time has passed since my husband and then his horse Beau, passed on, and I'm thinking I should get another horse so Chappie isn't alone.  He actually has never seemed to miss Beau, but I think horses like having a herd mate.   
As I get older I tend to try to simplify life when I can, so I'd like to find a horse that's a breed not inclined to be IR.  I'm leaning towards a Quarter Horse.  If I were younger, I'd try a Thoroughbred, but I think I need to be realistic about my aging skills.  😊
A friend and I were talking and she thought there may be certain lines of Quarter Horses that might be prone to IR.   Has anyone here heard that or know what lines they might be?  Or maybe that's just something that pops up on the internet like so many things do these days.  
Thanks,
Laura K. Chappie & Beau over the bridge
2011 N IL


Re: L-glutamine

Lamourah Perron
 

Hi Cindy
Why I am interested in adding L-glutamine is because it helps to absorb insulin from what I have read. I have a Morgan mare who maybe IR and has had 2 bouts of laminitis. 

Her hay has been tested as per recommendations.

I will be doing a case history.

Lamourah 





Sent from my Galaxy


-------- Original message --------
From: Cindy Q <quarian@...>
Date: 2021-06-06 8:35 AM (GMT-08:00)
To: main@ECIR.groups.io
Subject: Re: [ECIR] L-glutamine

Hello Lamourah

Welcome to the group!

1) You asked if you could add L-glutamine. It is safe for EMS and there are some discussions here on ECIR on it helping horses with diarrhea. Searching the group, I see that Dr Kellon has recommended some amounts depending on the situation 
https://ecir.groups.io/g/main/search?p=recentpostdate%252Fsticky%2C%2C%2C100%2C2%2C0%2C0&q=l-glutamine. You have not mentioned why specifically you think she needs the l-glutamine so if there's any special concern, do mention.

2) Is your equine nutritionist balancing according to the NRC Plus/ Dr Kellon's recommendations? You can read more about this under the diet section below.

Below is our official welcome letter and it will cover many details on the Diagnosis, Diet, Trim + Exercise (when the horse is comfortable to) protocols recommended by ECIR. You can get more detailed advice if you complete your case history for your mare. Always a good time to get started without the pressure and stress of an acute episode! Without further ado, here is the 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 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. 

--
Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response





--
Lamourah Perron
British Columbia, Canada 2020


Re: Best Prascend dose for 750lb horse

Sherry Morse
 

Hi Irmali,

Please take a minute to create a signature. You only have to do this one time and it will automatically appear with all future messages on the main forum. It helps us help you to better locate resources in your area as well as see what information and discussions you may or may not have seen since you joined.

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window to type in your name, general location, and year of joining.

Example:
Sally Doe
Somewhere, TX 2019

NOTE: If/when you are adding a link to your Case History or photos, make sure you make it "live". Adding a space after your link or hitting enter on your keyboard will turn it blue.

3) Make sure you check the 2 boxes saying "Use Signature for Web Posting" and "Use Signature for Email Posting”.

4) IMPORTANT: Scroll to the bottom and hit SAVE!

All posts that you write or reply to, using either the web or your email software, will then have your signature automatically added at the end.


The correct dose of Prascend is the one that controls ACTH and that is not dictated by the size of your horse.  As your mare's ACTH is so high and she has been PPID positive for at least 2 years I would expect she will need over 1mg to bring her ACTH down prior to the seasonal rise.  You can read more about treatment of PPID here: https://www.ecirhorse.org/treatment-ppid.php.




Re: Different types of insulin (or glucose) tests, vet is asking which one I want done

celestinefarm
 

Dr. Kellon, I"m confused. The link you posted above says compared to CGIT, sensitivity and specificity of FI for diagnosis of ID were 14.6% and 100% at a cut-off of 20μIU/mL and 63.4% and 87.2% at a cut-off of 5.2μIU/mL, respectively.

MSU's information page states: 
  • Fasted: insulin concentration > 145 pmol/L (20 μU/mL) supports insulin dysregulation.

Are they not saying the same thing, that Insulin dysregulation or resistance is diagnosed at at cutoff of 20?

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 .


B vitamins and recommended supplements

Ann Nuno
 

Hello,
I just received my hay analysis for this year and decided to try the Feed XL program to balance my horses feed.  Based on this program's analysis of my current feeding program the only area lacking is B1, B6, Niacin, and Folic acid.  The program does note that this may not be fully accurate as they do not have full nutritional details for the LMF low starch complete (NW) but I'm only feeding 3-4 pounds of this a day as a supplement carrier (he gets 1.5-2 lbs 2x/day). I do not use a general purpose multi-vitamin as I've found most don't have the right ratio's of what I want and often have things I do not want.  I am still waiting for my well water analysis as I have concerns about iron intake as I am getting more red staining in troughs and this year's hay is also high in iron.  I may end up seeking out help from someone in this group to review my full diet in more depth once the water analysis is back but I'm curious about the need to supplement B Vitamins and if this is commonly needed what are some good options to consider that do not include other vitamins/minerals.

I also recently got my lab results back which looked good overall so my current diets seems to be working well for my little guy who is suspected IR following a bout of laminitis after receiving cortisone injections over the winter.

Thank you
--

Ann Nuno
Gilroy, CA
2020

https://ecir.groups.io/g/CaseHistory/files/Ann%20and%20Nahar

https://ecir.groups.io/g/CaseHistory/album?id=263663


Re: Ventral Line Edema and PPID

Nancy & Vinnie & Summer
 

Hey all I wanted to post an update on this after doing a search for pigeon fever.

Summer was hospitalized at UCD  4/10 through 4/17 for what presented initially on 4/9 as colic but then the following day 4/10 she was febrile on banamine. 

She ended up being a complicated case that UCD really never figured out the root cause. She was treated for peritonitis and azotemia and what was thought to be an atypical displacement.

During her stay at the hospital they did umpteen ultrasounds abs belly taps and bloodwork etc..at one point exploratory abdominal surgery was on the table but the following day the plan changed as her symptoms changed/improved.

She was sent home with the understanding we needed to redo blood work but the peritonitis and atypical displacement were resolved.  She still had the presence of a low grade infection and mild azotemia.

Her 4/26 bloodwork improved her azotemia but the presence of a low grade infection prevailed.  Since she was still seemingly on the mend I have just been letting her be a horse and turn out etc.

Fast forward to last Wed, summer broke out in the worst hives I have ever seen from head to to with massive ventral line edema that ended in a 102 fever on Saturday.  Her guns have been bright red and this seems to coincide with the hives or fever onset.  She was treated with hydroxyzine for 3 days and then with the amt of edema pooling I her front legs and abdomen we gave her 5mg dex.  She started to improve. We pulled blood again and are testing for internal pigeon fever. 

Her cbc and chem came back azotemia resolved, fibrinogen normal but still fighting a low grade infection. 

Since Saturday, her fever broke Sunday am, but then she spiked a fever again yesterday but it held with banamine. This morning it was normal but I could still feel that internal heat from her body.  The hives have mostly resolved and the edema is about 85% improved.

Her internal pigeon fever test is still pending but the vets are stumped.

Couple of questions:

1:If this is pigeon fever are there drugs antibiotics tor antimicrobials are contraindicated for IR/PPID horses?

2: if this isn't pigeon fever, does anyone have any experience with what this could be and a treatment or diagnostic recommendations.  My GP vet suggested that perhaps we go back to UCD for more of their diagnostics should the pigeon fever test come back negative-- but after a week in April of not finding anything--and honestly my vet bills this year have exceeded 20k because of Vinnie, Summer and my dog Hayley, (and we just had to replace our hvac at another 7k and my hubby had hip replacement surgery which is still pending billing of our portion,)  so I am hoping for a more targeted approach to diagnostics.

Thanks in advance.  I will update CH and post bloodwork..it has just been a crazy 3 months for me. When it rains....

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


Re: Best Prascend dose for 770lb horse

Eleanor Kellon, VMD
 

You  could try just starting her at 1 mg/day. If you  have side effects like not eating, drop down to half that for a while.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Confused about feeding iodized salt

Eleanor Kellon, VMD
 

That's unusual to say the least, unless maybe the farmer used salt as a preservative. Could you post the whole analysis?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Best Prascend dose for 770lb horse

Irm
 

I have an Icelandic horse that will be starting Prascend this week (when it arrives in the mail). She's probably had PPID for several years. She tested positive in March of 2019, ACTH baseline was 95.6 pg/mL. She was tested again May 2021, with ACTH baseline now at 341 pg/mL.

Over the last few years she's stopped shedding her hair coat, and requires frequent clipping. She's also become more lethargic in the past year, which is why I am wanting to try the medication. She's about 770 lbs. I'd love any advice on getting her started on the meds. Thanks!


Re: Pony with rt front lameness

Sherry Morse
 

Hi Melanie,

In looking at your Case History you managed to include a long email from your vet in it regarding April's feet. 

Good Morning All,

Here are some measured radiographs from April’s front feet. All images can be seen by clicking on View Images in the Asteris Link below

Josh - April has been sore in front and happened over a wk ago I saw her around that time and she was significantly better that day. We discussed possible post trim soreness as there was some hoof tester sensitivity (it wasn’t much), post vaccine rxn, sub solar bruising  and/or a possible laminitic episode. She came up quite sore again this wk and saw her Tues this time she was moderately lame w/ the rF and had increased pulses.

No evidence of any real P3 displacement.

There were moderate pulses in that foot only and more reactive w/ HT than before and essentially normal w/ LF.

So possibly she had a one sided laminitic episode, but that’s not common. In any case in boots and on meds. Not to worry Josh, not asking for shoes or pads, just wanted you to appreciate what you already know is there: a very thin distance below the toe of P3.

Mel - the Insulin and Glucose test were fine. The minimal elevation of Insulin beyond normal is not surprising in a non-fasted, stressed pony. Hope she is doing better.

Let me know if questions 


The link to the x-rays (https://keystone.asteris.com/#/share/BURLTNEQVET/share-request/86145410-0421-4000-1054-ffffff210428/share-recipient/96ba907e-4000-8814-1054-ffffff210428) shows that she has very little sole depth and this could certainly be contributing to the lameness you're seeing. IMO her insulin level and weight indicate that she should be treated as IR until you have a test that proves otherwise (after she's lost weight and no longer is lame).




Re: Confused about feeding iodized salt

Sherry Morse
 

Hi Julie,

Most horses will not lick a block enough to get the salt they need.  If you think he needs more than the usual amount you can put it in the feed or sprinkle it on wet hay.




Re: Pony with rt front lameness

Trisha DePietro
 

Hi Melanie. What follows is our Welcome letter that highlights our protocol for IR/Cushings care. Was just wondering your Vet thought about Lyme Disease? Might be something to consider.  Is the grazing muzzle completely sealed or can she get some of that short stressed grass? We advise to seal the bottom holes of the muzzles because the sugar content of the stressed grasses in overgrazed pastures can be very high and contribute to soreness/inflammation. Good for you to soak the hay- you'll get more information and ideas from our welcome letter as you try to get on top of her problem. 

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. 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. 

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


Re: Confused about feeding iodized salt

trails4jd@...
 
Edited

If he needs more (hot day, long ride) than the 1+ tablespoon I'm giving him with his supplements (in the evening) won't he lick what he needs off the salt block? 
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Julie D OR 2021

https://ecir.groups.io/g/CaseHistory/files/Julie%20and%20Porter


Re: Confused about feeding iodized salt

trails4jd@...
 

OMG.  I didn't notice the "per pound"!

--
Julie D OR 2021

https://ecir.groups.io/g/CaseHistory/files/Julie%20and%20Porter

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