Date   

Re: Questions regarding adding salt to the IR diet (emergency or otherwise)

Maxine McArthur
 

Here is the link, Sue. In the Files section there is a folder named 'Core Diet', and the 'salt and iodine' information is in there. If you type 'salt' in the Search box at the top of the Files section, it is the first folder in the list.

main@ECIR.groups.io | Files

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Re: Questions regarding adding salt to the IR diet (emergency or otherwise)

Sue Ring
 

Hi Bonnie,  Thank you for your response.  I'm not seeing the link however, to the document on salt use....help!  Am I missing it?  Thanks.
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/SUE%20and%20DAKOTA
 


Re: Questions regarding adding salt to the IR diet (emergency or otherwise)

Sue Ring
 


Re: Boarding in San Diego area?

LJ Friedman
 

email  me  luke4275@....... I can get your facility checked out ,, visit myself  or have trainers give me their true data.. with some barn owners being,, " a bit off". a good  411 dig on the facility would be helpful  .. email me what you pay now.?  etc,, .. bonsall is a great community   50 miles  but very fine places there..some smaller and private
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: Canagliflozin (Invokana) and Triglycerides

Lecia Martin
 

Thank you Dr. Kellon for the clarification.  Flyte is not in formal work at this time, and is on free choice hay at nite.  I will continue as is until we get the blood results at the end of April.   As always, I appreciate all this groups does.

Hoping for your speedy recovery!
--
Lecia Flyte and Flame
Alberta, Canada


Re: Questions regarding adding salt to the IR diet (emergency or otherwise)

 

Sue, 
Here is a helpful document link about salt usage. Yes, many of us use just plain iodized table salt  for most of our horses. Horses have a requirement for iodine yet very few salts sold for horses have iodine in them. Depending on exercise and temperature you horse may or may not need additional electrolytes. Do some searching of our files and messages on the topics of salt, iodine and electrolytes. 
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased


Re: Canagliflozin (Invokana) and Triglycerides

Patti SoCal 2020
 

Dr Kellon,

If we choose to go with one dose, then check urine daily to see how long the effects last, would you start with the full dose?

--
Patti
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny 
https://ecir.groups.io/g/album?id=262934  


Re: Canagliflozin (Invokana) and Triglycerides

Patti SoCal 2020
 

Thank you, Dr. Kellon. I was wondering about the possibility of intermittent doses.

i, too, hope you have a quick and complete recovery. We missed you!
--
Patti
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny 
https://ecir.groups.io/g/album?id=262934  


Re: Working on CH

 

Betty,
Here is/are some directions which should help you manipulate the document. I have found that when I try to add another blank row into a section it is best to NOT go to the very bottom row to add another row. It often fails for me (windows PC). It always works correctly if I add the new rows 1-2 rows above the existing bottom row. Hope that makes sense.

https://ecir.groups.io/g/main/files/Case%20History%20Tools/Tools%20and%20How-To%20Help/How%20to%20Use%20Word%20to%20Update%20and%20Edit%20Your%20Case%20History.doc

Betty, I am attaching our Welcome document for new members below. Your first post didn't ask any questions about your horse's health, diet etc. Please reply to this welcome message and tell about your equine and what we can do to help you. The document below is pretty meaty, full of information and links to even more material. Active links are in blue type. We ask that you review this document then open links to more in-depth material. 

Searching: It will help us if you use our search tools to find answers first before posting a question. There are "SEARCH" buttons on every page. The messages hear in the Main Group can be searched and our "FILES" can also be searched. In the left hand column you will find a link to the Files area and of course there is a search button on every page of the files. 

We have a "WIKI" also. The Wiki gives you detailed HOW TO instructions for moving around in this group, creating storage folders, changing you signature, etc. Please explore and read.

Bonnie

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. 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased


Re: Working on CH

~NeanPiggy~
 

When you have your curser in a box so that row is active, drag to the skinny column all the way to the left, it doesn't always show.  when you double click/right click on it the Add row above or below option shows.  ALSO on the very bottom of the CH form there are directions on how to do it.
--

Jeannean, Cricket, Chispa de Vida (& Prince Willy over the rainbow) Mercuri ~ PHCP Barefoot Trimmer
Ridge 2011

https://ecir.groups.io/g/CaseHistory/files/Jeannean%20and%20Prince%20Willy
https://ecir.groups.io/g/CaseHistory/files/Jeannean%20and%20Chispa%20de%20Vida 

https://ecir.groups.io/g/CaseHistory/album?id=79126 
https://ecir.groups.io/g/CaseHistory/album?id=78466


Re: Canagliflozin (Invokana) and Triglycerides

hdavis
 

Thanks Nancy and I totally agree covid is brutal snd feel for anyone on it. I guess I’m just somewhat confused is all as she was already in formal exercise since Nov/Dec. I guess I just stop the Invokana for now as I can’t stop exercising her at this point I don’t think and hoping this will be the safest solution at this point. I am not sure what else to do. 



--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Working on CH

Betty Altman
 

How do I “add rows” to blood work results?
Betty A


--
Betty A
NE GA 2019


Re: Canagliflozin (Invokana) and Triglycerides

Nancy C
 
Edited

Hey Heather

Just in case Dr. Kellon cannot get back to you (this virus is just awful) I wanted to point out what I would call a fairly straight forward statement from her in this very message: https://ecir.groups.io/g/main/message/263668


I do not recommend starting formal exercise when on this medication.

--
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


Re: Canagliflozin (Invokana) and Triglycerides

hdavis
 

Thanks Dr.Kellon and hope you are feeling better soon :(.
 
I have a few questions if I can possibly ask.
Riosa has been on Invokana since May/June 2020 and her insulin has responded well except for some increases over the winter (Dec & Feb) which could be due to cold weather as well as improper storage of the drug on my part.  The storage issue was realized and fixed about 1 weeks before the tests we did.  
 
She has been in formal work on the ground since Nov - January and then took a break in the cold snap and resumed in March.  We recently have added under saddle work too.
 
She is on 300 mg pills given in the am.  She was not losing weight so I have not increased her hay except if cold temps require it.  She has been getting an after exercise meal of 50/50 ODTB cubes and oats - about a lb each right now plus regular weighted feeding.  
 
  Are you saying I should discontinue her exercise now?  Or take her off of Invokana?   Or how should I proceed as want to make sure I am doing the best for my horse.  Thoughts and suggestions please.  We are still awaiting blood test results for insulin, glucose and triglycerides.  Thanks in advance.
 
 
 

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Re: Canagliflozin (Invokana) and Triglycerides

chemelle
 

Dr. Kellon,
I am so sorry to hear you've been ill with Covid. My most sincere wishes for a speedy recovery.

If we stop or reduce invokana dosage, do we need to taper down gradually?
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

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


Re: Chemelle and Andy - Invokana

chemelle
 


Canagliflozin (Invokana) and Triglycerides

Eleanor Kellon, VMD
 
Edited

The increased triglyceride levels seen in some horses on canagliflozin appears to be unique to this species. It also behaves differently from other hypertriglyceridemia/hyperlipidemia states in ponies and minis in that, except for some reports of weight loss, the condition is asymptomatic. In horses followed to date, triglyceride levels drop rapidly with discontinuation of the canagliflozin.

 

It appears the triglyceride release is a physiological response to an energy crisis caused by the loss of glucose in the urine. Glycogenolysis and gluconeogenesis are able to keep blood glucose levels normal but there is insufficient supply for the cells. The result is mobilization of triglycerides, such as also occurs with starvation or prolonged exercise.

 

Triglyceride levels and any elevated liver enzymes improve rapidly and dramatically within a week. At the same time, insulin begins to rise and hoof pain may return.

 

The search is on for a better way to utilize this drug. Trying a lower dose is one possibility. Another option is to check urinary glucose levels daily after a single dose to see how long the effects last. Daily dosing may not be necessary. Dietary adjustment could also be useful – specifically adding generous beet pulp. Beet pulp fermentation generates large amounts of acetate which can replace glucose in energy generation. Allow free choice safe hay unless the horse needs to lose weight. I do not recommend starting formal exercise when on this medication.

 

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Chemelle and Andy - Invokana

Eleanor Kellon, VMD
 

I'd hold off on formal exercise until you get your blood results.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Dr Kellon/Dr. Clougher - need help re significant increase in triglycerides

hdavis
 

Dr. Kellon,
so sorry to hear about you being sick with Covid:(. Thoughts and healing prayers to you and hope you continue to get better.  So appreciative for all that you do for us and I know we are all sending u well wishes and prayers. 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Re: Now what

 

I use both Pages and Word on my Mac interchangeably.  I’ve definitely merged cells in Pages but if you’re more familiar with Word, I suggest going with that.
--
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


 
 

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