Oops that was sent without a message!  Sorry!

Thanks Dr. Kellon.  Hopefully her blood work comes back with good results as well!  Great to hear we are on track with the trim. My vet was very pleased with the rads and mentioned the same as you regarding the bony column alignment and sole depth.  She also mentioned I had about 6 weeks she figured left to regrow out the hoof capsule.  

I was wondering what your thoughts were on getting her back to work based on these rads.  So far we have been working in hand or online in the fields and arena focusing on big squares and straight lines.  At times we do have to do smaller squares as she can be full of beans.  But so far no issues with soundness that I can see.

Would you think we continue with the ground work and increase the duration of trot and canter? Would you wait a full year from her initial episode (end of Feb 2019) to do ridden work or wait longer to when her insulin dropped from addition of Invokana (started end of May and dropped to 200 when tested in July). Thoughts and comments?

-- 

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

--
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

Thank-you.  I put stall wraps on this morning.  I will wean her off the bute and gabapentin.  And draw some blood for the blood test that you recommended for PPID.  She is on the emergency diet  

I will also work on filling out the case history to give more info.  
--
Shannon B in Ontario 2020

Hi Shannon!

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. 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. 

 

--

Candice 

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

 

thank you for the reply and thank you for setting things straight with my worming knowledge 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Hello Dr. Kellon,

I sent the hay sheets to the above address. I also just uploaded Candy's most recent X-rays in Photos. She has been trimmed since then with specific attention to lowering heels and she is scheduled for another trim 12/14.

Unfortunately, Candy is off her feed. I can only assume she has some kind of ulcer situation going after all these months on NSAIDs. She is off them now, but only for a few days. Argh. Gave 3/4 tube dose of Ulcergard and will start treatment. I saw that I need to give it 2 hours before or after j herb, I beleive. I am trying to stay calm. She is on phyto-quench, but she is not as comfortable as I would like. She continues to tread. And is not walking as well as she was yesterday, so my plan is to start Jiaogulan tonight. I will be syringing that with the mov-ease 2 x a day and drop the phyto-quench. As I understand it interferes with the Jiaogulan, however if I should continue for comfort and give it at some staggered time I will do that. Please advise. I also ordered PEA, so its on its way if she needs that. Maybe, I will see her get more comfortable quickly on the J herb. My biggest concern is keeping her eating now. My feed store has the sample hay bags so I grabbed alfalfa and timothy. Of course  they have not been tested, but I was hoping to grease the wheels in the appetite dept. I am not sure what to do. She has always had a very strong appetite, but now has lost interest in her safe Teff hay and Timothy balanced cubes. She has rejected soaked grass hay in the past. I really should not be soaking hay because of my arthritic hands, but will do so in this emergency. I did giver her a pound of timonthy hay and 2 # of alfalfa which she ate. Any advise on this. I think she would eat soaked alfalfa, not sure about the timothy hay. Or should I just feed her as usual tonight and see what happens overnight with the one dose of ulcergard on board or should I give soaked alfalfa? I am not clear on what poses a bigger threat to her.

Thanks for any input.



--
Shawn
Dec 2020, Santa Cruz, CA
Candy Case History:  https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy

If you do monthly ivermectin you won't have encysted forms.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Pain doesn't interfere with PPID testing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459856/ .

Gabapentin is worthless is my experience, and bute may be making things worse.

She needs leg wraps and socks on her feet inside the boots. More details coming soon.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Alignment is good on the films. Good sole depth.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thanks for the reply. I understand that. My question is why were using ivermectin  if it doesn’t kill those and its the major problem?
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Just for the record 9.3 to 10.4 would be too high for some horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

It's talking about the encysted forms. Ivermectin doesn't kill those.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

This article was in horse.com today. I’m curious to know why we use ivermectin monthly if the small strongyles are all the major problem and Ivermectin doesn’t kill them? Or do we differ in what this article states?
-- Cyathostomins, or small strongyles, are the most pervasive internal parasites of horses and the primary targets of adult deworming programs. LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Hi Tori and all

These links will take you to conference proceedings
https://www.ecirhorse.org/proceedings-2017.php
https://www.ecirhorse.org/proceedings-2015.php
https://www.ecirhorse.org/proceedings-2013.php

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA

Hi Janet,

I can't speak to your question directly, but I tested the Standlee Teff pellets twice. They are advertised at 9% NSC. When I tested them the NSC was considerably higher, 12.6% and 13.6%. BUT THE ESC + Starch was 9.3% and 10.4%. So this seems like a safe range. It is really hard to say without testing every bag! When I was still looking at NSC I freaked out because it was certainly high enough to cause my horse problems and I thought it was the culprit. Now I am not sure at all. 
I contacted the company and she said the Teff pellets were a new product and I think they only tested them 1 time.  She steered me to their Timothy pellets and indeed I have tested those 3x and their esc + starch  7.9%, 8.1% and 7.7%. Impressive, I suppose and my horse loves them, she loved the Teff pellets as well. Hope this helps.

Shawn
Dec 2020, Santa Cruz, CA
Candy Case History:  https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy

Hello,
I have posted the rads from yesterday we took of Rio’s fronts.  My vet had said she would send them clean with no text but when I received them they have text on them :(. I wonder if it is her program maybe that does that as she did say yesterday she would make sure no text.  I have sent a message off to see if she can send clean ones.

I would be  interested in your feedback Lavinia and thoughts on how we are progressing for her trim and overcoming our laminitis episode(s) from last winter. 

--
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

Hi Tori,

I should have clarified the purpose of creating these databases and how they benefit ECIR members. The database from Oregon started in 2001 as a long-term project with Jannalee Smithey. She has collected samples from the same fields/growers. We're using the data to look at the effects of different factors on nutrients and then using these data to inform ECIR members through the conference presentations and proceedings. For example, I used these data in the last conference to show the effect of hay quality on protein, calories, estimated fructan, simple sugars and starch. Many experts recommend that horses with metabolic disorders should eat "poor quality hay," and these data provided evidence that the majority of HAY (97%) test with less than 10% ESC+starch. In contrast, if using 10% NSC as a threshold, only 14% of these same hays would be deemed acceptable. 

That said, while this database is expansive, I realize that we need databases from different regions so that we have a comprehensive picture of regional differences. I've created my own database using Eastern KS, Western MO hays and am working with someone in Texas to develop a coastal Bermuda database. In my dreams, and only after I retire, I hope to compile a master database from member hay analyses in the case histories. If I can answer any specific questions that you might have, feel free to ask.

Kathleen (KFG in KCMO)

Director and Research Advisor, ECIR Group Inc.

Missouri, USA, 2005

https://scholar.google.com/citations?hl=en&user=3-I7UI0AAAAJ 

 

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125

I am having a chat with my farrier this evening.  Im seriously reconsidering the metal this time of year.  It dipped below zero here already last night and Im concerned about keeping her feet warm with metal shoes this time of year.  Im hoping he has a composite/glue option for me.  I know he has them and has done them.  
Thanks much for your input!  It always helps!
-- 

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

That really depends on the horse.  If J has EMS at baseline as well as PPID, then you have to be extremely careful with the diet.  If J does not have EMS at baseline, then you can get away with doing a little less diet-wise.  Lots of our members feed whatever it takes to get the Prascend in, sometimes its a scoop of feed that is not low sugar, sometimes its a piece of carrot.  Sometimes, it is syringed in with applesauce.

To evaluate whether or not she is EMS, you need to know if J has elevated insulin.  J's case history does not report her insulin numbers we can't know if she is also EMS or not, in addition to PPID.  Given her breeding and her BCS of 6, she definitely could be EMS at baseline...usually horses with only PPID usually have a lower BCS and its hard to get/keep weight on them.

Another important question is has she ever had laminitis?  If she hasn't, then perhaps she does not have EMS or perhaps it has always been well enough controlled by diet and exercise that it didn't become a problem.  She doesn't have a history of laminitis documented in her Case History, so it may be she can tolerate the senior feed in the amounts you were feeding it.

This is where more information in her case history would really help us advise on J.  It might also be possible to remove the senior feed and replace it with beet pulp and soaked hay cubes entirely, but that's where an experienced hay/diet balancer needs to be involved.

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