Your RISQI was .19 = IR WHAT DOESTHIS MEAN? What #s do I compare this to???


http://www.sportshorses.com/cases/rollinslinda.Peanut.htm

--- In EquineCushings@..., lindarollins38@... wrote:

Your RISQI was .19 = IR WHAT DOESTHIS MEAN? What #s do I compare

this to???

The VA Polytech group did a study in ponies a few years ago and used
some measures of glucose and insulin to determine what was the most
sensitive measure for determining what they termed "prelaminitic
metabolic syndrome." (PLMS) They used several tests that are used in
humans including the G:I ratio and RISQI (reciprocal of the square
root of insulin). To calculate the G:I ratio, you need both glucose
and insulin results. To calculate RISQI, you need only insulin.
According to the criteria they set, anything less than 0.32 is
insulin resistance.

What they found was that two tests, first RISQI and then the G:I
ratio were the most senstive for catagorizing/diagnosing/determining
risk (however you want to phrase it) for PLMS. Here are some quotes
from the article:

(RISQI) - The reciprocal of the insulin square-root index is
calculated as insulin -0.5 and estimates insulin sensitivity as being
relative to the amount of insulin compensation required to
chronically maintain basal glucose homeostasis. (measure of insulin
sensitivity)

*We statistically derived criteria for prelaminitic metabolic
syndrome in apparently healthy ponies that have 3 or more of the
following characteristics:

1. Insulin resistance:
(RISQI < 0.32 [mU/L]–0.5)
2. Compensatory â-cell secretory response :
(MIRG > 5.6 mU insulin 2/[10•L•mg glucose])
3. Hypertriglyceridemia :
(triglyceride concentration > 57.0 mg/dL), OR
4. Obesity:
(body condition score > 6.0 with localized fat deposits on
neck and tailhead).

*Source: Treiber, et al. (J Am Vet Med Assoc 2006;228:1538–1545)

Since we only have Peanut's insulin numbers we can only calculate the
RISQI score which is 0.19. He's not obese, we don't know if he has
hypertriglyceridemia and we don't have any glucose numbers, so we're
kind of stabbing in the dark. With Cushing's, he's at risk for IR and
the reason we all get worked up over it is because we want to prevent
lamintis, especially this time of year when ACTH goes up and the
grass gets more dangerous.

At your last update on 10/27 (today) you have listed for feeding:

5 pounds Poulin Carb-Safe
4 lbs. ODTC
4 lbs. TCSS
12 lbs. orchard grass
For a total of 25 pounds of forage, so I assume he's off the grass
now?

Kathleen (KFG in KCMO)

For a total of 25 pounds of forage, so I assume he's off the grass now?
Pretty much, which I know is the wrong answer.
He has 3 hours w/o the muzzle on very, very stubby, scant grass. The muzzle has been a process over that past few weeks, with warnings from my vet about causing "stress" (which I have asked about on this group) and next, perhaps, ulcers (he is prone to them, they say, he is that "type") If the consensus of this group is that the risk of muzzle/stress-induced reactions is less than the risks of a 2-4 hours w/o a muzzle, then I will go down to the barn tomorrow morning, strap the thing on him, kiss him on his nose and assure him that it is in his BEST interests and quality of life that I do this, I will. Period. I also struggle with the "quality of life thing" probably because I am sensitive to it now every day with my post-stroke father. Is dying in the next few years, with grass between his teeth, better than living another 10, head hanging low in the pasture, miserable, w/ a muzzle hanging from his face, BUT with great labs, only then to founder, or colic, with no return....I don
't know. The morality & ethics of it all are seeping over from my Dad's life - or what's left of it...*sigh*
Linda



http://www.sportshorses.com/cases/rollinslinda.Peanut.htm

Regarding Linda's quality of life question (and please remember to trim
posts, not quote someone else's entire message), the whole point of the dietary
modifications being recommended here is precisely to improve quality of life.
The strict adherence to proper diet is what can prevent founder, not cause
it. (the phraseology was "Is dying in the next few years, with grass between
his teeth, better than living another 10, head hanging low in the pasture,
miserable, w/ a muzzle hanging from his face, BUT with great labs, only then to
founder".

An uncontrolled diet is what is likely to cause laminitis and its frequent
sequel, founder. A horse that feels well, enjoys life. A horse with
uncontrolled metabolic problems is usually the one that is just plain feeling
'yucky', not enjoying life. If you will actually commit to doing what needs to be
done, 100%, I think you will be amazed at the change in your horse, for the
better. I am not normally so blunt, but I was perceiving that a proverbial
kick in the seat of the pants was called for at this time<G>. If I was wrong, I
apologize.

Jeanie



************************************** See what's new at http://www.aol.com

"He has 3 hours w/o the muzzle on very, very stubby, scant grass. " - That
is the very worst kind! Go read _www.safergrass.org_
(http://www.safergrass.org) for details, but stressed grass is higher in sugars than healthier grass.

Jeanie



************************************** See what's new at http://www.aol.com

Linda,

This is an easy for me. Let me tell you more about this "quality of
life thing".

Dazzle is 20. I made a decision 2.5 yrs ago to do colic surgery on her
to remove an enterolith. I had full assurance from the surgeon that
although there were risks, there was no reason to think that we
wouldn't be out riding in 90 days.

Dazzle was perky, fun, full of go. She had abundant personality. She
was the princess of my heart and my life. She was smart, funny,
active. We were involved in dressage, a mounted patrol with the city
police department, and trail riders. She had 3 full time jobs. We both
loved life.

After the surgery, she couldn't walk. Her back end seemed disconnected
from her front end. At 90 days, we weren't riding, She was walking
better, but still couldn't trot and I handwalked her.

She steadily got better, but we always had set backs. In the fall, she
didn't seem to be doing as well. We had a tooth removed. I thought
maybe that was it. At the advice of a vet, I put her on Equine Senior.
She just got sicker. She was miserable. I cut back on the equine
senior. She seemed to be doing a bit better, but last fall, her health
declined. I watched her slip away before my very eyes, unable to do
anything to help her. At a loss, along with the vet, as to what the
problem could be. My heart was so sad. I thought it was the end of our
life together. I cried. I prayed. I searched the internet for ANYTHING
that might help her.

And I found this group. She was not obviously laminitic, but I grabbed
a hold what I could. I reviewed her supplements. I cut out the sugars.
I weighed her hay. I figured out how to store 3 months worth of hay
and test it. I learned how to get her blood tests done, although it
meant that I had to change vets. I had Dr. K review her case history
and balance her diet.

What was hard? Lots of things. No carrots. No cookies. I explained to
her, firmly believing that at some level, she comprehended, that I
couldn't do that anymore. I found some alfalfa treats that were 12.8%
for the occassional "cookie".

I had to weigh her hay. This was exceedingly difficult because my dad
was anorexic and that experience has made me want to NOT tell people
(and horses) what to eat.

I had to syringe her minerals. She acts like I'm killing her. I know
that she hates it. I do it anyway.

And I look at her now. We have just started back to riding - about 10
minutes a couple of times a week. She's witty. She's funny. She's
interactive. She participates in life. She looks forward to our time
together. I see the sparkle of the horse that I used to have. And I'm
so overwhelmed and thankful to this group.

This fall, with the ACTH rise, we're doing OK with the symptoms. I
tested in Sept. I will test again within the next couple of weeks,
depending on the date I can get from the vet's office. BUT, she has
not made the massive decline that she did the last two autumns. So,
I'm on the right track.

What's better? Her diet is balanced. The addition of the minerals has
helped us get the insulin number lower. - That insulin wouldn't budge
without the balancing of the hay. Even when I knew that the hay was
low sugar starch.

Her Cushings is being addressed. Am I perfect at it? Not at all. But I
am testing every other month until I can get a feel for where we need
to be.

And I took her out over Labor Day. It was the first time we had
trailered out in two years (except for the horsie hospital). I just
hiked with her, but it was awesome.

For pictures, check these out:

http://pets.ph.groups.yahoo.com/group/ECPhotos/photos/browse/56da?
b=1&m=t

Or here:

http://www.flickr.com/photos/7900950@N08/

I have wrestled with the "quality of life" issue a thousand times. And
I never wanted to give up hope on my little girl. I look at who she is
today and I firmly believe that my sticking to it was worth it.

Do I like doing the syringe and making her feel like I'm killing her?
Absolutely not.

Does Dazzle miss the cookies, carrots and sweet feed she used to get?
She doesn't seem to mind the new routine.

What's crazy is that I didn't want to stop feeding Dazzle cookies and
carrots. Yet, I would clearly say that it's unacceptable to give a
diabetic child cookies, just because the child wanted them.

And I look at Dazzle now. I'll do the hard things for this. And once
again, I thank this group. I owe a debt of gratitude as large as the
Grand Canyon to this group and Dr. K.

Joan and Dazzle

I also struggle with the "quality of life thing" probably because I

am sensitive to it now every day with my post-stroke father. Is dying
in the next few years, with grass between his teeth, better than
living another 10, head hanging low in the pasture, miserable, w/ a
muzzle hanging from his face, BUT with great labs, only then to
founder, or colic, with no return....I don

't know. The morality & ethics of it all are seeping over from my

Dad's life - or what's left of it...*sigh*

Linda

--- In EquineCushings@..., lindarollins38@... wrote:

Is dying in the next few years, with grass between his teeth,
better than living another 10, head hanging low in the pasture,
miserable, w/ a muzzle hanging from his face, BUT with great labs,
only then to founder, or colic, with no return....

=================

Remember you have to worry about YOUR level of stress too, with all
this going on!

As for the above, Cushing's horses have lived 10+ years on pergolide
after their diagnosis. There's even a chance that once you get his
ACTH under control his IR will normalize. With a thoroughbred, odds
of that are better than most. With great labs, he won't founder.
That's the whole point. Founder is infinitely worse than a grazing
muzzle. Your starting point, without having to deal with laminitis,
is much better than many horses on this list who have fought their
way back from that and are now happy and comfortable, albeit without
grass in most cases. You may end up having to manage him more
carefully than when he was younger but it won't be as difficult as
it is for many other horses.

There's a bumper sticker that says "Ageing Ain't for Sissies". Too
true, and quality of life issues can be extremely difficult. Do you
honestly think though that he would choose to die if he couldn't
have grass? Look in his eyes. The will to live is a very powerful
thing. When it's gone, you'll know it.

Eleanor

--- In EquineCushings@..., "Joan and Dazzle"
<horsies4luv@...> wrote:

For pictures, check these out:

http://www.flickr.com/photos/7900950@N08/

Joan - She's gorgeous! Look at that crater above her eye and how shiny
she is! I'd never heard your story before and it was a joy to read.
Thanks for sharing it with us.

Kathleen (KFG in KCMO)

--- In EquineCushings@..., "Kathleen Gustafson"
<katmando@...> wrote:

--- In EquineCushings@..., "Joan and Dazzle"
<horsies4luv@> wrote:

For pictures, check these out:

http://www.flickr.com/photos/7900950@N08/

Joan - She's gorgeous!

She certainly is, and the shine in her eyes is even better than her
coat.

Dazzle (aptly named) is a good example of the importance of BALANCE.
She was actually being oversupplemented and needed some tweaking.
Once that was done, there was obvious improvement literally within
days. It doesn't have to be complicated, doesn't have to be
expensive. Just balance to the diet, give their body what it needs,
keep away from excesses and things they can't handle, then watch
them basically heal themselves.

Eleanor

--- In EquineCushings@..., lindarollins38@... wrote:

He has 3 hours w/o the muzzle on very, very stubby, scant grass.

The very stubby grass is probably very high in sugar.

I hate muzzles, but I love my horses more than I hate muzzles. I
have FIVE here that never go out without muzzles; one is mine, one
belongs to the SPCA, and 3 are boarders' horses. Some have never
even tested high for insulin, but are obviously more foot sore when
allowed to graze. Mine doesn't even get foot sore - he's just too
fat - it's a preventative.

Quality of life - I get it too. I watched my dad fade away (VERY
slowly) from muscular dystrophy, my aunt from cancer, and my mom has
dementia. If they had been told that something as simple as a muzzle
would have saved them, I KNOW they would have grabbed onto it. They
grabbed on to gene therapy, chemotherapy - all more involved and
painful than a muzzle.

With his diet balanced, he may be less prone to the ulcers, plus
there are other things to do to prevent them, like U-Guard. Can't
remember if he's to be out with a sealed muzzled or not, but if not,
you'd be amazed at the amount them eat through those things - and hay
too!

And ditto what Dr. Kellon said about taking care of yourself during
such stress. I'm so sorry to hear about your dad.

Last thing - I know you still want to have help with getting his diet
balanced - the point of your posts lately! I still think with your
iron numbers that you really need a consutlation with Dr. Kellon.
The amount of trace minerals needed to offset the iron requires
expert knowledge and finesse IMO.

Vicki Kline

And I look at Dazzle now. I'll do the hard things for this.

We need to save this story in the files!! Hall Monitors - can we?

Thanks, Joan, for the encouragement. Awesome job with your Dazzle :)

Vicki

I have been through so many struggles with Tilly over the last 3
years I cannot count them. She has been so sick I would sit in her
stall and cry my heart out. The she gets better and she is so full
of life that I wonder what I was so upset about. This has happened
many times, but she has never looked at me and said it is time. She
has been feeling great for several weeks, then yesterday I came out
to feed in the morning and there she was down on the ground and
didn't want to get up. I couldn't believe it. What is going on? I
padded her boots really well and let her rest. She would get up, but
was walking very poorly. Today the farrier came (yes on a Sunday)
and scaped a little sole from both feet and there was dried blood
there on both feet in the toe area. Now if all can remember she had
a laminitis attach back in August when she got into the bucket of bad
food. So Randy said I really think she is trying to abscess. I
cannot tell you how happy that made me. Some might think I am nuts,
but I can deal with a couple abscesses over laminitis anyday. So I
have a poultice on both feet along with diapers and her boots. She
is laying down, but looks bright. Does this sound plausible to all
of you?
Anyway back to my story. Your horse can be really happy without
grass. I have two that will never have it and they are very happy.
Tilly has struggled to stay on this earth and I will give her every
opportunity until she tells me it is time to go.
Karen, Chantilly and Tommi--- In
EquineCushings@..., "Eleanor Kellon, VMD" <drkellon@...>
wrote:

I have 3 horses who wear muzzles every day. They get used to them,
even putting their heads in when you hold them out. They have
wonderful, active, complete lives...they even mutual groom with their
muzzles! They look forward to their low sugar hay when they come in
and I can't for a moment imagine them (or me) choosing grass over
death. Once the metabolic issues are under control, the rest is easy.
Paula