Hi Jana

It would not surprise me that his glucose is low after work. When you are stumped you need to think about DDT+E

It appears your PPID is controlled.  Looks like other blood work is good, but I could be wrong.

Check the file on putting our metabolic guys back to work here. 

Feeding Recovered Laminitics

With Sandra, check protein and amino acids.  You might need to add Lysine and Leucine.

But most importantly check his salt.  You report he is sweating and that will have a huge impact if salt is not increased to accommodate loss.

Quick loss of "weight" during hot days could be dehydration.

Anemia could be from copper deficiency due to excess iron (has his water been checked?) or an uncontrolled disease, like PPID. 

If his trim is not right or he is foot sore, that could also contribute (hence the request for pics)

No magic answers, I am afraid.  Just some places to go to try to tweak.

Thanks a lot, Nancy.
I'll try to answer the questions: the vet told me that his glucose should be rised again to the before work level in 30 min. Mikados glucose haven't been high enough after 45 min. I'm not 100% sure, but I think I found a statement of Dr Kellon, she said the same.
About the lysine and leucin: I will ask Sandra for that, but I think Sandra did a proper balancing of his minerals. There is also an amount of salt in his diet, and of course I give more salt, when he is sweating.
The water is tested yearly, and it's fine. We have got a mashine that gets the iron off the water (sorry, çan't find the englich word for that mashine).
The loss of weight is not quick, more a slow process, but I don't want him to be that thin during winter. He drinks enough I think, I don't have automatoic waters, I use warter buckets and could see how much he and the little shetland buddie is drinking.
I'll try to make hoof pictures, but I don't think the hooces are really part of the problem, I trim by myself, with the friendly suppoert of our farrier who is really an expert in trimming  and shoeing difficult hooves (he worked as a barefoot trimmer for a few years- not a "normal" farrier) and a german member of this group who is also trimming the hooves of her horses on her own.

Is there an explanation for Mikados low temperature? And the poor coat? Maybe there a solution that fits to all his problems?
Jana Germany 09/11
ECHistory7

 

I personally would not worry about his temperature.

It's only a guess but the raise in glucose levels could vary due to condition, age and Dx of the horse and amount of work asked to do.

Blood glucose level is highly dependent on diet and timing of sampling related to last meal plus the composition of the last meal.

The pH of your water could be bigger issue than the amount of iron but I guessing that is part of your testing.

Review the diet very carefully.  Make sure you are using the nutritional requirements for work. Help him replenish by following the work article I pointed to in last email on ecirhorse.org.  I assume your are not working him beyond his ability.

As for coat.....lots of things could be driving that. Since you ACTH is under control I'd look to diet and deworming.

Review his feet.

Hi Jana,

 

I looked at your diet spreadsheets:

 

2000IU Vit E and 20 mg biotin is the recommendation for 500 kg horse, but your light work diet is half of that.

 

There is no need to add more calcium as a supplement.  Your haylage has enough for both activity categories.

 

Iodine:

Maintenance sheet says 14 g iodized salt (25mg/1000g )  is the source for 3.5 mg Iodine.   The light work sheet does not name the source.

*****BUT   14 g of this salt will only provide 0.35 mg of iodine, not the 3.5 mg requirement.******

 [25 mg/1000 g = 25 divided by 1000 = 0.025 mg/1 g.  

       14 g of this salt will provide 14 x 0.025 mg = 0.35 mg iodine]

                  If this 14 g amount of salt is the only source of iodine, then these diets are very deficient in iodine.  Correcting this needs to be a priority.  You may increase the salt for more iodine, but to provide the 3.5 mg you will need 140 g of this salt every day.  

         You still need to consider the sodium needs for sweat losses, too.

    If needed, I might suggest finding an additional source for iodine supplementation. Perhaps Lugol’s iodine is available in Germany, or some other form of standardized iodine.  Feeding kelp that is not standardized to a definite concentration of iodine is not recommended.   Kelp can also contain hidden heavy metals.

     Rough coat, low body temperatures, fatigue, etc are symptoms of low thyroid that may result from iodine deficiency. 

   However, with Cushing’s disease, the coat may not be as thick, as long or as warm as before, and a blanket may be necessary for the colder weather.  Each horse is different.

 

I will also mention that when our pony lost a lot of electrolytes due to choking, he later experienced diarrhea that was due to low sodium and chloride.  The diarrhea also caused more electrolyte loss.  Dr Kellon told me that normal intestinal function (think desire to eat and manure production) were dependent on adequate electrolytes.   The diarrhea cleared up after feeding lots and lots of salt (45-60 g /day to 200kg pony), since it provided both the sodium and chloride that he was deficient in.

 

 

This haylage is rather low in protein.

 *****Mikado is not getting enough protein or lysine for the level of work he is doing*****

You want to have at least a small “buffer” over the target protein levels, especially when seeing muscle loss.  Regarding lysine, since this is an essential (vital for life) limiting nutrient and our figures provide only an estimate of what is in the feed, it’s best to be well over the target level.

 

Mikado is a bit underweight, so increasing calories by feeding a bit more haylage would be beneficial: 

-Maybe 10.5 kg maintenance. This would also increase protein and lysine, to provide some “buffer” protein but est. lysine would still be deficient at 22 g.  I might add 10 - 15 g more for a total of 32 - 37 g lysine to make sure you had enough since he needs to build more muscle.

-Maybe 13 kg Light Work.  This would increase protein (780g) and lysine (27.3g), but you can see yourself that these both were and still would be VERY deficient for work.  If you do not feed enough calories or protein for work, Mikado’s body will breakdown his existing muscle to try to get these nutrients.  (A good amount of lysine to supplement for LW might be 20 – 25 g.) 

     You may increase haylage more, and increase split peas to further increase protein, but then you might have too many calories using JUST these to meet the ALL the requirements for protein. (However, I don’t know if there is an upper limit for feeding split peas.)   

    If you have whey protein isolate available, that is what I use here in Canada to increase protein deficient hay for my IR/Cushings/Iron Overloaded ponies.  It is usually 90% protein, and very low sugars (<1%).   I feed the whey in the meal right after exercise so the nutrients are available to build muscle.  Since the whey is easily digested and absorbed, you can feed 50% of the required CP.  (eg. If need 100 g CP, feed 50g whey protein isolate.)

     Since Mikado is exercising 6 days a week, I suggest feeding according to Light Work everyday to help him recover. Deficient protein levels might affect the coat, hormones, immunity and muscles.

 

 

These comments do not address the salt needs for sweating from exercise or hot weather, or the guidelines for feeding metabolic horses after exercise to address low glucose levels as already mentioned to you.   

     As well, when the weather becomes cold, you will also need to increase the calories over and above what is on these 2 diet sheets, or else more weight loss will occur.  When you increase the haylage for calories, the fed levels of protein will also increase, so the amount of protein as a supplement may be less.   All of these factors need to be considered in the diet.

 

Eva

SW Ontario, March 2005

Thjanks for your reply, Nancy. I haven't been online for a while, I spent a lot time with Mikado, who wasn't happy and fit during the last days.
I really worry a lot because of the low temperarture, it's not normal, and I can't fnd out why he is too cold. I think that he often doesn't feel comfortable when he is cold.
The water is the same water that the neighbours and I drink. We have very strict regulations for water here in Germany, so I think the ph and the iron should be okay. We have ti test the water every year, and the ph has been always neutral, I think the number is 7?
The diet is made by Sandra who is member of this group and is following the advices of the group. I can't imagine that she did so wrong that all this problems were because of his diet? I emailed to Sandra, to ask her about the diet. I am no expert in nutrition, and I tried to choose the best way to have a best fitted diet for my pony.
I didn'z forget the hoof pictures, but I really think the hooves are not the problem, if he is able to work, he does pretty good.
Mikado and I have a quite good connection, so I think that the level of work is matching his ability.
Hope we will find out whats going on with Mikado, if we cross out other factors that could caise problems.
Jana Germany 09/11
ECHistory7

 

Whow, Eva, thank you so much for working out whats wrong with Mikados diet. Pretty bad thing is, that this diet isn't his current diet, I bought new haylage last month, and Sandra made a new diet advice. But, nevertheless, your notes should be helpful for Sandra and me.
About the amount of haylage: He gets free choice haylage, the number in the diet plan is the amount he is eating. No idea how to make him eat more haylage. At the moment he is getting 2-3 times per day an extra meal of beet pulp and peas flakes. He doesn't eat all of it very often. I add iodine as lugols solution, and give the peas flakes to have enough protein.
Is there a trick to make a picky eater eat more salt?
I don't know enough nutrition for special need horses, my other horses are eating grass, haylage and oats if working hard. I am glad to have Sandra as an expert on my side, and I think she will read this and make changes if necessary. She did a really good job on my younger horse, her diet worked better than I had ever could imagine.
That is the point I am wondering about: How could a diet, that is perhaps not 100% fitted for Mikado cause all this problems? Are there no other possibilties?
Mikado wears his winter blanket every time when I wear more than a t-shirt, and his temperature is even low when is with his blanket.
Hope we will find out whats going on with Mikado, if we cross out other factors that could caise problems.
Jana Germany 09/11

ECHistory7

 

Can low thyroid cause low temperature and cold intolerance in horses as well as in humans?

Hi Bonnie

PPID and IR horses can have low thyroid which keeps them from self-regulating in the cold and heat, especially if not controlled.  Here's a couple of messages from Dr Kellon.

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/124326

 

As I understood Jana, thyroid was not an issue but cannot get the labs ope to see first hand.

Jana - We've been talking about salt for this pony for sime time now.  I don't think we ever hear exactly how much he is getting.  I know Jana wants to do her best by him as she posted herself on this issue.  Just make sure his balanced diet matches the amount of work he is doing.  that is not clear to me.

Insufficient salt can have a huge effect along with the other areas Eva pointed out.

There may be something else but it's not clear to me those boxes have been checked, so to speak.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
Equine Cushing's and Insulin Resistance Group Inc.

 

Hi Nancy,
Mikados current diet includes 14mg salt for maintenance, when working (and sweating) I try to feed 35 mg. Quite difficult, because Mikado sometimes refuses to eat.
The thyroid issue is another problem, here in Germany horses don't have thyroid dysfunctions. It's not possible to have TSH tested. A doc for humans told me that there could be a mild dysfunction even when T3, T4 and free thyroxin were in the normal range. Is it the same in horses?
Jana Germany 09/11

ECHistory7

 

The Idexx thyroid test in your  files, which I got open this morning, show T4, free T4 and T3 within normal range, although the T4 may be falsely high as reported by Idexx.

Horses do no typically have hypothyroid unless dirven by other factors, ie uncontrolled PPID/IR Here's some info:

euthyroid
http:/groups.yahoo.com/group/EquineCushings/message/105460

Refusing to eat......I would have ulcer concern on my checklist.  Perhaps adding aloe vera juice and papaya puree to his meals.

Making sure he has adequate salt and iodine as Eva outlined is important.
Getting more salt into him can be done by feeding him a meal directly after work, as outlined in the Feeding Recovered Laminitics when in work doc:

Feeding Recovered Laminitics

 

Make sure you look at protein and amino acids, lysine and leucine.

I misspoke in my post yesterday.  Meant to say,  Sandra is doing a good job for you. Sometimes it takes tweaking and thorough review and trial is the best order of business.

I have a feeling you are looking for some mystery diagnosis yet to be discovered....So far, not seeing that however, I would review concerns again with my vets.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
Equine Cushing's and Insulin Resistance Group Inc.

 

My apologies for this mistake, it's g, not mg. Sorry, I can't use my brain when tired. Mikado has been so very tired and weak and I spent a lot time at the barn, and didn't sleep enough.
Mikado have had gastric pain before, he suffered a long time after the vets gave him bute for weeks during his last laminitis episode. He doesn't look like that. He is on a low dose omeprazol (Gastroguard) and he has been fine with that.
I would say the blood is treated all right. I have a vet who is very used to this test. He lives near by my barn, and took the blood in the stabilized container. The vet found higher levels in Mikados blood before, and sometimes very high levels in other horses blood and he uses every time the same procedure.
Yesterday we have had a very bad episode of getting tired after weak, he didn't eat, increased breath rate, (I was kind of shocke, didn't check the heart rate), and he was rolling his nose (its "flehmen" in Germany, can't find the English word) that is typical for him when he had colic or is stressed. He seemed to be disoriented for a while. About one hour later he was as as normal as ever. he ate most his meal, he ate haylage, he walked around in his paddock, and was friendly and happy whenever I visited him that night.
That was shown up after 15 min walk and 5 min trott when I lunged him.

Jana in Gemany 09/11Yahoo! Groups

 

Jana, I don't recall- did you send a fecal to Probios to rule out a fungal infection in the intestines?

Hi Jana,

 

We need to know all the details of what Mikado is actually eating… weight of haylage, beet pulp, peas, flax, etc. – everything.   Also, how much Lugol’s solution (ml) and the strength of Iodine as stated on the label.

If he is not eating all of his food or supplement meals, then he may not be getting enough of what is necessary to have a healthy body. 

 

To answer your question if Mikado’s problems are entirely or partially diet related, consider this.  Unlike people or wild horses who eat a large variety of different foods each day, we are feeding our horses exactly the same food, generally from the same field everyday, so we have to make sure ALL the essential nutrients for life and activity level are being provided.   If an essential nutrient, mineral or vitamin is deficient or out of balance, that can be a contributing factor making the situation worse if there is another illness present.   A deficiency or imbalance can even be the root cause of a health problem.  

An easy example is, if a healthy horse needed to drink 10 litres of water everyday, you would never want to only give him just 5 litres per day.   That could cause many problems to develop, and lack of water would certainly aggravate any other existing health issues.

 

Do you know all about haylage?  It needs to be carefully made to prevent bacterial growth, and the plastic bags should have no punctures.  Holes in the bag allow oxygen to enter which could cause the contents to mold. A sour, fermented odor is expected, but dark or brown discoloration, obvious mold, or other signs of decay will mean the haylage may no longer be suitable for feeding. Horses should not be fed haylage from large bales.  Once opened, the bag needs to be consumed over a short period. There is a lot that can go wrong.  Haylage is not commonly fed to horses here, so I found a few links that provide some factors to consider:

 

http://www.pasture4horses.com/conservation/haylage.php

 

http://www.teagasc.ie/publications/2009/938/HaylageForHorses.pdf

 

http://www.omafra.gov.on.ca/english/livestock/horses/facts/info_botulism.htm

 

Does Mikado show any of the signs listed for botulism?

 

Did the analysis for the haylage come from the manufacturer?  Was it a guaranteed analysis printed on the bag or was this an actual analysis of a particular lot number of haylage? 

If you did the analysis yourself, how did you take the samples?  Were they from only one bag or multiple bags?  How did you reseal the bags if from multiple bags?

 

Dr Kellon has requested Mikado’s current haylage analysis.  Would you please include the units of measurement?  European reports are different than what most of us are familiar with in the Americas.

The units of measurement on the haylage analysis are missing.  By working backwards on the previous diet pages provided, I’m guessing here that the units for major minerals on the analysis must be g/Kg. 

The sodium level of the haylage appears to be quite high (Na 1.5 g/Kg), so 10 kg provides 15 g sodium, equivalent to  37.5 g salt (which is 40% sodium).   This should be enough for baseline maintenance level (no exercise) and moderate temperatures (not much sweating due to heat).   

If an additional 14 g salt (5.6 g Na) is fed, that comes to 20.6 g Na, equivalent to 51.5 g salt. 

****Someone with more experience, please comment whether this analysis is within the expected range for European haylage and also about allowances for sufficient sodium for Mikado’s exercise/sweat/illness situation.

(For comparison, my Canadian hay is usually very low Na 0.004% = 0.004g/100g = 0.04g/1000g = 0.04 g/Kg.)

-----

 

I cannot open the “Mikado.odt” document.  If this is blood work, please tell us what this is.

 

Does Mikado still have frequent watery manure?   Are you still feeding Brewer’s yeast?  I have seen reports on this EC list that yeast can cause diarrhea or abdominal distress.

 

For ACTH, the vet “took the blood in the stabilized container.”

Do you mean that he used the correct lavender top EDTA tube? 

ACTH is a very unstable hormone and needs special care in handling the sample, otherwise test results will read falsely low.

Was the sample immediately chilled by placing it into an ice water bath or refrigerator?   You would have seen this happen if you were present.

Does the vet centrifuge the sample immediately, the sooner the better, no longer than 4 hours after the blood sample is taken? 

Was the sample immediately frozen then later shipped to the lab on ice packs? 

Was the analysis performed by the lab the day after being sent, with no long time interval from the date shipped?   --Get copies of all lab work.  Look at the dates on the printed bloodwork from the lab.  How many days from the date the blood was drawn and the day the lab did the analysis?

Delays during shipping can mean that the sample had thawed and warmed up, causing the ACTH to degrade, so ACTH values can be falsely lower.

Answers are needed for all these detailed questions.   Any deviation from the procedure can mean the ACTH lab results can be lower than they really are in the horse.

Like your vet, I had a vet tell me that she was very familiar with ACTH tests and did them “all the time”.  But she did not freeze the samples, so any results could be falsely too low, and not reliable. 

 

-------

For others following this, here are the notes made by the lab on the results page for the Thyroid tests (computer-translated from German):

“Please note that due to a change in method of FT4 test EDTA plasma as material not suitable. Measurements from EDTA plasma lead to falsely high values​​.”

 

Also, please consider this:

https://ahdc.vet.cornell.edu/docs/EqMetabolicSyndromeV2.pdf

“Free T4 may be falsely elevated in heated samples due to dissociation of T4 from its carrier proteins. Special care should be taken when shipping samples in the summer.”

 

If the wrong type of sample (EDTA) for FT4 was sent, and if the sample was not chilled immediately after the draw, or frozen for shipping, the FT4 results can be falsely high, no matter what the season.

-------

 

Jana, since lunging for that short time caused such distress, if Mikado was my horse, right now I would only be hand walking beside him for a short time, letting him set the pace, and above all, only doing so if he wanted to move.  No trotting.  Lunging may be doing more “formal work” than he really feels he wants to, or is able to do, and maybe he is performing just to please you. 

Does he move at a trot or brisk walk while being on his own, without you asking him to move?  Or does he prefer to stand and moves only slowly, and only if absolutely necessary?

Any heat or pulses in his feet?

 

Does Mikado have a normal heart rate and respiration while at rest?   When you say his temperature is “low” what exactly is it?   Do you see any muscle twitching anywhere on his body?

 

We know that you are under stress, but if it is at all possible, an updated, DETAILED case history that lists ALL his current symptoms/ diet / current and past test results in one document, even if typed into a word document, would make evaluating Mikado’s situation much easier.  

 

Eva

SW Ontario, Canada.   March 2005

 

Hi Jennifer,
what I am wondering about is that a fungal infektion should cause these diarrhoe and extra liquid only when he is working? And, it's not every day, there are good days with a happy pony, who is able to work and produces perfect manure. All these strange behaviour happns only durning winter, I am asking for that since two years (it's the third time now). It has never started so early like this year, I was used to have this symptoms from october/november and it disappears in late January. No problems like that in spring and summer.
But I don't know anything about fungal infections, if Mikados symptoms are typical for that, I will send a sample to the lab. I had only asked for a check on worms, yet.
Jana Germany 09/11
 Yahoo! Groups

 

In first place I want to thank you all for helping to find out whats going on with Mikado. The last two days he was quite normal, able to work and very hungry :-) that makes me happy too, and will allow me to sleep the whole night.

In second place I'll try to answer all the questions:
I think I know enough about haylage: I know the fields, I know the farmer, I usually buy haylage in large bales for winter and small bales for Mikado and his shetland buddie for summer. I usually had both delieveries tested, I take the sample by myself, and bring the sample to lab (it's near by). I had it tested for all that's possible. I want to be sure to know all the ingredients in the haylage and want to be sure to have good quality.
I usually take a two bale sample, I don't cut holes in bales that can't be feed during the next days. To be sure that the test is allright I usually make a second test from to other bales a few weeks later.
If there is a bale that is not 100% perfect like holes in the plastic I don't feed it. Better to pay for a new bale than to pay for a new pony. The summer bales were usually feed within max. 2 days, the larger winter bales were only feed when it's cols, and were feed within 4 days. If there is something left after the 4. day, I don't feed it. There is no chance to hay because Mikado is very allergic on pollen, mites, mold and any thing else that can go wrong with hay. In his case there is no chance to help him with cortison, when he shows a strong allergic reaction.
Only symptom that fits to botulism is that Mikado is sometimes tired. I know a horse thet died because of botulism, and Mikado is not looking like that poor horse did. Botulism would kill a horse, or be cured, but would not appear every winter and disappear every summer.

I know how important a proper diet is, I found out some tricks to make Mikado eat his minerals: He is mostly very hungry after work, so he gets a small meal with his minerals after work, when he ate all of the meal he gets another bag with beet pulp without minerals. That works on most of all days, there are 1-2 days during winter when he is not eating all of this meal.

I will try to add the analysis of the current haylage, I need to have help for that, I am not very familiar to work with the computer. Sorry for that! I could also try to add his current mineral mix.
The Mikado odt is the proof for my disability to work on the computer, it was my first try to create a case history. Sandra was so kind and posted the same file again, in a readable form.

I am still feeding a teaspoon brewers yeast, without it Mikado won't eat the minerals. The manure is normal on most days, there are days with one or two pieces which are too soft. The diarrhoe only appears when he is working, and even when working not every day. He often gets better with a day off work (don't blame me, I know he shouldn't have days without work) after a bad day. When I keep him working, there is mostly another bad day after a bad day.

I had the ACTH, Insulin and glucose test made by our vet, he lives near by the barn, he usually is coming in the morning, take the blood and drive back. He needs to drive 20 minutes, the special container allows to transport it much longer.I asked that in the lab, and Mikado was the first PPID horse that my vet met, so he also called the lab, to learn how to do the test.  I had some bad experiences with having the blood tested in the equine hospital, there were values like ACTH less than 5, and insulin 1. That of course was because of not proper treatment of the blood. That is what happens to the thyroid test, I had it tested in the equine hospital, because my vet told me, that he is not used to test  a horse for thyroid dysfunction. (One thing I like the most, my vet does not only tell me what he knows, he also tell me what he doesn't know)

MIkado has absolutely the will to please, but I know that he will let me know when he is not able to work. As you can see in my older postings, he sometimes does not seem to realize that he is getting out of energy. On the very bad day, he stárted pooping after 5 minutes, and I didnt take that for seriuos. That was definetly a huge falt. Usually he starts pooping after 15-30 min, and I stop work after the third time. When I stop work at this time, usually nothing bad came after that. Mikado hates handwalking, thats the reason why I lunge him.
As I mentioned before, there are good days and bad days. On the bad days I see him mostly walking, but he is walking with nice long steps, and he walking without any important reason, not only for food, water or shelter. He lives in a 250m long grass free paddock besides the paddock of the healthy śtablemates, and he often trotts with the other horses, he comes trotting when he sees me, when he is expecting the next meal or the visit in the other ponies paddock. ( I have him every day for about 1-2 hours with his stablemates, during his visit I close the pasture, and all ponies are together without grass. He enjoys these short visits, and he also likes to walk back to his haylage eating place.

There is no pulse or heat in his hooves, I check both ponies daily. I think he is really comfortable on his feet.

Nothing unnormal when he is not working. Only thing that is not normal is his change in appetite. The heart rate and the respiration is pretty normal. No muscle twitching ( can't remember that he had that ever before)

lowest temperature I found was 36.5 °C which is 95.9 °F, at the moment he has a temperature between that and 37°C/ 98.6°F. Normal was (all the 17 years I know him) 37,4°C/ 99.32°F. I check that about 5 times a week.

I would need some more help to add a new case history, I work with an old computer without microsoft software. I can't write a word document, and I only habe these open office, which is not compatible to the yahoo neo.
Jana in Gemany 09/11Yahoo! Groups

 

I would in any case rule out a dysbiosis problem. Gut flora problems can cause a myriad of symptoms. His gut flora might be perfectly okay, but I would make sure.