Laura & Hope - 22 yr old TB mare


Laura Cull
 

Hi,

My mare was recently diagnosed and I would just like an opinion about her case history.

I am planning on having her ACTH level retested in late Dec / early Jan and based on those results will decide whether to start her on pergolide. If I do start her on pergolide should I stop the Cushings Care? I'm wondering if they are contraindicated.

She has not been tested for IR and considering having that done at the same time. What is the test you most recommend for that?

Last year she started tripping more often and this summer when we were riding it was more frequent. Could this be cushings related?

She has had persistent scratches since the spring of 2009 and this Sept she developed a really painful eye infection. I would like to support her immune system via nutrition and supplements. What would you recommend?

Any other suggestions for her care based on her case history?

Many thanks, Laura & Hope


https://groups.yahoo.com/neo/groups/echistory8/files/Laura%20and%20Hope/



Maggie
 

Hi Laura,
 
Welcome to the group!  And thanks for getting your CH done and including a link to it!  It's so helpful to have that information and quick access to it as well!  Let me tell you about our philosophy and answer some of your questions. 
 
Our philosophy in called DDT/E, which stands for Diagnosis, Diet, Trim, and Exercise.  You have at least a partial diagnosis of Cushing's (PPID).  PPID and IR are 2 distinctly separate conditions that can have some overlapping symptoms.  A horse can have a diagnosis of just PPID, just IR, or a combination of both or, of course, neither.  You have an ACTH that does show that Hope is above the normal range, so positive for PPID.  To get a complete diagnosis we recommend that you get an ACTH, insulin, glucose and leptin levels.  This helps to differentiate if you are also dealing with IR as well.  A horse can be IR at baseline, or a high ACTH can drive the insulin up as well.  Leptin is a hormone that says "stop eating" and leptin resistance and insulin resistance go hand in hand.  Because a high ACTH can also drive the insulin up, all PPID horses should be treated as though they are IR until proven otherwise.  PPID is treated with medicine (pergolide) and IR is treated with diet.  The Chaste Tree Berry (CTB) that you're giving Hope can help with the symptoms of PPID, but it will not slow the progression of the tumor.  So, yes, you should start Hope on pergolide.   It's fine to continue to use the CTB with the pergolide, but it may make using the symptoms as a guide in determining if you are at the correct dose of pergolide more difficult.
 
Some, but not all horse experience what we call the "pergolide veil" when first starting on the drug.  To avoid this, we recommend that you start with 0.25mg for 3 or 4 days and increase the dose by 0.25mg every 3 o 4 days until you reach your target dose.  Once at your target dose for 2-4 weeks, we recommend retesting the ACTH to make sure that the amount of pergolide that you are giving is controlling the ACTH.  What lab did you send your original testing to?  Here's a link to Guelph lab:  http://www.guelphlabservices.com/AHL/Fee_Schedule.aspx?s=acth  They have an equine metabolic panel that includes ACTH, insulin, glucose and leptin--scroll down to the bottom of the page to see it  The instructions on drawing and handling the blood are detailed there as well as on our website here:  http://ecirhorse.org/index.php/ddt-overview/ddt-diagnosis  Lots and lots of information on our website about PPID and IR, so you should spend some time exploring there.  One more quick thing and then on to Diet.  In addition to weaning onto pergolide slowly, there is a product called APF that is an adaptogen that works really well to avoid the pergolide veil.  It's available at some local tack and feed shops, online and on their website:  http://www.auburnlabs.com/html/eqProdGen.html
 
Ok, Diet:  The diet that we recommend is a balanced low sugar starch (under 10% sugar plus starch) low fat (4% or under) diet.  So that's grass hay (tested to be under 10% sugar+starch) with minerals added to balance the hay to the analysis, and to replace the fragile ingredients lost in the hay curing process we add ground flax seed and Vitamin E.  If you haven't had your hay tested yet we recommend starting the emergency diet.  Details of the emergency diet can be found on our website here: http://ecirhorse.org/index.php/ddt-overview/ddt-diet  As important as what you do feed is what you don't feed.  No pasture, no sugary treats, including apples and carrots, etc. In addition to the iodized salt you are feeding, you should provide Hope with a white salt block, not brown/red ones.  A mineral balanced diet is a great way to support Hope's immune system. Once you get your hay tested you can get help from one of our balancing folks with balancing Hope's diet.  Look here in our Canada file for information on hay testing:  https://groups.yahoo.com/neo/groups/EquineCushings/files/Canada%20-%20%20Sources%20for%20Products%20%26%20Services/  Once you get you hay tested, look here for help with balancing:https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/ 
 
I see in your CH that you are feeding Hope 1 cup of canola oil.  A high fat diet can actually induce IR.  We aim for about the same amount of fat that's in grass, which is ~4%.  I also see that you are feeding Vitamin C and Vitamin E from herbs for horses.  Horse make their own Vitamin C and supplementing it can increase the absorption of iron.  Since most IR horses are already iron overloaded, we do not recommend giving Vitamin C.   Also, is the Vitamin E a powder?  I couldn't tell by looking at the product online, but Vitamin E is a fat soluble vitamin and needs to mixed with a bit of oil for proper absorption.  Lots of us use the Vitamin E gelcaps.  Make sure , if you go that route that the ingredients list contains oil (usually soy oil).  I buy mine at Costco, and when they have a coupon, load up on it.  Swanson is another place.  You should be giving Hope 1000IU's/500 lbs BW per day.  Sorry, I'm not familiar with the Equi-cal by Otter coop.  Can you provide us a guaranteed analysis/ingredients list?  That way we can help you to determine if it's safe or not.  In the mean time, I would stop using it.
 
Trim:  A proper trim is toes backed and heels lowered so that the hoof capsule closely supports the internal structures of the foot.  The tripping you describe could be related to her trim or it could also be low grade laminitis.  You are encouraged to post pictures of Hope's feet in the PHOTOS section of ECH8 so that one of our hoof gurus can look and see if you have a proper trim in place.  Here's a site that tells how to take good hoof pictures: 
http://www.all-natural-horse-care.com/good-hoof-photos.html  Also if you have any xrays of Hope's feet, you can post them in the PHOTOS section of ECH8 as well.
 
Exercise:  The best IR buster there is, but a laminitic horse should never be forced to move. 
 
So that about wraps it up!  Do please take the time to read our website, and peruse the files.  There is so much valuable information there!  We ask all members to sign their name, general location, date of joining and a link to their CH each time they post.  You've already caught on to most of it and thanks!  Let us know if you have any more questions!
 
Maggie, Chancey and Spiral in VA
March 2011
EC Primary Response
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/


From: "lauracull@... [EquineCushings]"
To: EquineCushings@...
Sent: Thursday, November 6, 2014 2:14:05 AM
Subject: [EquineCushings] Laura & Hope - 22 yr old TB mare

 

Hi,

My mare was recently diagnosed and I would just like an opinion about her case history.

I am planning on having her ACTH level retested in late Dec / early Jan and based on those results will decide whether to start her on pergolide. If I do start her on pergolide should I stop the Cushings Care? I'm wondering if they are contraindicated.

She has not been tested for IR and considering having that done at the same time. What is the test you most recommend for that?

Last year she started tripping more often and this summer when we were riding it was more frequent. Could this be cushings related?

She has had persistent scratches since the spring of 2009 and this Sept she developed a really painful eye infection. I would like to support her immune system via nutrition and supplements. What would you recommend?

Any other suggestions for her care based on her case history?

Many thanks, Laura & Hope


https://groups.yahoo.com/neo/groups/echistory8/files/Laura%20and%20Hope/




Laura Cull
 

Hi, I should have said that I've read the whole website so I am familiar with your philosophy, the diet, etc.

I did have the hay tested and results are already attached in the file. I have also uploaded the details on Equi-Cal, which was specifically recommended by two vets as it is low sugar and starch but high fat and fibre. I did not do your "emergency diet" as if anything she needed to gain weight not lose it. She has done well over the past month on her new diet and has even gained 50 lbs. I am not taking her off the Equi-Cal as I specifically switched to it when she was diagnosed. If I am going to make further changes to her diet then I need good reasons to do so.

I buy all supplements from Herbs for Horses as their products are all pharmaceutical grade and researched and tested at the University of Guelph in their equine program. I am not willing to change companies when it comes to supplements. Quality and efficacy are very important to me.

Her blood test was done also at the University of Guelph.

About Vitamin C, I've read that horses do make their own but as they age this declines. One of the first symptoms Hope had was a compromised immune system as she has battled skin infections for 5 years. I want to support her immune system as best I can, hence the Vitamin C & E. I guess I will know more about whether I should continue giving her the Vitamin C once she is tested for IR. The Vitamin E is a powder so if it needs to be given with oil then it is a good thing I am giving her canola oil.

I am surprised that the tripping could be from low grade laminitis as she does not show any tenderness. In fact, while trail riding she shows a great willingness to trot and canter. Could there be another reason for the tripping? As for her hooves, I am a little uncomfortable getting into posting photos. I have confidence in my farrier and while he is likely very open to having his work examined and receiving feedback, it is not something I am willing to do at this point. Maybe in the future.

Hope lives outside 24/7 year round. She has her own grass paddock as she is a slow eater and easily bullied. Where she lives is a small family acreage with her two buddies beside her in a large corral. During the spring, summer and fall they are all let out on pasture during the day and brought in at night. Given the circumstances I am not able, and not willing I should add, to restrict Hope from grass pasture. While that may be ideal from a diet perspective, there is also the issue of mental well-being. I want her to be able to graze with her friends. Sometimes we have to work with what we have and make the best of it.

One question ... why the white salt block?

Finally, now that you see my hay analysis is complete and the guaranteed analysis of the Equi-Cal is also uploaded, perhaps someone could have a look and provide feedback on her diet. If there is someone who is quite familiar with the Otter Coop products that would be most appreciated because one thing I've learned since Hope's diagnosis is that the label does not tell the whole story. I wish they were forced to provide all the details we need to make informed decisions.

Many thanks,

Laura & Hope
Kelowna, BC, Canada
Oct 2014



Lorna Cane
 





Hi Laura,


>I buy all supplements from Herbs for Horses as their products are all pharmaceutical grade and researched and tested at the University of Guelph in their equine program. I am not willing to change companies when it comes to supplements. Quality and efficacy are very important to me.

I am very familiar with Ralph's products,and they are good quality ,as you say.
The catch is that Cushing's Care is Chastetree Berry.If it were my horse,with an ACTH as high as Hope's was in August, I would be putting her on Pergolide right away.
CTB will often improve some of the Cushing's symptoms,such as coat shedding,but it does not address ACTH levels.

Our Canada Sources File has the contact info for a reliable pharmacy ,in B.C.,which a lot of us have used for years for our compounded pergolide. Island Pharmacy.Ask for Kathryn.

https://groups.yahoo.com/neo/groups/EquineCushings/files/Canada%20-%20%20Sources%20for%20Products%20%26%20Services/

It's possible that Hope's tripping is from her trim,but also possible she is experiencing low grade laminitis,arising from high ACTH levels. Or i could be wrong on both counts,of course.
It would be very helpful for the hoof people here if you could bring yourself to posting hoof pix.


Lorna in Ontario,Canada

ECIR Moderator 2002
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Laura Cull
 

Hi Lorna & Maggie,

Thank you both for your replies. It is such a tough diagnosis to come to terms with and there is so much information to sift through to try and figure out what is right for you and your horse. It is easy to get frustrated, disappointed and overwhelmed. I've really tried really hard to do a lot of research before posting to this group so that I would not waste anyone's time and avoid a lot of back and forth. I also waited until I had my horse on her new diet for at least a month so I could update her CH (she gained 50 lbs which I was very pleased about) and at the same time I included the hay analysis and guaranteed analysis on the Equi-Cal as I knew it was important in order to get an informed response.

I apologize if I seem impatient but this has been an emotional roller coaster as I'm sure you can imagine. The news of the diagnosis was devastating to me. It has been made more stressful trying to sort fact from opinion, old research from new research findings. So, please allow me to be more clear on a few points to help us move forward.

1) I did not want to put my horse on pergolide until the seasonal fall spike was over so we could base the dosage on more accurate results. I will have her retested in late Dec / early Jan and based on those results I will start her on pergolide. I am aware of the peroglide veil so I will start with a low dosage and work our way from there. The one concern I have is whether there is value to keeping her on the Cushing's Care. Is it contraindicated? If it is ok to keep her on it then how much should I be giving her? Would it depend on the pergolide dosage?

2) I have a very open and trusting relationship with my farrier and it is important to me to keep it that way. I am very thankful to know that I can post photos and seek additional assistance from this group. I now realize that tripping could be caused by low grade laminitis but I am wondering if there are other possible reasons for it, either cushings related or not. I keep my horse barefoot all year and when we ride she wears Cavallo simple boots on her front hooves. I would say that the only thing I'm not very open to is putting shoes on her.

3) Why do you recommend white salt?

4) As for diet, I changed her feed program over a month ago to reduce sugar and starch and get her weight up. Otter Coop recommends that horses are fed 2% of their body weight. I've been giving Hope 12 lbs of their Equi-Cal (based on their directions for use) and 4 lbs of their FibreMax a day in addition to access to grass pasture and hay. She has done quite well on this diet, even gaining a much needed 50 lbs, but now I am thinking the concentrate to forage ratio is off. I am considering reducing the Equi-Cal so it only consists of about 25% of her total feed program. This will likely mean that I will have to compensate with added vitamins and minerals which is fine by me. I have uploaded the guaranteed analysis of the Equi-Cal and additionally I phoned them and obtained the following data:
       NSC 16%
       WSC 8.2%
       ESC 6.4%
       Starch 8.4%
When reviewing her overall feed program, please realize that I am likely going to reduce the Equi-Cal to 5 lbs a day and increase her hay to 15 lbs a day as we go into the winter months. She lives on grass pasture 24/7 and that is not going to change given her living arrangements. My wish when someone reviews this feed program is that they will identify (a) potential problem areas, (b) any nutritional gaps and (c) make recommendations based on the whole feed program and what is available in feed stores here in BC. For example, in case you aren't aware, it is not possible to buy beet pulp without added molasses. I've looked into this and it just isn't sold here.

Thanks again,

Laura & Hope
Kelowna, BC, Canada
Oct 2014


janieclougher@...
 

Hi, Laura - it is good that you are asking questions.  Don't take what we say as gospel, without reviewing the studies and evidence available; by the same token, don't take information from feed companies or others as gospel, because often the rationale for their suggestions is based on out-dated information (or even no information, just opinion)

I apologize if I seem impatient but this has been an emotional roller coaster as I'm sure you can imagine. The news of the diagnosis was devastating to me. It has been made more stressful trying to sort fact from opinion, old research from new research findings. So, please allow me to be more clear on a few points to help us move forward.

The diagnosis can indeed be devastating, because as short a time ago as 10 years a diagnosis of PPID was pretty much a warning to start digging the hole.  Things have changed - and the beauty of the protocol used by the ECIR group is that it is based on science, not opinion. Unless there are scientific studies showing a clear benefit to a practice, we don't suggest it.  If there is something that might help, based on studies in other animals, we will say that there are no studies on horses, but that it may help. Dr. Kellon is one of the most knowledgable people in the field of endocrine disorders and nutrition that you will find anywhere - and she clearly differentiates between science and opinion.



1) I did not want to put my horse on pergolide until the seasonal fall spike was over so we could base the dosage on more accurate results. I will have her retested in late Dec / early Jan and based on those results I will start her on pergolide. I am aware of the peroglide veil so I will start with a low dosage and work our way from there.

The seasonal fall spike is the most critical time in PPID horses, because the increase in ACTH can result in laminitis.  If this were my horse, I would start her on pergolide now, today, tapering up the dose by .25 mg every 3 days.  I would re-test 3 weeks after reaching 1 mg.   Once a horse is diagnosed with PPID, the aim is to keep the ACTH in the  low to mid-normal range at all times. Additionally, the ACTH levels don't really determine what pergolide dose will work.  One starts at 1mg, tests again, and doses to effect. My horses have their highest levels in November, so Hope may be heading for a big ACTH increase (normal, non-PPID horses start the rise in late August and are on the downswing by the end of October; PPID horses start earlier and the rise lasts longer)
Also, another effect of un-addressed PPID is a suppressed immune system - so you get rain-rot, scratches, goopy eyes, sinusitis and a host of other issues. That alone would be enough to start her on pergolide.
If you want to get a baseline ACTH, you could wean her off the pergolide starting in March; then test in early May. (April and May should be the lowest natural ACTH levels).

The one concern I have is whether there is value to keeping her on the Cushing's Care. Is it contraindicated? If it is ok to keep her on it then how much should I be giving her? Would it depend on the pergolide dosage?

Chaste tree berry can be very useful in some of the clinical signs, such as hair coat changes, that aren't always controlled by pergolide. There are quite a few horses in the data base that get both CTB and pergolide, and do quite well.  Because actual information, beyond anecdotal, is so limited, it is hard to know what to suggest.  If it were my horse, I would keep her on the same dose of Cushing's Care (CTB), and just add in the pergolide.

2) I have a very open and trusting relationship with my farrier and it is important to me to keep it that way. I am very thankful to know that I can post photos and seek additional assistance from this group. I now realize that tripping could be caused by low grade laminitis but I am wondering if there are other possible reasons for it, either cushings related or not. I keep my horse barefoot all year and when we ride she wears Cavallo simple boots on her front hooves. I would say that the only thing I'm not very open to is putting shoes on her.

There are many reasons for tripping, but the two most common are long toes (and I will say long toes and under-run heels tend to be very common in TBs); and low grade laminitis. There is no reason to use shoes, if you can use boots for comfort during trail rides (assuming she even needs boots) Do you have any x-rays of her hooves?  It would be nice to know the sole depth, and x-rays are very valuable for toe length and coffin bone angle.

3) Why do you recommend white salt?

White salt provides salt (or iodine and salt); mineral salt contains salt plus iron, and smatterings of minerals, plus often molasses or a flavouring to encourage use.  Iron is contra-indicated.    Redmond salt blocks and Himalayan salt blocks are that lovely pink colour because of contaminants (eww!) and iron. Hay is  almost always deficient in copper and zinc; no mineral blocks provide anything like enough of these two minerals to be useful, and the extra iron reduces copper and zinc absorption even more.


4) As for diet, I changed her feed program over a month ago to reduce sugar and starch and get her weight up. Otter Coop recommends that horses are fed 2% of their body weight. I've been giving Hope 12 lbs of their Equi-Cal (based on their directions for use) and 4 lbs of their FibreMax a day in addition to access to grass pasture and hay. She has done quite well on this diet, even gaining a much needed 50 lbs, but now I am thinking the concentrate to forage ratio is off. I am considering reducing the Equi-Cal so it only consists of about 25% of her total feed program. This will likely mean that I will have to compensate with added vitamins and minerals which is fine by me. I have uploaded the guaranteed analysis of the Equi-Cal and additionally I phoned them and obtained the following data:
NSC 16%

WSC 8.2%
ESC 6.4%
Starch 8.4%
When reviewing her overall feed program, please realize that I am likely going to reduce the Equi-Cal to 5 lbs a day and increase her hay to 15 lbs a day as we go into the winter months. She lives on grass pasture 24/7 and that is not going to change given her living arrangements. My wish when someone reviews this feed program is that they will identify (a) potential problem areas, (b) any nutritional gaps and (c) make recommendations based on the whole feed program and what is available in feed stores here in BC. .


Your instinct regarding the concentrate/forage ratio is spot on.  Is there any reason why she couldn't have free choice hay?  The first and best food for any horse is forage, rather than bagged feeds. Especially in winter, horses don't actually keep themselves warm by just calories; they get warmth from the fermentation of fibre in the hind-gut, so fibre is *very* important in winter. Not only that, but horses would normally consume forage many hours out of the day; those of us with easy keepers need to deal with slow feeders, double netting the hay and so on to provide 24/7 forage, but Hope could likely have hay in front of her all day and not get overweight. That is a win-win: she has the more natural way of feeding so it is optimal for both her digestive system and her mental state. In any under-weight horse, the very first thing I suggest is free choice hay. I am glad her weight is coming up - I will just point out that un-addressed PPID makes weight gain really tough, as it puts the horse in a catabolic state.  Not only weight is lost, but a lot of that weight loss is due to muscle loss. I would just not be comfortable feeding any PPID horse EquiCal.  Bagged feeds are useful for horses whose teeth are compromised, so they aren't able to get  full nutrition from the hay; and often older horses don't have the same masticatory muscle strength to grind the hay down sufficiently. In those cases  pelleted or extruded feeds are great, if they are the right kind. A bagged feed with a starch of 8.4% would blow the feet off of just about any IR horse. I think Hope may have low grade laminitis due to PPID and the feed, but she has escaped frank laminitis so far because of her breed. A better bagged feed in your area would be Pro Form Pro Fibre Crunch, with an ESC of 4.4% and a starch of 5.2 % ; fat is 5%.  This is still not ideal, as fat should be less than 4%; starch less than 2%, but for a non-IR TB it should be fine. You should still feed mostly hay, and only a few pounds of the Crunch to get her supplements into her. (she can have much more when she is actively working - best fed in the two hours following exercise) Again, before  I upped her bagged feeds, I would increase her hay.

For example, in case you aren't aware, it is not possible to buy beet pulp without added molasses. I've looked into this and it just isn't sold here.

I buy un-molassed beet pulp, at my feed store, from Champion feeds in Alberta.  Chances are very good that your feed store gets things from Champion, so they should be able to get the beet pulp as well.  Even beet pulp with molasses can be made safe by first rinsing, soaking, then rinsing several times to clear the sugars. (I still rinse/soak/rinse, even though there is no molasses on the label, as beet pulp pellets are sometimes made to stick by a fine misting of molasses)
 One thing that all of us on this list have gone through is the experience of going to the feed store, making a request, and getting the "Are you from Mars?" stare.  However, feed store owners/employees love to help, and with only a little encouragement always seem to find a supplier that can provide the desired food.  (except for Ontario Dehy Timothy Balance Cubes - just not available in Alberta or BC.  Phooey.)

As you know, one must analyze the hay to determine what supplements to give. Unfortunately, the test done did not include iron or manganese, both of which are important in determining the necessary copper and zinc values to balance the hay.  We usually ask for the Trainer 603, which is available through Agri-trend (used to be called Nutrilytical) via their Equi-Analytical branch. Agri-trend might still have your samples, in which case you could ask for the Trainer 603, or at least iron and manganese. Also, I hate to say it, but the test you got is by NIR, which is less accurate (especially for ESC and starch) than wet chemistry.  So, unfortunately, I can't give you an accurate estimate of how much copper, zinc and manganese you need to add.  Magnesium and phosphorus are somewhat deficient in that hay as well.

Laura, there is a lot of information to digest and act on here.   Approach it like the way one would consume an elephant: one bite at a time.  If you do only one thing this week for Hope, it would be to start the pergolide.  Get your vet to send a script to Island Pharmacy at Shawnigan Lake on Vancouver Island.

Sorry this is so long!

Jaini (BVSc),Merlin,Maggie,Gypsy
Smithers, BC 09
ECIR mod/support
https://groups.yahoo.com/neo/groups/ECHistory/files/Jaini%20Clougher%2C%20Smithers%20BC/

 









 




 




Laura Cull
 

Hi Janini!
This is fantastic and very, very helpful. Thank you so much. Don't apologize for the length. This is exactly what I was looking for and it helps to get it all at once. Saves the back and forth and allows me to get a handle on the whole picture.
I am off to LA now for a few days but will get her on pergolide asap when I get back. Really, really appreciate your comments on that.
As for the beet pulp, I phoned the two companies that manufacture horse feed here in BC. They both told me they don't make molasses-free beet pulp because it wasn't selling. I asked about whether they import it as I know there is a company in California that makes it. They said no for the same reason. Still, I will check out the company you referred to. Always good to check every option.
About the salt, I already give her 2 tbsp per day iodized salt. Maggie had made the suggested for a white salt block in addition but she didn't explain why. I like to know they "why" of everything so I can make sense of it.
May 2014 was the first time Hope ever got laminitis. I am open to having her hooves x-rayed if it is important to preventing laminitis. I will talk with my vet and farrier about that.
As for her diet she does get free choice hay 24/7, she just never seems to eat it all. I think if I cut back on the concentrate she will automatically eat more hay. I was just trying to get her weight up before winter as she had lost some in September when she went off her feed for awhile. I'm so happy she is back to 950 lbs (would be happy with more) as she is such a picky, slow eater. There are days she doesn't even finish her mash never mind her hay! The only horse I've ever known to walk away from her feed.  :)
Do you think I should get her hay retested? Or should I instead just give her a complete vitamin & mineral supplement? 
I'm not sure about the value of testing for IR given that it is managed by diet and exercise. I have already made the adjustments to her diet and she is outside 24/7 so can walk all she wants. I won't be increasing our riding time so not much more I would do for exercise. I just don't like to spend money where there is little value. But if it is important to know I will certainly have the test done.
Thanks again so, so much. I really appreciate the detailed response.



Laura Cull
 

Hi Jaini!
I just wrote out a reply hit send and it didn't go through. That is twice that has happened to me. Hope this one works!
Thanks so, so much for your lengthy and detailed reply. No apologies, it is exactly what I was looking for. Saves a lot of back and forth and allows me to reflect on the whole picture.
I am heading to LA in a couple of hours but will put Hope on pergolide as soon as I get back. Wish now I had done it sooner but I really didn't know what the best answer was. So thanks very much for your comments about that.
I already give Hope 2 tbsps of iodized salt. Maggie had suggested a white salt lick in addition but she didn't explain why. I like to know the "why" so I can understand the logic behind it. Would you know why?
I will talk with my farrier and vet about getting x-rays of Hope's feet. May 2014 was the first time she ever had laminitis and I want to do all I can to avoid it. The tripping is a problem mostly when we ride. Once I fell off and don't want to do that very often either.
As for her diet, she does have free choice hay 24/7, she just never eats it all. She will even walk away from her mash if she feels full. She is great that way but makes it hard to keep her weight up. I was just feeding her so much concentrate because she lost weight in September. She is back to 950 lbs and her BCS has improved. She is a slow and picky eater which also adds to her being a hard keeper. I am going to cut back her mash when I get back from LA.
Should I have her hay retested or should I just go ahead and give her a balanced vitamin and mineral supplement? And do you agree that I should stop giving her the Vitamin C?
I phoned the two feed companies in BC and neither one manufactures non-molasses beet pulp. I asked about whether they import it and they said no. I will look into the company you referred to and see what I come up with. But she is fine on the soy hulls so I may not even bother.
Thanks again so very much. I will update you once I start her on the pergolide.



Maggie
 

Hi Laura,
 
Your reply did go through--twice.  The white salt block is to be used instead of red/brown salt blocks, which have added iron, minerals, molasses. Salt is the only mineral that horses crave, so we recommend that in addition to the iodized salt that you add to their feed, you let them have access to a plain white salt block as well. 

Maggie, Chancey and Spiral in VA
March 2011
EC Primary Response
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/


 


Lorna Cane
 


Hi Laura, et al,

>I already give Hope 2 tbsps of iodized salt. Maggie had suggested a white salt lick in addition but she didn't explain why. I like to know the "why" so I can understand the logic behind it. Would you know why?

To reduce frustration a Search in the Search Conversations box will often help nail something down.
I typed white salt block into the box,and the answer was found in one of Mandy's posts ,from October 9 - 

189725


>Should I have her hay retested or should I just go ahead and give her a balanced vitamin and mineral supplement? 

You probably know this, but for other new members  a 'balanced vitamin mineral supplement' may be balanced to itself. But it rarely can address the 
deficiencies/excesses in a particular hay.To know what we are dealing with we need to have the hay analyzed.Then we can add only what is needed,in correct ratios,which after some calculations can also address the excesses.


  Lorna in Ontario,Canada

ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

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Lorna Cane
 

Now I'm answering myself!

>You probably know this, but for other new members  a 'balanced vitamin mineral supplement' may be balanced to itself. But it rarely can address the 
deficiencies/excesses in a particular hay.

I need to add that there are a couple of mineral supplements which some members *can* use with confidence.
These products have been formulated by members of this group for hays from a particular area,which are pretty consistent in their analyses.
More info in our Files section.

  Lorna in Ontario,Canada

ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

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Laura Cull
 

hi - I will contact my vet tomorrow about starting Hope on pergolide.
from Jaini's reply "If this were my horse, I would start her on pergolide now, today, tapering up the dose by .25 mg every 3 days.  I would re-test 3 weeks after reaching 1 mg."
does this mean starting with 0.25 mg AND increasing by that amount? just want to make sure I'm reading that correctly.
we are about 2-3 days into a cold snap. the ground is frozen and we are getting as low as -11*C overnight. hopefully the seasonal ACTH spike is over.
Laura & Hope
Kelowna, BC, Canada
Oct 2014
 


Maggie
 

Laura,
 
>>does this mean starting with 0.25 mg AND increasing by that amount?
 
 
"Some, but not all horse experience what we call the "pergolide veil" when first starting on the drug.  To avoid this, we recommend that you start with 0.25mg for 3 or 4 days and increase the dose by 0.25mg every 3 o 4 days until you reach your target dose.  Once at your target dose for 2-4 weeks, we recommend retesting the ACTH to make sure that the amount of pergolide that you are giving is controlling the ACTH."
 
>>hopefully the seasonal ACTH spike is over.
 
 
"If this were my horse, I would start her on pergolide now, today, tapering up the dose by .25 mg every 3 days.  I would re-test 3 weeks after reaching 1 mg."
 
"One starts at 1mg, tests again, and doses to effect. My horses have their highest levels in November, so Hope may be heading for a big ACTH increase (normal, non-PPID horses start the rise in late August and are on the downswing by the end of October; PPID horses start earlier and the rise lasts longer)"
 
Again, once you have Hope on 1 mg for 3 weeks, you should retest to make sure you are giving enough pergolide.  After the seasonal rise is over in late November/December, or longer for some PPID horses, it does not mean that Hope will not need pergolide.  Hope's ACTH was over double the normal in August, the early part of the seasonal rise, which means she could well be much higher now, during the peak of the seasonal rise.  Since PPID horses have earlier and more prolonged rise in their ACTH, Hope's may stay up into December or later.  This year you will be chasing her ACTH with the pergolide trying to get it under control.  Next year, you will be ahead of the game and know to increase the pergolide before the seasonal rise starts.
 
Maggie, Chancey and Spiral in VA
March 2011
EC Primary Response
http://groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/


 


Laura Cull
 

Hi Jaini,
I will be picking up the pergolide from my vet tomorrow. I'm really nervous that she won't react well to it, just because she is SO sensitive. But I have to give it a try and hope for the best. If she doesn't do well on it then even that is helpful information.
I've checked and Champion doesn't have a dealer in BC south of McBride. I don't need to feed Hope beet pulp as she is fine with soya hulls. Would you agree that is fine or is there another product you would recommend as a beet pulp alternative?
I can get the ProForm ProFibre Crunch so I will gradually switch her over from the Equi-Cal.
Working on getting another hay analysis. Will upload it once it arrives.
Thanks for all your help.

Laura & Hope
Kelowna, BC, Canada
Oct 2014


Chanda
 

Just remember to move her onto the pergolide slowly and she'll likely be fine with it.  [You know start with a 1/4 dose for a couple days, then 1/2 for a couple days, then 3/4, etc til she's on completely.]

Chanda

MT 9/04



Lorna Cane
 

Hi Laura,

>I will be picking up the pergolide from my vet tomorrow. I'm really nervous that she won't react well to it, just because she is SO sensitive. But I have to give it a try and hope for the best. If she doesn't do well on it then even that is helpful information.

This is also helpful information.You may have missed it , in a post to you from Maggie:

"In addition to weaning onto pergolide slowly, there is a product called APF that is an adaptogen that works really well to avoid the pergolide 

veil.  It's available at some local tack and feed shops, online and on their website:  Auburn Laboratories, Inc. - APF and APF PRO


I have been getting mine from Susan Favro for years:


 

Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

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Connie Proceviat
 

Hi Laura,


I don't know if this is an option for you but I wanted to mention that I purchase my phosphorus supp from Uckele then have it shipped to a USA parcel pick up location across the border to take advantage of the free shipping within the US. Then I drive across the border to pick up the order.


Best To You,

Connie & Falki

Manitoba

August 2013



---In EquineCushings@..., <lauracull@...> wrote :


Any other suggestions for her care based on her case history?

Many thanks, Laura & Hope





Laura Cull
 

Hi Connie,
I was thinking of the same thing. I know someone who keeps a PO box just across the border. Crazy the extent of what we have to go to! Just wish tack stores here would sell all this great stuff.
Thanks for thinking of us.
Laura & Hope
Kelowna, BC, Canada
Oct 2014


Laura Cull
 

Hello everyone,

An update about Hope and then a question for you.

I have sent off another hay sample for a complete analysis including trace minerals. I will share those results when they arrive to get your recommendations for supplements.

After 3 months of trying different things with her feed with varying success I have resorted to going back to beet pulp as Hope loves it and it makes her very happy. This time I am rinsing, soaking and rinsing again before feeding it to her. I am still giving her the Equi-Cal but I will be switching her over gradually to ProFibre Crunch as it is the best option for what I can get in my area. I have done a thorough and exhaustive search and it is the best I can do. I have also cut out the canola oil.

Overall she is eating well, both her mash and her hay, and she is maintaining a good weight. Soon I will take photos of her hooves and have those pictures uploaded for feedback.

I started Hope on pergolide at 1/4 dose and worked up to 1.0 mg as of November 27. She has responded well so far with no signs of the dreaded veil and I am very thankful for that. Her mood and lethargy have improved, the latter was unlike anything I had seen in previous years. She is normally full of spunk so it was hard to see her laying down so often with no energy. We're getting there but we're not there yet.

Recently she developed another bad eye infection and her nose is constantly runny. These are symptoms that started last summer and were more persistent this summer but have never until this year continued on once the cold weather arrived. I've read that the fact that these symptoms are still ongoing is evidence that the pergolide dosage isn't yet quite enough. I will be having her retested in early January but I have to be mindful of my veterinary expenses. So I would like to be smart about how frequently I get her ACTH level tested.

My question is this .... can I continue to increase the dose on my own until I see these particular symptoms dissipate and then at that point have her ACTH level retested? Or would this be ill advised?

Thanks,

Laura & Hope
Kelowna, BC, Canada
Oct 2014


Eleanor Kellon, VMD
 


---In EquineCushings@..., <lauracull@...> wrote :


My question is this .... can I continue to increase the dose on my own until I see these particular symptoms dissipate and then at that point have her ACTH level retested? Or would this be ill advised?
=================

Immune system impairments can be related to both uncontrolled PPID and nutrition (mineral and protein issues) with the combination being a double whammy.  You need to consult with your treating vet about a strategy for adjusting pergolide based on symptoms and also need to get the diet evaluated and balanced so that issues there are not working against you.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001