Looking for some help and direction for IR Pony


Jlee DOrtona
 

 I am in Upstate New York.  I have been following this group on Yahoo and Facebook for some time, but this is my first post.  I have a 11 year old, 12hh.  He was suspected to have Insulin Resistance about 3-4 years ago. No blood work obtained but had all the physical symptoms of IR.  He was started on Thryo-L at that time.  He did lose some weight and but there was not a dramatic decrease in his fatty deposits.  Fall 2012 he had his 1st mild case of laminitis.  It was a brief bout and he recovered fine.  He had another flare up fall of 2013 and after a longer bout, xrays were obtained and no rotation was found and he again recovered back to normal/sound. Each time this has occurred, he has been placed on the emergency diet.  We have been working closely with our local hay supplier and have been testing our hay for the past few years.  Testing has come back within reasonable limits and when we did have a rather high level starch batch, we soaked. 

This past December 2014, Huckleberry, once again had a laminitic flare up.  It all started with a rock that had gotten lodged in cleft of frog.  It was removed, but an absess and bruising followed.  Within a week's time, he was dead lame, refusing to eat or move, he had foundered.  Xrays showed 10 degree rotation Left front and 11 degree rotation Right front.  He was started on Metformin and Previcoxx.  He spent a week or so on Styrofoam pads until his feet calmed and then was placed into wooden clogs.  At next reset, he had not made much improvement and appeared to be seeking even more support, 3 degree wedge pads were added.  He stayed the next reset (about 3-4 week intervals) this way and at the 4th reset, he seemed slightly better and we tried decreasing wedges by 1 degree.  He was painful after this adjustment and was put back up to the 3 degrees.  He has been re-xrayed in March and July and his condition appears to be under control.  No flares in past 6 months, sole growth is adequate and to further rotation.  He is able to get around relatively well and has been a stellar patient through it all.  My farrier has no other recommendations for him and if the clogs were going to be productive, they would have by now.  My vet has referred us to a surgeon for consult on Inferior check ligament desmotomy, in hopes of relieving the tension that is causing him to have reached this "plateau".  We are not making forward improvement, nor declining.  If he is a candidate for the procedure and can live with the added finances that will be added to the amount we have already put forth during this battle, he still has the IR component.  He may find comfort only to founder again or continue to have flare-ups of laminitis.  Aside from the exercise component that he is currently unable to physically do, I have the other bases covered, or so I think.  Hay is tested, grazing muzzle used when turned out (not currently doing), is on Empower Balance (nutritional supp and carrier for meds).  His condition is also sensitive to weather fluctuations (esp seasonal) and that of course, is beyond my control. 

So, am looking for some help as to if anyone else has been in this position and could offer some guidance in making this decision in this very difficult case. If I do nothing, surgeon says ligament will not un-contract on its own and basically I will be keeping things as they are until he is no longer comfortable or his next laminitic episode.  I am waiting on a second opinion from another surgeon as well as his equine podiatrist.   Going forward, if he ends up having the procedure, am looking for help and advice to make sure I am doing everything possible, in hopes of, prevent another laminitis episode or founder.

Thank you in advance for your help!



Lavinia Fiscaletti
 

Hi,

Sorry your little guy is having so many problems. In order to be able to give you the best answers we can, we need some more information from you. Please go to our sister site ECHistory8 and download/fill out/upload a case history form for your boy. You'll need to join but it only takes a few minutes:

https://groups.yahoo.com/neo/groups/echistory8/info

It would also be extremely helpful if you could get and post pictures of Huckleberry's feet and any of the xrays that have been done in the PHOTOS section of ECH8. Here's the link to taking good pictures:

http://www.all-natural-horse-care.com/good-hoof-photos.html

As you are probably already aware, we use a protocol of Diagnosis, Diet, Trim and Exercise (DDT/E for short) as the basis for everything we recommend.

DIAGNOSIS: This is thru blood work. We recommend having NON-Fasting blood samples sent to Cornell for the following tests: Insulin, glucose, leptin and ACTH if the equine is 10yo or older. These will determine whether you are dealing with either IR, OR PPID, OR both OR neither. Feed only soaked hay the night before/day of the testing. Have blood pulled at home rather than traveling to the vet clinic as travel will influence the results. Right now, it is likely you are dealing with IR as ponies tend to be IR just because they are ponies. IR is not a disease but a type of metabolism and requires management for the life of the animal. PPID is a progressive disease that is treated using meds - pergolide in either compounded or name brand form (Prascend). Primary hypothyroidism is extremely rare in equines so even if blood work showed thyroid levels to be low, the problem is likely secondary to something else. Fix the primary cause (like disease or dietary imbalances) and the thyroid will fix itself. Many times Thyro-L is prescribed when IR is suspected but it does not treat the condition. It will only temporarily jump-starts a sluggish metabolism until the body re-adjusts by slowing natural production of thyroid hormones.

DIET: Should be low sugar/starch/fat, forage-based with minerals balanced to the forage analysis. Until you know whether your hay is suitable, it should be soaked for one hour in cold or 1/2 hour in hot water, with the water drained where the pony can't get to it. Following the emergency diet is recommended until you are able to fine tune your pony's diet appropriately for the long haul. Soaking will not lower starch but does remove some sugars. The emergency diet is as much about what shouldn't be fed as what should - no grass, grain, feed from a bag, red salt blocks, apples, carrots, sugary treats, unsoaked/untested forage. Ontario Dehy Balanced Timothy cubes are one of the few safe options that are widely available that could completely replace your hay/grain and be fed as the sole source of safe and complete nutrition. If your local feed store carries Triple Crown Products, the ODTBC are perfect, esp for a pony. All you need to add are ground flax, vit E and plain salt. See more info on our website:

http://www.ecirhorse.org/index.php/ddt-overview/ddt-diet

Stop the Empower Balance - it has too much fat (5%) with an inverted omega 6 to omega 3 ratio; sugar plus starch is a whopping 14%, with the starch number being 8% and starch converts 100% to glucose.

TRIM: Should be physiologically correct, with toes backed and heels lowered so the hoof capsule aligns properly with the internal structures. It is the most common "missing ingredients" when soundness hasn't been achieved if all the other aspects of diagnosis and diet have been addressed. Boots and pads for comfort are recommended while the realignment process is going on so that the frequent trims needed to attain and maintain the corrections can be done. By now, if the trim were correct and the causes of the laminitis/founder removed, Huckleberry should have no rotation visible on xrays and his hooves should have grown out almost completely. Really encourage you to post pictures of his feet so we can help optimize his trim as esp. with these little guys, getting the trim correct many times results in almost immediate soundness.

EXERCISE: Best IR buster there is but never force a sore animal to move. Given his founder, obviously this is not something that you can do with him right now.

Overall, we do not endorse having tenotomies/desmotomies done as they rarely help because they are not what is causing or perpetuating the rotation in the first place. As the rotation only occurred 6-7 months ago, it is unlikely that the tendons/ligaments have permanently contracted. What is more likely is that the trim is still not correct and the muscles in the upper legs and shoulders have contracted.From the thousands of cases we've seen here, correcting the trim issues and having targeted muscle therapy work done to address the soft tissue issues would likely be a better avenue to pursue.

We ask that everyone sign all their posts with their name, general location and year of joining (Oct, 2013 ). It helps us to suggest local sources for products and gives us an idea of where you may be in your learning curve. Ask any and all questions as they come up, we're here to help.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team



Jlee DOrtona
 

Lavinia,

Thank you for your help in helping me get started on here.  I am starting him back on the emergency diet tomorrow while I work through this.  I have just finished uploading his case history and will be working on getting x-rays and hoof pics up tomorrow.

Jenilee, New York
October, 2013
ECHistory8

 

https://groups.yahoo.com/neo/groups/echistory8/files/Jenilee%20and%20Huckleberry%20Case%20History/


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

Hi,

Sorry your little guy is having so many problems. In order to be able to give you the best answers we can, we need some more information from you. Please go to our sister site ECHistory8 and download/fill out/upload a case history form for your boy. You'll need to join but it only takes a few minutes:

https://groups.yahoo.com/neo/groups/echistory8/info

It would also be extremely helpful if you could get and post pictures of Huckleberry's feet and any of the xrays that have been done in the PHOTOS section of ECH8. Here's the link to taking good pictures:

http://www.all-natural-horse-care.com/good-hoof-photos.html

As you are probably already aware, we use a protocol of Diagnosis, Diet, Trim and Exercise (DDT/E for short) as the basis for everything we recommend.

DIAGNOSIS: This is thru blood work. We recommend having NON-Fasting blood samples sent to Cornell for the following tests: Insulin, glucose, leptin and ACTH if the equine is 10yo or older. These will determine whether you are dealing with either IR, OR PPID, OR both OR neither. Feed only soaked hay the night before/day of the testing. Have blood pulled at home rather than traveling to the vet clinic as travel will influence the results. Right now, it is likely you are dealing with IR as ponies tend to be IR just because they are ponies. IR is not a disease but a type of metabolism and requires management for the life of the animal. PPID is a progressive disease that is treated using meds - pergolide in either compounded or name brand form (Prascend). Primary hypothyroidism is extremely rare in equines so even if blood work showed thyroid levels to be low, the problem is likely secondary to something else. Fix the primary cause (like disease or dietary imbalances) and the thyroid will fix itself. Many times Thyro-L is prescribed when IR is suspected but it does not treat the condition. It will only temporarily jump-starts a sluggish metabolism until the body re-adjusts by slowing natural production of thyroid hormones.

DIET: Should be low sugar/starch/fat, forage-based with minerals balanced to the forage analysis. Until you know whether your hay is suitable, it should be soaked for one hour in cold or 1/2 hour in hot water, with the water drained where the pony can't get to it. Following the emergency diet is recommended until you are able to fine tune your pony's diet appropriately for the long haul. Soaking will not lower starch but does remove some sugars. The emergency diet is as much about what shouldn't be fed as what should - no grass, grain, feed from a bag, red salt blocks, apples, carrots, sugary treats, unsoaked/untested forage. Ontario Dehy Balanced Timothy cubes are one of the few safe options that are widely available that could completely replace your hay/grain and be fed as the sole source of safe and complete nutrition. If your local feed store carries Triple Crown Products, the ODTBC are perfect, esp for a pony. All you need to add are ground flax, vit E and plain salt. See more info on our website:

http://www.ecirhorse.org/index.php/ddt-overview/ddt-diet

Stop the Empower Balance - it has too much fat (5%) with an inverted omega 6 to omega 3 ratio; sugar plus starch is a whopping 14%, with the starch number being 8% and starch converts 100% to glucose.

TRIM: Should be physiologically correct, with toes backed and heels lowered so the hoof capsule aligns properly with the internal structures. It is the most common "missing ingredients" when soundness hasn't been achieved if all the other aspects of diagnosis and diet have been addressed. Boots and pads for comfort are recommended while the realignment process is going on so that the frequent trims needed to attain and maintain the corrections can be done. By now, if the trim were correct and the causes of the laminitis/founder removed, Huckleberry should have no rotation visible on xrays and his hooves should have grown out almost completely. Really encourage you to post pictures of his feet so we can help optimize his trim as esp. with these little guys, getting the trim correct many times results in almost immediate soundness.

EXERCISE: Best IR buster there is but never force a sore animal to move. Given his founder, obviously this is not something that you can do with him right now.

Overall, we do not endorse having tenotomies/desmotomies done as they rarely help because they are not what is causing or perpetuating the rotation in the first place. As the rotation only occurred 6-7 months ago, it is unlikely that the tendons/ligaments have permanently contracted. What is more likely is that the trim is still not correct and the muscles in the upper legs and shoulders have contracted.From the thousands of cases we've seen here, correcting the trim issues and having targeted muscle therapy work done to address the soft tissue issues would likely be a better avenue to pursue.

We ask that everyone sign all their posts with their name, general location and year of joining (Oct, 2013 ). It helps us to suggest local sources for products and gives us an idea of where you may be in your learning curve. Ask any and all questions as they come up, we're here to help.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team



Lavinia Fiscaletti
 

Hi Jenilee,

Thanks for getting the case history up - it makes it so much easier to keep all the information straight.

Two quick questions for you: is Huckleberry still on the Previcox? If so, what is the actual mg dose he is getting?
 I assume that the ifof in the case history for the dates in Dec should all be 2014 - not 2015 as some of them say?

Thanks for clarifying.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team

>>>>>>>>>>>>>>>>>>>>>>
ECHistory8

 

https://groups.yahoo.com/neo/groups/echistory8/files/Jenilee%20and%20Huckleberry%20Case%20History/



Jlee DOrtona
 

HI Lavinia,

Huckleberry is still on previcox 227mg, 1/4 SID mornings. I have tried weaning him to every other with no luck. I have his current xrays, but vet is sending me over all now. 1 set from episode where he had no founder or rotation and 3 sets from 2014/12/26 thru 2015/7/3. I'm shooting to have those up tonight. Do they get uploaded to the pictures file too?

Thanks,
Jenilee, New York
October 2013

https://groups.yahoo.com/neo/groups/echistory8/files/Jenilee%20and%20Huckleberry%20Case%20History/


janieclougher@...
 

Hi, Jenilee - Huckleberry is 540 lbs, and the correct dose of Previcox is .045 mg per lb, for a correct dose of 24.3 mg.  It would be much safer to use half of a 57 mg tablet, for a dose of 28.5 mg.  One quarter of a 227 mg tablet is 56.75 mg.

It would be best to reduce him to half a 57 mg tablet for a couple days; then start adding in PhytoQuench or something similar so you can go to half a tablet every other day. Long term high dose NSAIDs can cause rebound pain when suddenly stopped (aside from the potential for other side effects), so weaning him slowly down is important rather than stopping cold turkey.

For interests sake, here is a wee chart of Previcox doses:

317 lb equine....14.27 mg = one quarter of a 57 mg tablet

634 lb equine....28.5 mg = one half of a 57 mg tablet

950 lb equine....42.75 mg = 3/4 of a 57 mg tablet

1270 lb equine....57 mg = a whole 57 mg tablet or one quarter of a 227 mg tablet.

For comparison sake,  a 25 lb beagle (or similar) gets a whole 57 mg tablet. Different species, different dose.

Here is some more information about NSAIDs ( eg Bute, Previcox etc)


https://groups.yahoo.com/neo/ groups/EquineCushings/ conversations/topics/123633

And how to wean off:


Hope that helps.



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

HI Lavinia,

Huckleberry is still on previcox 227mg, 1/4 SID mornings. I have tried weaning him to every other with no luck. I have his current xrays, but vet is sending me over all now. 1 set from episode where he had no founder or rotation and 3 sets from 2014/12/26 thru 2015/7/3. I'm shooting to have those up tonight. Do they get uploaded to the pictures file too?

Thanks,
Jenilee, New York
October 2013

https://groups.yahoo.com/neo/groups/echistory8/files/Jenilee%20and%20Huckleberry%20Case%20History/


Jlee DOrtona
 

Hi Jaini,

Thank you for your input and I will call the vet tomorrow and get the smaller mg tabs of previcox and start with that for weaning him down.  I will also be looking into Phyto-Quench and get that ordered.  I am just so overwhelmed at the moment.  I thought the team I had in place was doing right by him, but in just 3 days this group has really helped me take a look at how to make light of this situation effectively.  I basically need to re-do everything.  Vet didn't think blood-work was necessary- need to get it; vet said Empower Balance was safe for him- it's not, vet has wanted to decrease previcox to every other day- we have not and it appears the dose is too high for him anyways...  It just feel as though all the things I was told to do for him and I have done everything, was backwards.  I have him on the emergency diet right now.  We are due to get new hay this weekend and it will be tested, as we have been testing right along these last few years, but part of me thinks I should go with the original reply to my request for help, of starting the Ontario Dehy Timothy cubes and balancing it with Vitamin E, Flax, and salt.  Can someone tell me just how to implement all these new changes.  I don't want to upset my pony's progress, if any.  Do I keep on emergency diet and work on weaning of previcox? Do I start the new diet first?  Should I see what my hay tests like and balance him from there if its suitable? I found a hay dealer on one of the links on this group, who already has his hay tested.  Would need to run numbers and logistics to get it, but is this something I should consider?  I have so much $$ into this little guy, that I am saddened to know that I was so badly mislead and misinformed.  Anyone have a local veterinary contact in my area (Upstate NY) whom adheres to this group's philosophy and protocol?  I would be very interested in a change of vet and since I need some blood work pulled, it would be a good time.

Jenilee and Huckleberry
New York
October 2013


Kerry Isherwood
 

Jenilee,

Where in NY are you located?

Just breathe; we're here to help--its quite overwhelming at first, and at times, TBH, will still be overwhelming as IR/PPID is an ongoing battle, but one of the best things about this group is the support system and many friends you'll make that truly do care about your pony's plight and can really empathize with your agony. There will be wrenches thrown into your best-laid plans along the way (ie, "oh Heck no, Im not eating that expensive supplement/specially-ordered product/one add'l molecule of iodized salt" etc) and this group is a bastion of creativity for combatting such roadblocks, most likely bc someone has already been dealt & has conquered the obstacle you're facing. So never hesitate to ask a question as you go along.

Kerry in NY
Sept 2014


Jlee DOrtona
 

Huckleberry's most recent xrays are up.  I will be working on the pictures, however, he does still have those clogs on, is that alright?  I will add the initial barefoot xrays from December 2014, as soon as the vet sends them over.  Works in progress...to be continued.

Jenilee and Huckleberry
New York
October 2013
ECHistory8

 


Jlee DOrtona
 

Kerry,

Thank you for your kind words and positivity!  I am trying to wrap my head around everything.  I am near Albany.


Jenilee
New York
October 2013


Jlee DOrtona
 

Good morning,

So, just an update on some things.  Huckleberry has been back on the emergency diet for a week now.  I am starting to add in flax, vitamin E, and salt this morning.  I have bagged organic flax, like the kind you get from the grocery store.  Is that suitable?  I am having a hard time finding Magnesium.  Dose is 1.5g per 500lb.  So, I would need 1500mgs for my ~500lb pony.  I can only find 400mg tablets, is this what I should use?

Vet called in Previcox 57mg, so that I can start weaning Huck off.  Now, with the suggestion of starting Phyto Quench, will that provide him with some pain relief?  He's not in severe pain, but is uncomfortable daily.

Vet is coming Monday 7/20, to pull blood to send to Cornell.

Most recent xrays have been uploaded.  I will start working on hoof photos, except he still is in the clogs.  Is that alright for pictures?

ECHistory8

 



Getting hay tomorrow and hay test will be sent out Monday.  So, I should keep everything diet wise, as is, until hay testing is back, then make some determinations, at that point, as to whether my hay is suitable and can be balanced or if going with the Ontario Timothy cubes are the route to go, or another hay supplier, correct?

Thanks!

Jenilee & Huckleberry
New York
October 2013


Chanda
 

The flax you can get at the grocery store is ok, but probably not stabilized, so the omega 3s are probably gone from it, which is the main reason for feeding flax.  If you have a TSC store near you, they likely have Omega Horseshine, which is stabilized flax for horses, and is suitable for IR/PPID horses; for just a single horse to buy for, I like the Manna Pro Simply Flax, I get it from Horse.com (since I now have more than one horse, I special order Triple Crown flax through my feed store, so I don't have to pay shipping costs for a larger bag).

The 400mg magnesium tablets should be fine, someone will correct me if I'm wrong, but I doubt it would hurt him any to have a little bit extra, so 4  400 mg tablets would be 1600mg (1.6g).

Chanda

MT 9/04


Jlee DOrtona
 

Thank you Chanda,

I will check out those options. The profile for this FlaxUSA product is as follows :

Alpha-Linoleic Acid (ALA) Omega 3- 2800mg
Linoleic Acid (LA) Omega 6- 850mg
Oleic Acid (OA) Omega 9- 1000mg
Lignans- 120mg
*based on a 2Tbsp (14g) serving

Only checking thus further, because I had this at home already. But can definitely make trip to TSC if there is something better suited.

Jenilee
NY, October 2013


Chanda
 

The horse products in this case are probably cheaper than those labeled for people, mostly due to packaging size.  I'm sure they will work, since you have it on hand, but next trip to TSC try a bag of Horseshine or the Simply Flax (don't know if TSC carries Simply Flax or not), TSC might have their own brand of stabilized flax.  I know many on the group buy whole flax and grind themselves in a coffee grinder (dedicated to this purpose), but I can't get whole flax locally, so go the easy route and buy stabilized ground.

Chanda

MT 9/04


Nancy C
 

Hi Jenilee

If you have a Blue Seal dealer near you, you can ask our retailer to to special order  40 pound bag of Magnesium Oxide for about $20.00.  If kept dry it will last you a good long time and do the job at just  few pennies a day. Call the store in advance.  Don't let them get away with saying "there is no such thing."

Nancy C in NH
ECIR Moderator 2003
Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers

 





Lavinia Fiscaletti
 

Hi Jenilee,

As you are getting new hay tomorrow and sending it out for testing, I'd be inclined to go with the 400mg tablets of magnesium until I got the hay results back - you may not need to supplement it at all. My hay (10 years now) has never needed extra magnesium added.

Flax from the grocery store is fine, just way pricier than the flax intended for horses. Triple Crown Omega Max is one of the most cost effective, available thru any feed store that carries Triple Crown products tho you may need to have them order it in if they don't already carry it. As the flax is something you will need regardless of the results of the hay analysis, sourcing the best product for your situation is worth your time.

Phyo-Quench does help with pain but is ineffective when combined with NSAIDs. You can start it while tapering off the Previcox so it's already on board once the Previcox is all done. If you haven't used it before, it has quite a strong smell -some horses are fine with it, some think it's poison. Start with a tiny pinch each meal until Huckleberry gets used to it then work up to full dose. If he continues to hate it, you may need to just syringe it in.

I took a look at the xrays. The heels are too high, toes are too long. Pastern axis is broken forward so is tilting him onto the leading edge of his coffin bone. Appears as if there is too much foot overall. Take the pictures of his feet regardless unless you're planning on having the clogs removed in the very near future.

You're right on course with your plan, Good job.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team

>>>>>>>>>>>>

ECHistory8

 




Jlee DOrtona
 

I am off to the feed store tomorrow.  Huck has decided to start being picky with his beet pulp, flax, vitamin E, salt, magnesium, med mixture.  I'm going to try adding some of the Ontario Balance cubes to help, but what about Timothy Hay pellets?

Jenilee & Huck
NY, October 2013


Chanda
 

While he might like the Timothy pellets, they aren't guaranteed to be under 10% sugar/starch like the ODTB cubes, so it might be a bit of a gamble if he's teetering on the brink of more problems.

Chanda

MT 9/04


Jodie Jensen
 

Hi Jenilee,

I just discovered something with Copper that might apply to you and is a suggestion I haven't seen with the other picky eater questions lately. He was never a picky eater when he was just IR, but since we added PPID and pergolide to the mix, he has been on and off his bucket. I've tried all sorts of flavorings, decreasing the salt and slowly re-introducing it (that usually helps) and more, but what worked the best is number 6 on the picky eater check list - scrub the bucket. He likes his bucket spotless! Once we started scrubbing, I mean really scrubbing, not just a rinse, he started eating everything up again. Sometimes it's the simple things.

Jodie and Copper
WA, 2007


 

Speaking of simple things, I have had a similar experience.  My IR/Cushings mare has been a picky eater lately causing me some anguish.  I keep my feed in my garage and mix my feed in buckets for each horse.  Each bucket is a different color and has each horses name on them.  Well, when I was going out to feed, Amber (IR/Cushings) was waiting at her stall door and the other two horses were squealing and kicking at each other.  I quickly let Amber in her stall and instead of emptying the bucket in her feed tub, I just dropped the 4 quart bucket in and went to separate the other two.  By the time I got back to Amber to empty her bucket she had eaten all of her food.  Hmmmm... take note I told myself.  So now I just drop her bucket into her feed tub and she eats everything.  This has been going on now for three weeks. I do rinse the buckets out daily - don't know if that was the problem with the feed tub but for now I am sticking to what works.

Jean and Amber
in South Carolina
August 2004