18 year old POA winter laminitis help needed
JUDITH S. SCHNEIDER
-We are at a total loss with the onset of winter laminitis. Rosa is currently getting: Quiessence, Thryro-L, Jiaogulan, Prescend 1.5grams per day. She is getting 2 grams bute daily, however, as we suspected - not very effective in relieving her pain level.
She is tender to the touch, not very interested in interacting with humans/horses. Her gait is stiff and short.
She is fed low starch/sugar hay - AM/PM. The hay was tested to ensure it was appropriate for her dietary needs. We just added watermelon rind to help with circulation (?).
She is blanketed, has "socks" w/o the foot part attached underneath her leg wraps. She is wearing Cloud boots w/cushions that are cut out to help with pressure.
Also, the vet recommended InsulinWise as her Leptin levels are high. Her insulin level is > 200. The InsulinWise was recommended by Cornell specialist.
We have scheduled new radiographs for next week to see what is going on with her. Farrier is coming out every 2-3 weeks for trims. The vet is working with farrier to have him come out at the time of the radiographs. They do work well together.
Thank You for your time and assistance.
Eleanor Kellon, VMD
Hang onto your proof of purchase of the InsulinWise. You'll probably need your money back.
You should be using wool socks with the foot still on to protect her feet from cold boots and pads. The bute is keeping the Jiaogulan from working and, as you said, it's not helpful anyway. I would stop that and add L-arginine https://www.amazon.com/BulkSupplements-L-Arginine-Base-Powder-Grams/dp/B00EJTZGZC?th=1 8 grams three times a day for nitric oxide support. Watermelon rind won't cut it.
Eleanor in PA
www.drkellon.com BOGO 2 for 1 Course Sale Through End of January
Hi Judy. Welcome to the group. Your first post here triggers a welcome letter that contains the protocol we use . You should also have received information regarding completing a case history for your horse. This creates an easy to reference history, where all of your horses lab work results, diet, trim, turnout, symptom information is all readily available for both Dr. Kellon and the volunteers to review so that we can give you the best information and advise as things come up over time.
First- getting your insulin down is key. Focus on the diet section in the welcome letter. How was your hay analyzed? What was the ESC and starch levels? Combined, they should not be exceeding 10%. IF it is close to 10% or greater, soak the hay in hot water for 30 minutes or cold water for 1 hour. Rinse and let drain for about 10 minutes before feeding... How much does your horse weigh? You need to feed 2% of his ideal body weight.
Second- Need your blood work results- have your vet send them to you Specifically, the insulin, glucose and ACTH level on the 1.5 of Prascend. You will need that for your case history.
The bute is not going to help with pain control. Hoof pain will get better when the insulin is down around 20-40. Hoof pain can begin around 80. So, that is why your first goal is to get that insulin way down.
This could be Winter Laminitis pain superimposed on top of the high insulin causing pain. . For Winter Laminitis, get wool socks, Large or X large mens size. Don't cut off the bottom, feed it right over the hoof and up the leg and then apply the boots. You can use fleece lined shipping wraps and his usual boots with support as you described.
We,ve not seen great results with Insulinwise...so you might as well stop that and I think they have a money back guarentee....I would stop the J- herb for now. And follow the emergency diet.
https://ecir.groups.io/g/main/files/Insulinwise --info on insulinwise for your review.
The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.
Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.
Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have.
Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.
PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.
The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".
In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now.
Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed.
DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse.
*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it). The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it.
What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only.
No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.
We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.
TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.
Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet.
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.
There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.
For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.If you have any technical difficulties, please let us know so we can help you. Trisha DePietro
Dolly and Hope's Case Histories
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993
Make sure there's no pink tinge at all on that watermelon rind. I personally would not feed it while insulin is so high.
I would also start soaking her hay. Even if it tested low in sugar and starch, soaking will make it lower. Some horses are more sensitive and in a crisis situation you have to pull out all the stops until she's feeling better, then you can try adding things back in 1 at a time. I found with my horse that I had to soak his 7% ESC+starch hay to prevent laminitis.
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
|1 - 4 of 4|