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ACTH first time testing

Linda A
 

For suspecting metabolic issues, I've asked vet to do ACTH. will be sending in this week. Wondering if we should add anything else to that particular test. Horse is 17 yr old gelding, very lethargic, fat behind cinch, neck seems "lumpy and hard". He's been laid up due to lameness issues (torn middle patellar ligament) Very easy keeper. On half and half alfalfa and orchard, Myristol Pro joint supplement, salt, minerals (707 Super Sal), Gastro Ease and  Adequan.

Thanks so much!

Paula Hancock
 

On Thu, Sep 15, 2016 at 10:25 am, <ojaildy@...> wrote:
For suspecting metabolic issues, I've asked vet to do ACTH. will be sending in this week. Wondering if we should add anything else to that particular test. Horse is 17 yr old gelding, very lethargic, fat behind cinch, neck seems "lumpy and hard". He's been laid up due to lameness issues (torn middle patellar ligament) Very easy keeper. On half and half alfalfa and orchard, Myristol Pro joint supplement, salt, minerals (707 Super Sal), Gastro Ease and  Adequan.

 Hi and Welcome to the ECIR group!

Yes, your horse's symptoms indicate testing for metabolic issues.  He could be PPID/Cushings (high ACTH), insulin resistant, both or neither.  The only way to tell is to do the right kind of tests and make sure they are done the right way.

I will send a more detailed response later today as I have an appointment I need to leave for shortly, but wanted to help you get started in the meantime.

If you include your name (first is fine), your horse's name, your general location, date of joining and once you create your case history, a link to it in your signature, it will help us keep information straight and make it so much faster to respond to your questions.  There was a very informative email just sent out and it will help you get started. The link to that is:

https://ecir.groups.io/g/main/topic/message_posting_etiquette/2730245?p=,,,20,0,0,0::RecentPostDate%2FSticky,,,20,2,0,2730245

Also good information on ECIR, symptoms, testing, etc. here at this link:

http://www.ecirhorse.org/

More later!
--
Paula with Cory (IR) and Onyx (IR)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/album?id=1624

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx



Paula Hancock
 

On Thu, Sep 15, 2016 at 10:25 am, <ojaildy@...> wrote:
For suspecting metabolic issues, I've asked vet to do ACTH. will be sending in this week. Wondering if we should add anything else to that particular test. Horse is 17 yr old gelding, very lethargic, fat behind cinch, neck seems "lumpy and hard". He's been laid up due to lameness issues (torn middle patellar ligament) Very easy keeper. On half and half alfalfa and orchard, Myristol Pro joint supplement, salt, minerals (707 Super Sal), Gastro Ease and  Adequan.

 Hi,

If you haven’t started your case history yet, here is some information on that:

https://ecir.groups.io/g/CaseHistory

Follow the instructions to:

Download a case history template

Fill it out

Save it to your computer

If possible save it as a pdf document and then upload it into the ECIR History files section (make a folder first, with your name and your horse’s name on it)

Thanks in advance for doing that!  Once you have the case history, please include a link in your signature each time in case we need to check something before answering your questions.

 

The approach we follow here is based on the most up to date information and tons of experience on how best to help horses with Cushings/PPID and insulin resistance (IR).  It sounds like he may be both, so it’s urgent he is managed well to avoid more issues.  Uncontrolled IR can trigger laminitis of varying levels of severity and uncontrolled Cushings/PPID can increase IR, reduce shedding, cause muscle wasting as well as depress the immune system.  Lethargy can be from reluctance to move due to sub-clinical laminitis or just not feeling well.  A horse can have low level laminitis and appear sound because he is equally uncomfortable in all his feets.  If you suspect any illness, talk to your vet about appropriate blood work for that.

 

DDTE stands for Diagnosis, Diet, Trim and Exercise:

 

DIAGNOSIS:  Is done with blood work. We recommend having blood drawn to test for Insulin, Glucose, Leptin and ACTH. ACTH is used to diagnose PPID (Cushings) while insulin, glucose and leptin are used to diagnose Insulin Resistance (IR). The samples should be drawn at home and NON-fasting (fasting will produce artificially low results and is a holdover from human testing protocols). Cornell is the recommended lab in the US. A horse can be only IR, only PPID, neither or both. It would be great if you could post what tests he has already had with the results and the ranges - add them to your case history file. Just because the results come back "within the labs normal ranges" does not necessarily mean they are negative. Also, many times vets have been known to call results that are a "little bit outside" normal range normal negative, which is clearly not the case. Most vets and farriers/trimmers do not focus on the most recent information on PPID and IR or have tons of experience.  We do.  Prascend (pergolide) is the treatment for PPID, with 1mg being a common starting dose.

 

 

DIET:   To provide a low carb, (less than 10% ESC sugar+starch) low fat (4% or less), mineral balanced diet, we use grass hay, tested to be under 10% ESC sugar + 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 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 use the Emergency Diet.  Though not intended for long term use, the emergency diet addresses some of the most common deficiencies.  More details about the emergency diet can be found on our this page of website: 

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

  It does involve soaking your hay (if untested or over 10% sugar+starch) for an hour in cold water or 30 minutes in hot water to remove ~30% of the sugar content.  Make sure you dump the soaking water where the horse(s) can't get to it.  And then to a safe carrier such as rinsed/soaked/rinsed beet pulp, you will add the Iodized salt, Vitamin E, ground flax seed and magnesium in the amounts as outlined on the webpage.  It takes some horses awhile to acclimate to beet pulp as it has a different "mouth feel".  Some horses love it though!  Other safe carrier choices if you can't or don't want to use rinsed/soaked/rinsed beet pulp, are dampened Ontario Dehy Timothy Balance cubes, Nuzu Stabul1 and soy hull pellets. The LMF Low NSC Stage 1 is also an acceptable option.

 

What you don't feed on the IR diet is every bit as, if not more important, as what you do feed!  No pasture.  No sugary treats, including apples and carrots.  No brown/red salt blocks which contain iron and sometimes molasses, and interfere with mineral balancing, so white salt blocks only.  No products containing molasses. Adding fat is not advised as that will exacerbate IR.  Alfafa can make some IR horses footsore, so avoid that for now until you have a better idea of what his IR status is.

 

 EquiAnalytical  is a good lab to use for hay testing.  You want the #603, trainer's package.  Call them ahead of time and ask them for some free forage kits.  They contain everything you need (except the hay probe) for sending your sample in for testing, including a postage paid envelope.  Here's a link to EA's "supplies" page:  

http://equi-analytical.com/supplies/

  If you don't have or know anyone that has a hay probe, try your local extension office or coop.  They often have one that they will lend out.

 

Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing:

 

https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Getting%20Help%20with%20Mineral%20Balancing%20.pdf

 

You mention his current diet includes Myristol Pro Joint supplement, which contains a number of ingredients not recommended for metabolic horses.  You can check out ingredients to avoid here:

https://ecir.groups.io/g/main/files/1%20Start%20Here/3.%20Avoid%20These%20Items.pdf

 

Mov-Ease, available from My Best Horse has been used by many ECIR members as a joint supplement and avoids those ingredients not recommended for IR horses.

 

707 Supersal minerals has iron, which you don’t want and unless it is balanced to your hay, is not helping your horse the way a balanced mineral mix would.

 

I am not familiar with GastroEase.  Has he been diagnosed with ulcers?  Other digestive issues?  Maybe one of the moderators can provide comment on that product:

http://perfectproductseq.com/products/gastroease/

 

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 horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis.  And it's often the missing link in getting a laminitic horse comfortable again.  Look on the following pages of our website for more information about a proper trim. 

 

Here:  http://ecirhorse.org/index.php/ddt-overview/ddt-trim

 

and here:   http://ecirhorse.org/index.php/laminitis/realigning-trim

 

You are welcome to post hoof pictures and any radiographs you might have to an album in the Photos section of the case history site so that we can look to see if you have an optimal trim in place. – NO photos in your case history file, please.

 

 Here's a site that explains how to take good hoof photos: 

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

 

 EXERCISE: The best IR buster there is, but only if the horse is comfortable and non-laminitic. Once the laminar connection to the hoof has been damaged, it doesn’t really repair, it has to grow out and be replaced. If there has been laminitis, we recommend no riding or exercising in tight circles until at least 1/2-2/3 of the hoof damaged by laminitis has grown out (at least 6-12 months, sometimes longer). Also recommend the use of boots and pads as needed for comfort vs shoes/appliances as frequent realigning trims will be needed, which is difficult to do if there are shoes. We also recommend only using NSAIDs sparingly if at all as they interfere with healing and can allow a horse to do more than its fragile feet are ready to handle.

 

That highlights the main points of our philosophy.  I know it’s a lot of information.  You might find it useful to either save this email or copy and paste it into a word type document.  You can also add any useful links to a word document.  I've answered your questions to the best of my ability without further details from you.  If there is anything I missed, one of the moderators will jump in.  Hang in there!  We can help you, we just need more info!  This is a great group of vets, scientists and experienced PPID and IR horse owners, who volunteer their time and knowledge to help people like you with horses like yours.

 

Best regards,


Paula with Cory (IR) and Onyx (IR)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/album?id=1624

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx