--
Sarah Radachy

As a young QH, it's highly unlikely she is IR at baseline but pregnancy induces a degree of IR in all mares and causes a high laminitis risk.  The Total Equine Low NSC still isn't low enough for laminitis and both products are alfalfa based which aggravates some laminitics.

Blood work now won't tell you about her nonpregnant state but you still need to know if she is dealing with an insulin issue. I would also strongly recommend radiographs and please get photos of her feet posted ASAP (instructions in the Wiki).
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

--

--
Sarah Radachy

Hi Sarah,

Good to hear she is feeling better.

You need to test her now to know what is happening at this time so you can manage her appropriately thru the pregnancy and foaling.

Afterwards, you can retest to determine her "normal" status just to be safe going forward.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

If she has had EMS since before the pregnancy there will be evidence of changes in her feet (the horn lamellar zone). I'm actually also looking for evidence of something else to explain the pain - like the poor digital cushion development and flat to negative palmar angle that is so prevalent in QHs.  No harm in testing her after she foals and is weaned.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi, Sarah, and welcome to the group! I am sorry your mare has had an episode, but glad she is feeling better.  Good work with the Soft-Rides - many horses just love them.

Great work on your case history - many thanks for that!

Pulling the Total Equine was a good decision. I am sure it has been a player here. As Dr. Kellon says, pregnancy can induce a degree of IR, and until you know for sure what you are dealing with, it is best to treat her as IR.

NRF2 is most likely a waste of money; there are better supplements to use as anti-oxidants. Here are Dr. Gustafson's and Dr. Kellon's posts about Protandim (NRF2)
 https://ecir.groups.io/g/main/message/237520   
 https://ecir.groups.io/g/main/message/235716  

Heiro is most certainly a waste of money - some more information in the files here:  https://ecir.groups.io/g/main/files/8%20Commercial%20Items%20Targeting%20IR%20and%20PPID  They sure have good marketing, though! :)

Here is a list of safe bagged feeds, and also acceptable ration balancers: (also found at these links in the files https://ecir.groups.io/g/main/files/5%20Core%20Diet and https://ecir.groups.io/g/main/files/6%20Diet%20Balancing  )

SAFE BAGGED FEEDS

Rinsed/soaked/rinsed beet pulp

 Soy hull pellets

Ontario Dehy Timothy Balance Cubes  http://www.ontariodehy.com/tab02-07.htm  

 Nuzu Stabul 1 http://stabul1.com/stabul-1/   

 LMF Low NSC Stage 1  https://lmffeeds.com/low-nsc-stage-1/     

 LMF Low NSC Complete http://lmffeeds.com/products/low-nsc-complete/ 

Haystack Low Carb/Low Fat Pellets  http://haystackfeeds.com/?page_id=69     

Acceptable Ration Balancers (but very much second best to hay analysis and custom mix). These all have no added iron, a very important consideration for our metabolically challenged equines.

Uckele U-Balance Foundation https://uckele.com/u-balance-foundation.html  (some horses don’t like the taste)

 

California Trace Plus  https://californiatrace.com/about/california-trace-plus/  (will need to add magnesium)

 

Colorado Mix  (no selenium) https://horsetech.com/equine-supplements/custom-non-stock-products/colorado-mix (will need to add magnesium)

 

 

Colorado Se Mix https://horsetech.com/equine-supplements/custom-non-stock-products/colorado-se-mix (will need to add magnesium)

 

 

VermontBlend   https://customequinenutrition.com/products/vermont-blend

 

  VifArgen Le Cheval au Naturel http://lechevalaunaturel.blogspot.com/p/blog-page_13.html 

 

Mad Barn AminoTrace+  https://www.madbarn.com/ca/product/aminotrace-pellet/

 

  For areas where added manganese is necessary:

Mad Barn Omneity Powder  https://www.madbarn.com/ca/product/omneity-equine-premix/

Mad Barn Omneity Pellet  https://www.madbarn.com/ca/product/omneity-equine-mineral-and-vitamin-pellet/

Mad Barn Trace Mineral Pack  https://www.madbarn.com/ca/product/madbarn-trace-mineral-pak/

Equi-VM  https://uckele.com/equi-vm-7lbs.html

 

Sport Horse Grass  https://uckele.com/sport-horse-grass-pellets-15lbs.html

Equi-Base Grass  https://uckele.com/equi-base-grass-pellets.html

Arizona Copper Complete (contains manganese)  https://horsetech.com/equine-supplements/custom-non-stock-products/arizona-copper-complete (will need to add magnesium)

 

Note that one should find out if one is in an area needing selenium, or if you are in a selenium-rich area; the same applies to manganese. Your agricultural extension office should be able to tell you.


Here is the full, official welcome letter - there is a ton of information in it, so take your time and don't feel overwhelmed! (most of us were overwhelmed at first, but it all gets easier).  You can just zip over the PPID information - I will eat my hat if that is a confounding factor here, but I left it in because there can be confusion about which disorder is relevant.

The ECIR provides the best, most up to date information on Cushing's (PPID) and 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 follow 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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:

• low carb (less than 10% sugar+starch)
• low fat (4% or less) 
• mineral balanced  

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 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. 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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.

If you have any technical difficulties, please let us know so we can help you.

Ask any and all questions, and, again, welcome!

 

--
Jaini 
Merlin and Maggie (over the bridge), Gypsy, Ranger
ECIR mod/support, Smithers, BC 09

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193  
https://ecir.groups.io/g/CaseHistory/album?id=39711

Thank you for your time. Looks like the consensus is to test her after she foals and weans. Also think I will test foal. Treat her as Ir until she is tested. I will probably continue the NRF2 as I was feeding a large dose of it and I personally take it myself. I will look into the feeds recommend and do some research. Also get my next stack of hay tested so I can get something that works well for that particular stack. 

When weather cools is she safe to ride? Like to keep mares in somewhat shape up until foaling.

Thank you!  
--
Sarah Radachy
Arizona 
Aug,2019
https://ecir.groups.io/g/CaseHistory/files/Sarah%20and%20Nala

No point in testing the foal until she stops growing. You can ride her as long as she's not lame. Protein and mineral levels are critical for the proper development of the foal. Get help.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001