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3 yo diagnosed EMS

 

Seeking recommendations for Valenti, 3 yo Lusitano/KWPN gelding, 17 hands, who is recently vet-diagnosed EMS. Blood drawn for labs on 2/24/20, during annual exam and sedation for dental and sheath cleaning. Cornell Lab Report showing IR compensated and EMS. In addition, GGT liver enzymes were elevated above normal. Vet prescribed Milk Thistle to improve GGT fed at 3 Tbsp daily. Possibly caused by dewormer since he stocked up in all 4 lower legs after deworming with EquiMax in October 2019. History: No other injuries or past illness. Mineral balanced diet, on lab-tested timothy hay in 1.5 inch slow feed multiple bale nets, from weanling to current age (done by Patti Woodbury). Castrated 9 months old. Delivered to my farm at 7 month old weanling, in herd of 5 geldings in 8-acre dry-lot turnout. No other horses in herd are overweight. Should I separate him out of herd to reduce his hay intake w/smaller hole nets? Increase exercise and start light work as 3yo? Add Spirulina to his diet? 

-Gin
2011, southern Oregon
Case History: https://ecir.groups.io/g/CaseHistory/files/Gin%20and%20Valenti
Valenti Photos: https://ecir.groups.io/g/CaseHistory/album?id=243533

Eleanor Kellon, VMD
 

Was blood drawn before sedation.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Trisha DePietro
 

Hi Gin. It sounds like you have a wonderful herd and turnout for your 3 year old. Just wanted to give you refresher information about exercise etc. ...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.

EXERCISEThe 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.

 

--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories https://ecir.groups.io/g/CaseHistory/files/Trisha%20and%20Dolly%20-%20Hope
Dolly's Photos 
Hope's Photos 
Primary Responder

Sherry Morse
 

Hi Gin,

You just got the refresher email from Trisha and my first thought was the same as Dr. Kellon's - when was the blood drawn in relation to the sedation?  Also, I just had a look at your CH and if your current and ideal weights are correct Valenti should be eating no more than 26lbs of hay a day (2% of ideal weight) so decreasing the amount of hay he's fed daily as well as cutting out the alfalfa would be the first thing I would do right now.

Is there a reason that his glucose wasn't tested at Cornell? 



 

Dr. Kellon,

Thank you for your help. 

Blood was drawn after sedation about 3:00 PM. The vet appt was originally scheduled for dental. Do you recommend another blood draw without sedation? My local vet lab ran Equine Profile Plus in their lab to check liver and kidneys for baseline for Valenti's records, as part of annual exam. I asked for additional Endocrinology report (ACTH, Insulin, Leptin) which my vet sends to Cornell. If reducing hay is the remedy for overweight, I will do that. Now that Valenti is 3 yo, I can also increase exercise with light work. Valenti has never had grain and now only a handful of dry alfalfa pellets (soaked) as carrier for minerals.

-Gin
2011, southern Oregon
Case History: https://ecir.groups.io/g/CaseHistory/files/Gin%20and%20Valenti
Valenti Photos: https://ecir.groups.io/g/CaseHistory/album?id=243533

Eleanor Kellon, VMD
 

Yes, you need to repeat the endocrinology with no sedation and no exercise that day either (quiet turnout is OK but no exuberant play/running around). Recheck your liver tests then too.

Because he is so young, "dieting" isn't really a good idea. You want to  make sure his protein, mineral and vitamin requirements are met while holding his calories at what he needs to maintain an ideal weight. Light work won't change that too much so set nutritional goals for the weight and age at maintenance then just add exercise and see how it goes.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001