Hello from France!


Casey76
 

I hope I'm not intruding, as I know my mare doesn't have PPID (negative ACTH test in Sep 2016); however I'm not convinced she doesn't have IR.


I have owned Tartine for 4 years in May, and her weight is a constant battle.  This peaked in May 2016 when I weight taped her at 518kg, and she had an accompanying solid crest and fat deposits on her neck.  I immediately institued emergency measures, put her on 12 hours soaked weighed hay and muzzled in the field during turnout.  As a bucket feed she had 1kg of low carbohydrate hay replacer to add her supplements to. Within 6 months she lost almost 70kg.  She has never shown any signs of laminitis.

In Sep 2016 she was diagnosed with PSSM1 after a lack of performance workup by the vet, and her diet was tightened even further, however she remains oveweight with a poor topline, though she has no obvious fad pads at the moment.  Obviously at this time of year I'm very concerned that she may balloon again.  She is currently 420kg, though feeling her current condition I think she could probably come down to 350-370kg


Her current diet is:

5kg meadow hay soaked for approx 12 hours split into 2 slow feeder nets while she is stabled overnight

approx 12 hours turnout on an oatgrass field that currently is 98% dirt and no green, though I imagine within the month I will need to muzzle.

Breakfast is 1/2 scoop (approx 200g) Agrobs Muesli (12% starch + sugar) with 1 measure of ProLaminae+ and 60ml Linseed oil

Dinner is 1/3 scoop (approx 200g) Agrobs Mash (11% starch + sugar) with 50ml (10,000IU) vitamin E, 25ml milled rosehips, 20ml boswellia serrata, 10ml glusocamine, 10g L-lysine, 5g DL-Methionine, 2g L-Threonine, 300ml linseed oil and a handful of dried spearmint


She is bedded on what straw, and unfortunately as it is included in my livery, it is not financially viable to switch my bedding to something non-edible at the moment.


This is the last side-on photo I have of Tartine, taken 2 weeks ago.  She is 13.3hh and 450kg in this photo.

[img]https://scontent-fra3-1.xx.fbcdn.net/v/t1.0-9/16406925_10154462879813337_1365779002129549646_n.jpg?oh=de7ee117f674501538d6677280d6a1b6&oe=59711EDA[/img]


This winter was very difficult for us.  I found it difficult to keep her warm enough, despite being a French native pony, originating in the French Pyrenees! Also as our school was out of commission for over 2 months it was very difficult to keep her exercised adequately, as, due to the PSSM, I can't just pick her up and put her down.  Since the above photo was taken, I've stopped putting hay in the field, and she has started back into work, doing gentle exercise with increasing intensity, and her hay belly is slowly diminishing.

Her latest blood test showed that her PSSM is stable, both muscle and liver enzymes are "normal" but she is currently anaemic which is under investigation.  Consequently her exercise tolerance is still diminished.


Sorry for the essay! It's hard to know what to include and what not to!

Kind regards


Katrina

 


 

Hi, Katrina, and welcome to the list!  You are certainly not intruding; this list is for IR as well as PPID.  

Tartine is gorgeous! She does look overweight in the photo, however.

Regarding hay soaking: if you can manage to soak for only one hour, you will still remove most of the soluble sugars that will be removed with 12 hours soaking; you will also avoid driving extra iron into the hay from the water (if there is iron in the water, which depends on your location and the water pH); and, in summer, you will avoid making hay beer, as in 12 hours the hay can start to ferment in the water (not such an issue at cooler temperatures)
Agrobs muesli  http://www.agrobs.de/futter/en/shop/AlpenGruen+Muesli/?card=1637#_tab_content3  (9.7% ESC, 2.8% starch)  and 
(9.3% ESC  2/5% starch) could be tolerated by some IR horses, but not all. However, you are only using a relatively small amount. Just be aware that if you run into problems, both the Agricob products should be discontinued, and you should switch to Speedi-Beet or rinsed/soaked/rinsed beet pulp pellets. The beet pulp is one of the best prebiotics you can use.

The straw might be an issue; could you get it tested to check the ESC and starch levels?  

The 300 mls of linseed oil is very definitely an issue.  High fat in the diet can cause or exacerbate IR.  Linseed oil (=flaxseed oil) is used to supply the fragile omega 3 fatty acids that are lost in curing hay. A one thousand pound horse needs about 38.5 mls of linseed oil to provide the required amount. The extra oil you are feeding will be contributing to her weight issues, and to the IR. PSSM horses require low starch and low sugar diets, with adequate oil, but not excessive oil. Using Acetyl-L-Carnitine instead of extra oil has been found to be beneficial to PSSM horses. The EPSM/PSSM Yahoo Group is a great resource for you. 
https://groups.yahoo.com/neo/groups/EPSM/info    
Quoted from the files of the EPSM Group (copyrighted material): 
"Acetyl L-Carnitine (ALCar) at a dose of 1 gram per 100 lbs. of body weight (10 grams for a 1,000 lb. horse), given once or twice a day. Helps with fat burning, and possibly with the the abnormal hardness of muscle present in some EPSM horses.  Vitamin E, dosage varied depending on blood results.  Low Vit E has been associated with neuromuscular disease in horses in addition to EPSM.  The primary source of E in the equine diet is grass.  Any horse not on grass should be supplemented.  Powdered supplements can lose potency quickly, and E needs fat to be absorbed.  A simple way to supplement is with human gelcaps in the dl form.  A minimum dose would be 2,000 IU/day in most horses, although many EPSM horses have benefited from higher amounts, ranging up to 10,000 IU/day.  Some have noted an improvement in symptoms on a higher level of E.

 

Selenium works together with E to support muscle function.  Toxicity can occur at high levels, but the target range should be 2-4 mg/day.

 

Magnesium as either magnesium oxide or magnesium carbonate, 5-10 grams daily.

 

Salt - 2 oz per day, with as much as 6 oz during hot weather."



The list philosophy is Diagnosis, Diet, Exercise and Trim.

Diagnosis: You already have a diagnosis of PSSM, and a suspicion of IR.  

Diagnosis of IR is by blood tests: Blood should be pulled from a non-fasting horse (or pony) in a quiet barn; blood spun, separated, and frozen or chilled asap, then sent to the lab at on ice. Ask for insulin, glucose, and leptin (or adinopectin), and ACTH. The blood for the ACTH goes into purple-topped tubes; for the other analytes it goes into red-topped tubes.  

More information at these locations:

 

https://ecir.groups.io/g/main/files/2%20DDT%20-%20%20The%20Diet%20Diagnosis%20and%20Trim%20Protocol/DDT%20Diagnosis.pdf

 

https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/2%20Diagnosing%20Insulin%20Resistance%202012.pdf

 

https://ecir.groups.io/g/main/files/Blood%20Testing%20for%20IR%20and%20PPID


Diet is supremely important, in some ways more for what is not fed: no pasture, sweet feeds, oats/grain, carrots, apples, iron-containing supplements. You have a bit more of a juggling act with the PSSM, but not hugely so; the diets are very similar. Diet consists of grass hay or haylage, with ESC (soluble sugars) and starch of less than 10%, plus minerals balanced to the forage, plus vitamin E, salt, and flaxseed or flaxseed oil.  One can use a carrier of beet pulp (rinsed, soaked, and rinsed) as a safe feed to get the supplements in.   The Temporary Emergency Diet uses hay soaked for 1 hour in cold water, or 30 minutes in hot water, with the water drained where the horses can't get at it; plus vitamin E, salt, and ground flaxseed in a safe carrier such as beet pulp (rinsed, soaked, rinsed).  More info on Temporary Emergency Diet here:

 

https://ecir.groups.io/g/main/files/2%20DDT%20-%20%20The%20Diet%20Diagnosis%20and%20Trim%20Protocol/DDT%20Diet.pdf


I also wonder if some of her current exercise intolerance is due to insufficient salt intake? This is much more common than is realized, but fortunately is easily remedied. Many horses will not take enough salt in from a salt block, due to having rather smooth tongues, so it is best to add salt to their minerals.

The Pro laminae https://progressive-earth.com/product/pro-laminae-2-88kg-forage-balancer-metabolic-support-hoof-health-immunity/  looks like it has adequate copper and zinc (depending on your hay), and I could find no added iron (good!); however, she should be getting 2 scoops rather than 1 scoop daily. (forgive me if she is also getting a scoop in the evening, and I just missed it in your post).  I see it has 2 grams of Acetyl-L-Carnitine, which is okay, but the required dose for her would be about 10 grams. Because iron overload can be a problem with IR horses, we use a little extra caution with Vitamin C (ie, the rosehips), and also caution with glucosamine.


Don't suddenly cut off the linseed oil, although I would reduce it by half. Post on the PSSM group first, and get the definitive answer to how much she should be having there.


 

Trim:  This is a trim physiologically balanced to the internal shape of the coffin bone, with short toe and low heels.  Trim is often a neglected or mis-understood piece of the puzzle. More information here:

 

https://ecir.groups.io/g/main/files/2%20DDT%20-%20%20The%20Diet%20Diagnosis%20and%20Trim%20Protocol/DDT%20Trim.pdf


Exercise: You are already au fait with the exercise requirements for the PSSM horse; exercise also helps keep insulin levels in check, and increases insulin sensitivity. (again, a juggling act with a PSSM horse who might also be IR).


You have a great resource, the principal of which lives in France:  The Laminitis Site  http://www.thelaminitissite.org/  


Also, regarding exercise tolerance, low-grade laminitis, which is present in a lot of IR horses, can be mistaken or present as exercise intolerance, stiffness, back pain, and a host of other issues that are really all due to foot pain.


I am glad you are here - nice to have a French native in our group!


NOw, last but not least, to be double sure we are answering your questions correctly, we need a little more information. Please take a few minutes and join ECIR Case History:

 

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

 

Go here to get instructions on filling out a case history, and to download the form:  https://ecir.groups.io/g/main/wiki/New-Member%27s-Welcome  


Ask any and all questions, and again, welcome!


--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Casey76
 

Thank you Jaini for the welcome :)

I've uploaded a case history and in the process of trying up upload my foot photos *aargh* no matter what I edit them in they keep coming out upside down! I hope this won't be too much of an issue.  It' a problem going from iPhone to PC I think.


Let me see if I can answer some of your questions here:

1) Tartine won't eat sugarbeet. I've tried Speedibeet (imported from the UK) in 2014 and she won't touch it, no matter how wet or dry I make it.  She also won't eat either of the two local brands (soaked and rinsed twice as probably have molassess added)  It's why I'm now trying the Agrobs mash as her supplements cost a fortune and I can't afford for her a) not to eat them and b) become PSSM symptomatic again.

2) I tried ALCAR for 5 months and it made no visible difference to her PSSM symptoms, and she has improved immensely taking her off ALCAR and adding fat instead.  I checked last night and I had overestimated how much I was giving, and it isn't 300ml, but 180ml split into 60ml at breakfast and 150ml at dinner. (which is much less than the 500g of rice bran plus 100ml linseed oil recommended by the university who did the genetic test)

When I was just feeding Tartine to get her weight down it was fine, and it didn't matter if she left half a bucket of low carb chaff; since the addition of the PSSM supplements, each bucket now costs in excess of 10€ so finding something which she finds palatable *and* is wet enough to make the supplement stick has proven to be a huge issue.  I currently have 6 different feed bags open, all of which (apart from the detested sugarbeet - which fortunately my other horse likes, but does not need!) is NSC checked and low carb.

3) I'd forgotten to add that I supplement her with 100g salt (unrefined sea salt) per day.  Supplementing this means she doesnt use her free-choice salt lick (plain NaCl, not himalaya), if I decrease this she basically eats her salt lick.
4) She gets extra selenium (1g), on top of that which is in the ProLaminae+ as our soil is very poor in selenium, and at her blood test in Septeber she was below LLN, now she is in the middle of the normal range

5) Copper and zinc are within normal range on blood test.

6) I switched from using a farrier to a barefoot trimmer at the end of Feb this year.  She had her second trim (4 week cycle) on 17 Mar. The trim is, well, rather extreme compared to what my farrier would do, but so far she hasn't had any issues with undue sensitivity.  She has always had excellent feet - they may not have met the parameters of a perfect barefoot, but she has never had any sensitivity issues, soles and walls always rock hard.

7) Finally... I'm not actually a French native, I'm a transplant from the UK. It's not without it's issues... French care (livery, veterinary, nutrition) is decades behind the UK.  I import all of my food from Germany, my vet is German, I provide a full service for my horses depsite paying livery so I know that they are mucked out adequately every day.  I'm often called "cruel" for muzzling Tartine in her field (other owners prefer to stable their horses 23 hours a day to limit grass consumption) and for putting hay in slow feeding nets.  Even my friends on the yard think I'm nuts (and paranoid) about putting so much care into Tartines diet and care, getting the vet to test for this and that.  I'm in a constant battle with my YO, who means well, but often gives Tartine "a little" extra hay (enough for a full night!) unsoaked, obviously, if she makes a fuss on a weekend at breakfast time.


Wow, sorry, that turned into a bit of a rant!
--
Katrina

Mar 2017, Alsace, France

Tartine Case History: https://ecir.groups.io/g/CaseHistory/files/Katrina%20and%20Tartine

Tartine Photos: https://ecir.groups.io/g/CaseHistory/album?id=4725


 

Hi, Katrina - excellent work on the case history and photos; well done, you!

The trim looks better than 99% of the ones we see. I will defer to Lavinia; the toes on the hinds might be a tad long, with slightly forward heels, but that's about the only comment I would have on the trim. Oh, except if I use my imagine-o-scope, I might be able to see a slightly different angle on the hinds between the new growth, which then angles out when it gets to an inch or so from the coronet. Fronts look fine to me. Hang on to that trimmer.

The extra information now makes a lot more sense. It will always be a juggling act for her to get the right supps for PSSM, and not induce/exacerbate IR. The oil amounts sound much more reasonable. Good on the salt end!

Blood tests for copper and zinc are usually unrewarding, in the sense that they will pick up very frank deficiencies; but the horse could be in a less-than-optimal state with regard to copper, zinc and iron (ie, too much iron). The only way to really check that is by liver biopsy, which no one in their right mind would do just to assess copper/zinc. It makes more sense to balance the minerals to the hay consumed. If I were you, I would double the Pro-Laminae. (Iron overload can be diagnosed by sending blood to Kansas State University, but by the time the blood got there it would likely be too degraded to be of any use).  Blood tests for selenium and Vitamin E are accurate; good to see that you upped the selenium, and she is now in normal range.

At age 9, it would be surprising (but not impossible, just unlikely) for her to be PPID. However, the blood pull you got to test that showed a lower than the reference range for glucose (47 mg/dL, ref. 63-101 mg/dL). This suggests that the blood may have sat too long, not been separated soon enough, or other mis-handling mis-adventures, meaning that since the glucose looks unreliable, the ACTH is probably not a reliable result either. Sorry - don't shoot the messenger!

I see she gets carrots as a treat. My little herd looked much like Tartrine: beautiful feet, no obvious signs of anything (thought the back pain was just back pain, and the older guy had arthritis, when really both had low-grad laminitis). They received a quarter pound of Christmas Eve carrots, and were pushed over the edge into frank laminitis. (which is how I found this group - that was the winter of 2008-2009). Can you find a different treat for her? 

--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Casey76
 

Hi!

I alsked the vet specifically about the glucose result. I was told that it was due to it continuing to metabolise after it was drawn.  The glucose test was part of a normal blood panel so wasn't handled any differently from the other tubes.  I know that the draw for the ACTH test was drawn into a separate tube.  My vet is over an hour away, and although I know they have a cooler in the mobile unit I don't know exactly how long after the draw was taken it was actually analysed.

I need to get another blood draw done in 4-6 weeks to check on T's anaemia; I'll request an early morning appointment and specifically say that I also want the tests for IR as well at the time of making the appointment so they can be handled expeditiously.


OK, about the carrots... I'm not really a treat feeder.  I have never given my horses cookies (anything that is manufactured) or fruit, however then I read this on the Laminitis site: http://www.thelaminitissite.org/articles/who-said-stop-the-carrots about 6 months ago and I incorporated a few carrots a day - spread throughout the whole day - into their diet.  Normaly they get a carrot upon turnout, one when they come in (bribary for leading without a halter or rope), one in their dinner and one as I leave.  of course repending on the size of the carrots, some days they get more (weight wise) than others.  I haven't noticed any difference in their feet or attitude... and believe me, I'm very attuned to any nose wrinkle or eyebrow furrow (which usually indicates muscle pain somewhere)  from Tartine.

If you think it would be best to stop them, I will, I'll go back to being mean old mom with no treats ;) No treats at all is better than the manufactured rubbish which is available here.
--
Katrina

Mar 2017, Alsace, France

Tartine Case History: https://ecir.groups.io/g/CaseHistory/files/Katrina%20and%20Tartine

Tartine Photos: https://ecir.groups.io/g/CaseHistory/album?id=4725


 

Oh, dear - I will have to email Andrea and have a talk about this. Two things: 1) The glycemic load information is for humans.   2) If you look at the dry matter % sugar and starch, it is 52%.  Carrots can have much the same effect as fresh pasture, in my experience.  Can you get any hay pellets, or even just use handfuls of hay for treats? Alternatively, there are some great treat recipes here:  https://ecir.groups.io/g/main/files/Treats%20for%20Horses   You could likely make something up without too much trouble, using the Agricobs as a base.  I use a modified ground flax, ground soy hull pellets, stevia and aniseed recipe (similar to Omar and Lesley's treats or Maggies treats); I roll them very thin, they bake up nicely and keep as dry for ages (although I keep most of them in the freezer). It's nice to have something on hand for treats. (all you clicker trainers out there, the various low starch treats work fab, as do the Timothy Complete Cubes= ODTB cubes)
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




 

PS - two more thoughts on this subject. Even the most sensitive Type II Diabetic human could eat fresh grass all day long,and not suffer much in the way of glucose spikes. We know this is not the case with horses (whose glucose spikes are immediately followed by the insulin spikes, that induce laminitis).  

Secondly, and I realize this is strictly anecdotal (but we have seen many similar such stories): a horse who was being re-habbed from a single case of clover-induced laminits continued to have low-level foot pain, despite the diet being supposedly in place. (the foot pain manifested only as a stiffness turning on the concrete barn aisle). It turned out he was getting a couple of tiny (slightly bigger than crab-apple size) apples a day. Once the apples were stopped, the foot pain resolved completely.
--

Jaini Clougher (BSc,BVSc)

Merlin (over the bridge) ,Maggie,Gypsy, Ranger

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy