Howdy has tested positive with outrageous numbers
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It's critical with these fragile cases to avoid the wrong feed or hay but I need to remind everyone they are not causing the outrageous numbers, just fueling the flames.
A normal horse given a large meal high in sugar and starch, like sweet feed, will top out the insulin reaction somewhere around 40 to 60 uIU (260 to 390 pmol). We're talking about reactions to diets with relatively low sugar and starch compared to that which are 20+ times higher than the normal response to a meal dense in sugar and starch. The danger zone for an acute laminitis episode seems to be start around 80 uIU (520 pmol) but there is smoldering damage being done to the laminae in all EMS horses with elevated insulin. -- Eleanor in PA www.drkellon.com 2 for 1 course sale |
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Tanna
Hi Victoria,
I'm not familiar with the group you note but curious to know where they get the information that the All Phase Lite is considered safe and also what that 9% consists of? Did someone send it for testing? I have been told on several occasions, by a dealer, that the Starch alone is 11%. Tanna April 2019, (Yahoo Group member 2008) |
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Hi Victoria
I see that Dr Kellon has responded to the metformin issue, and Lorna has mentioned the hay testing and mineral balancing. I think you are wise to just feed the soaked hay, and you can add the other items in the Emergency Diet (more details in the link below) until you can balance his hay appropriately. What follows is our welcome letter for new members. It contains an outline of the group's philosophy and details on diagnosis, and the recommended diet and trim for IR and PPID horses. It sounds like you are well on the way to implementing many of the suggestions (well done indeed!), but please do take a bit of time and read through it as you will probably find some things you weren't aware of and that may help Howdy. There are clickable links in blue. As a priority, I would try to get your case history done so the mods and vets can see all the details of your case. Things like Howdy's age, his previous history etc are important. The links to the instructions are included below. I would also suggest getting some hoof photos and uploading them to an album (link to instructions on how to upload below) and also any xrays you might have, as there may be things you can do to tweak the trim that will also give him further relief. Fantastic that you are padding his feet and keeping them warm, but optimising the trim is hugely important. Clouds are a great idea--I am using Cloud therapy boots on a horse at the moment, and find them excellent, so hopefully they will suit Howdy too. If you have further questions, please ask. Let's get your little fellow more comfortable as soon as possible. Hello Welcome to the group! 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 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 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:
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. 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. --Maxine and Indy (PPID) and Dangles (PPID) Canberra, Australia 2010 https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles
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Hello Tanna
I am taking everything away tonight and feeding only the soaked hay. Otter has not replied as yet. All Phase Lite is in the files on the Equine Cushings PPID site on Facebook as an appropriate feed. They said it was 9%. -- Victoria Gilchrist BC 12 2019 |
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Hi Lorna
the 14% was combined sugar and starch before soaking. I will be asking my hay supplier for the full test today. I pass his barn on the way to the barn my littles are at. Thanks for the information I am still learning how to navigate the web page. -- Victoria Gilchrist BC 12 2019 |
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Sorry I did not add in that I support his frogs with Vet wrap folded over and over to create a pad for his foot then wrap that in duct tape. Vet did this when he was out removing the glue on shoes and wanted to support his foot but give him breakover for his toe.
-- Victoria Gilchrist BC 12 2019 |
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Tanna
Very sorry your boy is struggling!
While you wait to speak with the manufacturer, I can add that I'm fairly certain I spoke with Ken at co-op about the Lifeline RB MD and I recall that it was only marginally better than the All Phase Lite which would be highly inappropriate for a horse with IR. What lab have you used for your test? Not sure what's happening out here on the west coast but maybe there is a pattern? -- Tanna April 2019, (Yahoo Group member 2008) |
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Hi Victoria,
Sorry that Howdy ( love his name) is sore. Do you have other test results for your hay? Was 11.4% Esc +Starch? Good that you are soaking it. If your hay test reflects mineral amounts,you're ahead of the game. The next step would be to balance his hay,to determine its deficiencies, allowing you to supplement just what is needed. In our Files,there is a folder(6th down) containing names of people trained by Dr. Kellon,who balance hay for people,if you decide to take that route. If your test only reflects Esc+Starch, I would test it for Major and Trace minerals( the group likes to use Cornell....more on that later).There is a Canada Source file,too,which will help. In the meantime, go to our Start Here File, and take a look at the Emergency Diet, to hold you over until you can balance your hay. It's amazing what a difference proper nutrition can make. Sorry for all the questions. You're in the right place to help your boy. -- Lorna Cane
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-- add styrofoam to the duct tape for immediate relief?? LJ Friedman Nov 2014 Vista, Northern San Diego, CA Jesse and majestic ‘s Case History
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We are seeing a cluster of cases with these very high glucose and insulin numbers in western CA - mainland BC and Vancouver Island. Different breeds, different locations but sometimes multiple cases on the same premises. It's very unusual.
Metformin is the place to start. This paper describes response to 15 mg/kg twice daily in much milder cases https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Metformin%20in%20Horses.pdf but the currently recommended dose is 30 mg/kg twice a day. If that is not effective we have seen very good results with canagliflozin. I have a file of background information on that I can send to your vet. -- Eleanor in PA www.drkellon.com 2 for 1 course sale |
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My little mini PPID gelding has tested with the following numbers Sugar 14.0 and Insulin 2165. He is on soaked hay that prior to soaking tested at 11.4% It is soaked 45 mins to 1 hour and rinsed. I do not limit the amount of hay he has. His weight is good to the point that I add freshly ground flax seed to his supplements to prevent weight loss. He has free choice white salt and he also gets Lifeline Ration Balancer MD (I do not know the NSC on this I am calling the manufacturer today). He also gets KER Rite Trac digestive tract support. He is currently gong through laminitis. We tried glue on shoes but his feet grew too fast and I finally had them stopped after three applications of the shoes to allow for more frequent trims. I have asked my farrier to put him on a three week rotation. I will reduce that time to two weeks if necessary. I have ordered Cloud therapy boots but they will take time arriving. In the meantime I am using duct tape to put support for his frogs allowing space at the toe for breakover. His legs are wrapped to prevent chilling with insulated socks, people socks LOL.
I am in Canada on the west coast. Other than potentially changing the Ration Balancer can anyone suggest what more I can do for him? I have mentioned Metformin to my vet and he is looking into it. We got the lab results yesterday afternoon. Thanks in advance. Victoria Gilchrist |
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