--
Sarah O. 
Rudolph, WI
2020

Hi Sarah. Welcome to the group. You will find ALOT of information here and it will be overwhelming at first, but just take a deep breath and read through the areas that Sherry already has you focused on...proper diet, and no grass, and soaking the hay will reduce the sugar and starch intake dramatically and actually help reduce the inflammation in the feet. All the links within the welcome letter will bring you to the "how to" sections and other pertinent areas. 

Hello 

Welcome to the group! 

The ECIR Group 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 and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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.

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. 

--
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

Hello Sherry, 

Thank you so much for your quick reply. I appreciate all the information and advice. We are trying our best to learn as much as possible to control this issue and prevent it in the future. I wish I would have found this website sooner as our vets have been giving us contradictory advice. 

We started soaking hay on Monday, after his "relapse". We researched this ourselves, the vet was recommending calorie restriction, but we chose to continue soaking the hay instead, concerned about whether or not further calorie restriction would be harmful. We will cut all grain and supplements out of his diet. At this point he only got a couple of tablespoons just to get him to take the Bute the vets recommended. However, we were only feeding him the Purina feed because our original vets recommended it. We fed him less than the recommended dose for his size because we were aware that he has always been an easy keeper. 

I have been looking at the materials on the website but I can't find a specific recommendation for the amount of Beet pulp to use to mix with the salt+minerals+flax your diet plan recommends. Can you please clarify how much Beet pulp would be appropriate? Bullitt is 39 inches tall, can you also explain what an "ideal" body weight for him would be? I have seen conflicting information online and from the different vets we have had. I am more familiar with the body condition score, but the weight information would be helpful if you can provide. He is a pony sized (height) mini. 

I will correct his case report - I caught a typo - his first laminitis incident was in May of 2016, not this year. Sorry about that. It is correct in the comments section. We have not had blood work done this year. Our vet recommended doing it now, but we are concerned that while he is still in this laminitis bout that the results will be biased. What are your specific recommendations? I will take proper photos today, but admittedly he meets many of the descriptions of EMS/IR - cresty neck, fat pads on shoulders, etc. 

Do you have any recommendations about stopping the Bute or tapering him off? We are concerned about pain management in this phase of the laminitis. Should we be replacing it with another NSAID? How quickly should we expect dietary changes to help? 

Thank you so very much for your help. We are so grateful for all the information and resources from this group. 

--
Sarah O. 
Rudolph, WI
2020

Hi Sarah

1) soaking hay - great job. Make sure you soak 1 hour room temperature water and drain the water well away from where the pony can get it.
2) beet pulp - make sure you rinse soak rinse. This is mentioned in the Emergency Diet so do look at it for further details. You only need to feed the minimum amount as a carrier to get his salt and supplements in. If all you need is a small handful, that's fine.
3) pain - try cutting padding to duct tape on his feet and see if he becomes more comfortable. Popular homemade pads are eva foam or foam children play gym floor mats, old wool or synthetic saddle liner, easycare pads, cloud pads (these seem to suit a wide size of ponies to horses but I have not tried on a mini - they do last very long). You may have to try different softness/density to find what he prefers currently. I searched the forum on stopping bute and weaning off and found advice from someone very experienced (Dr Jaini) https://ecir.groups.io/g/main/message/239008 :

"There is a good anti-oxidant pain reliever called PhytoQuench, that people have had success with:  https://uckele.com/phyto-quench-powder.html  Another anti-oxidant/pain reliever is Mov-Ease from My Best Horse:  http://mybesthorse.com/movease.html    Rather than stopping the bute cold-turkey, it is best to take a week or so, and stretch out the doses. So, go from twice daily to once daily for 2 doses, then next dose 36 hours later, then go 48 hours, then stop. (longer weaning off of bute to avoid "NSAID rebound pain" when they have been on the bute a long time, but for Brandy you can fast-track as he hasn't been on it that long).  There is more information in this folder:  https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives  , including a file on transitioning from bute to Phytoquench."

--

Hi Sarah, glad you found us! 

1/4 cup (measured when dry) RSR beet pulp is probably just enough to hold the supplements, but I know when I add the daily dose of salt to that small amount it makes it harder for my guy to eat it because it's too salty.  However, he does eventually eat it all.  You may need to feed salt (or some salt) separately or use a little more beet pulp.  Beet pulp is calorie dense so experiment to find the minimum amount that works.

If he is a lot of pain still, we generally advise holding off on testing as stress and pain can increase insulin and ACTH and scew a diagnosis.  But usually once they are on the emergency diet, pain often drops off within a couple days and you can have blood pulled.  He does not need to be completely pain free for testing, just not in a full blown acute phase of laminitis.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History  
Shaku's Photo Album   

Hello Everyone, 

Thank you so much to those of you who responded about Bullitt. It has been very helpful. He responded very well to the emergency diet and we were able to taper him off Bute within 48hrs of starting the diet. He was still a little sore at first but much improved and his hives subsided from the Bute. 

We have the hay testing results and would like some help figuring out what they mean and how to get the proper diet for him. This is my first time with any type of hay analysis. I have uploaded the three files to the case history folder, one for each of the types of hay we have available. 

I have also uploaded a couple body shots of Bullitt, but will try to replace with better ones as well as hoof shots soon. 

Thank you all again, 
Sarah 
--
Sarah O. 
Rudolph, WI
2020

Thank you Sherry, 

I appreciate your help. I would love more help with the hay analysis as I have never done this before. Bullitt is loosing weight on the emergency diet and I don't think it is in a healthy way. He still has a little bit of a cresty neck and a little fat around the tail but I can now see his ribs. Our vet has recommended exercise to help with that once he is sufficiently recovered. I would really appreciate any further insight into how to balance the hay. I feel like this diet is making him worse instead of better. It helped with his feet initially but it is now reaching a point that I am uncomfortable continuing. We spent quite a bit of money to get the hay tested and I would like to make the most of it if possible. 

Thank you, 
Sarah 
--
Sarah O. 
Rudolph, WI
2020

Hi Sarah,

In case this is of interest, Easycare now makes a boot for mini's, called the Easyboot Mini. These boots have made a huge difference in comfort with my mini, Bella, in dealing with laminitis. 

There are 3 sizes, and the cost is $45 apiece. Easycare has a generous return policy, where you can return the boots within $45 days, even if used. And their customer service over the phone is very helpful. Plus, the boots are totally cute.   https://www.easycareinc.com/our_boots/Easyboot-Mini.asp

Lynn Cox
Kern County, CA
May, 2007　

Bella Case History   https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Bella
Photos, Bella, Destiny, Zoe, Pip   https://ecir.groups.io/g/CaseHistory/album?id=247665  

Hello Sherry and others, 

I have gradually weaned Bullitt onto the #1 hay on the hay analysis in our case history. This had much lower ESC + starch than the "March" hay we were feeding with soaking, but even with soaking this #1 hay his symptoms for laminitis seem to be getting worse and he has developed hives even though he was on this hay in June and July before he had the laminitis and he had no issues with hives. I can't put him on the #2 hay which has the least amount of ESC+starch because the calcium ratio is way off and we are still desperately trying to figure out the mineral balancing. He has also started eating poop which is very concerning to us. Between the hives and the laminitis we are really struggling. There is nothing in his diet right now but soaked hay and the rest of the emergency diet because we are still trying to work out the mineral balancing. I don't know what to do about the hives because there is really nothing I feel comfortable leaving out from the emergency diet because it is already so minuscule in terms of nutrition and I feel like that is why he is eating poop. It seems like no matter what we do his situation is getting worse. Any input from the group would be welcome. 

Thank you, 
Sarah 

--
Sarah O. 
Rudolph, WI
2020

Hello Sherry and others, 

I have first tried to work out the balancing on my own. I am furloughed and my husband is facing a potential layoff due to COVID-19 so we are trying to be as economical as we can. There are some real financial challenges we are dealing with right now. I have reached out to some people on the list but have not heard back yet. 

We are not currently treating the hives; our vet is unavailable and we have reached out to another vet with no success yet. We added one of our smartpak supplements back for just 1 day over a week ago about the time we started making the switch with the hay because of the poop eating, but then we immediately stopped the supplements when the hives appeared. We were going to try that in very small amounts just until we got things figured out with the mineral balancing. At first we thought that the supplements were the issue, but like I said it has been more than a week back on just the emergency diet and he continues to decline both in the hives and in his laminitis symptoms. He is walking much worse than a week ago and has not been off stall rest. 

I appreciate your quick response. 
--
Sarah O. 
Rudolph, WI
2020

Hi Sarah,

A few issues stand out:

- the ongoing and now worsening pain has several possible components:
   - undiagnosed PPID driving insulin
   - NSAID dependence leading to exaggerated pain when you drop the dose (and 1.5 g is too high for him)
   - NSAID depressing abscess mobilization leading to exaggerated pain when tapering off
   - abscessation as above
   - trim issues
   - Lyme disease

- need that blood work sooner rather than later -  insulin, ACTH, Lyme Multiplex

- need hoof photos as per instructions in the Wiki

- the calcium deficit in hay #2 could easily be corrected with a combination of beet pulp and crushed human calcium pills.  For the time being I would continue to soak his hay regardless of which one you use

- your diet can't be balanced yet because you don't have a trace mineral analysis [iron, copper, zinc, manganese]. Once you have that information I can balance it for you free of charge is you use Uckele supplements (5% discount for members of this group)

It helps to remember that the focus should never be on blocking pain. It should be on removing the cause of the pain. Big difference in the game plan that way. Metabolic laminitis is not inflammatory so antiinflammatory drugs like NSAIDs don't make much difference. However, the body can become dependent on them and hypersensitive to pain if they are used long term and then stopped. You can taper off while having both Jiaogulan https://uckele.com/jiaogulan-powder-1lb-bag.html and Hemp Joint (Devil's Claw plus Hemp) https://uckele.com/hemp-joint-support-2lb-bag.html on board to start (use coupon code ECIR). If he does have abscess collections that need to drain (very common), he will need to go through that process before getting more comfortable. That should take an average of 10 days to 2  weeks after stopping the NSAIDs.

However, it's also important to keep the big picture in mind. PPID, Lyme and trim issues need to be ruled out as contributing to the laminitis and pain.

As for hives, it may or may not be related to IR or PPID. A food allergy is the least likely cause. Antihistamines are safe if you want to try that. In some cases just getting minerals properly balanced makes them go away.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Sarah,

If you are going to have your hay re-tested to get the 4 trace minerals Dr Kellon said are missing, please do also request that ESC and starch are analyzed by wet chemistry/ICP methods this time so you get accurate numbers since these are so important.  I don't know how cost compares between River Rock and Equi-analytical, but the 603 package at Equi-analytical will give you the best, most complete data.  You could ask River Rock what their equivalent is then compare prices, just make sure River Rock gives you a price for wet chemistry analyses, not the cheaper and less accurate NIR analyses.  If River Rock still has your samples you could ask for a quote to add on ESC, starch, Fe, Cu, Zn and Mn, all by wet chemistry to your original analysis.  Might be cheaper overall.

Personally for now I would choose the hay that appears to have the lowest starch, which soaking cannot reduce, but still continue to soak the hay to lower the ESC.  I believe that is hay #2 as Sherry suggested, which appears to have the lowest ESC as well.  The minerals are less important than getting him comfortable by lowering sugar/starch at this moment.

Dr Kellon has already told you what else is a priority: blood work and hoof photos.  You can get a first full evaluation here for free of the hoof photos if you take a full set as per these instructions: https://ecir.groups.io/g/main/wiki
(scroll down to Photos and Evaluation Help and read all the links)

Hope that helps a little.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History  
Shaku's Photo Album   

Thank you all for the advice. I greatly appreciate it. However, as I mentioned earlier there are some real financial constraints and also physical ones that limit our ability to do everything that you ask in this group precisely the way you have required them to be done. I cannot get the hay tests redone without starting over from scratch and we had to search for someone with the hay drill and they had to come out and take the samples and send it to their lab, which is why we have the results we do. Our main vet clinic closed in July and since then we have had to practically beg the only remaining vets in our area to come and take care of our two minis. All of the other clinics have refused to see us. One of the only two vets we have has refused to do any bloodwork on our mini even after we sent him the link to your web page with all of the detailed information. We also having trouble getting farriers out to our area. We are scheduled for a trim on Monday, but there is no point in posting photos now that I know are bad when I will just have to pay down the road for follow ups. 

I believe that all of you have our best interest in mind, but I hope none of you face the job loss and other challenges that we are currently struggling with on top of this. Perhaps I am just not wealthy enough to take the best care of Bullitt, but I am trying my best. We have ordered the  Uckele U-Balance Foundation in hopes that that will help and be here much sooner than if we keep waiting and trying to get this done over again. Hay analysis would cost as much as this supplement, which is already very expensive (as others have noted in the reviews). It would take us more time to get all of the hay tests and results in order and I want to do what I can now since it has been ongoing since July. 

Thank you for your time, 
Sarah 

--
Sarah O. 
Rudolph, WI
2020

Don't worry, lots of us understand financial constraints, although obviously the degree of which varies widely.  We will still always advise you with what is best to do, but then you can chose your priorities within your budget.

If you can't retest the hay, just make sure it is soaked and use an all around mineral supplement that has no added iron, sugar (molasses) or other no-no foods, like the Uckele U Balance.  California Trace, Arizona Complete, Vermont Blend, Amino Trace+ are a few others that come to mind.  Some states have regional databases of typical hay analysis ranges that you could also use to best-guess which supplement is a good fit if you know where the hay was grown.  I'm sure some of our American members could advise more on that.

The first markups are probably the only ones you'd need for quite some time because Lavinia shows you where you need to go, not just what to do at the next trim.  Until you reach her goals, you can refer back to them over and over again, as I do.

For future reference, equi-analytical will mail you a probe for taking your hay sample for I believe just the cost of shipping.  So will some other places.  Might be cheaper than having someone come do it and not getting the best data to work with.  If that helps for next time.  :)

Anyways, we are here for you and we know you are doing your best.  That's why you are here, too. 

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History  
Shaku's Photo Album   

Hello Kristen and others, 

Thank you for the kind and supportive email. I appreciate it. This has been confusing and overwhelming. We have had two different vets working with us and each contradicts the other and the information on this website. We are so limited here with vets that we don't want to alienate anyone. It has been very challenging on top of our financial issues. I want to get through this crisis and then have the information for how best to move forward. It is just a lot to do all at once. We really are trying to do our best. I hope the Uckele U balance will help address the diet issues along with continuing to soak the hay. 

I uploaded hoof photos from today. I tried to clean them the best I could, but he is still pretty sore and not very cooperative. I know that they look very different to me than his non-laminitis state. I have tried to follow the instructions for labeling and posting the photos to the photo album, but what do I do next to get the assessment? What do I do once I have it? Our farrier is coming Monday (Sept 21). I am just not sure where to go from here. This is my first time dealing with any sort of laminitis. 

Thank you again for your help. 
--
Sarah O. 
Rudolph, WI
2020