Topics

Current Sinking Founder- 7yr Pony


Victoria
 
Edited

Approx 7yr old Welsh/Shetland. Only ever been on hay in net and salt lick in a dry lot. As of May 2020 IR went from 44 to 170 in June. In May she started on a tablespoon of Thyrozine. To get her to eat the powder I give sprinkle of Triple Crown Ration Balancer, Sprinkle of Alfalfa pellets, 500IU vitamin E, teaspoon of chia seeds, teaspoon of kirkland powder turmeric once a day. I also started soaking hay in May 4lbs am and 4lbs pm. She tape measured at 660lbs and should probably weigh 500lbs. Now she is sinking!!! In soft ride boots. Banamine 500lb dose am/pm. Started Sept 5th Metformin 18pills am and 18pm. What am I doing wrong? If she doesn't eat throughout the day she is destructive. Leptin, glucose, acht all normal range. T4 high due to thyrozine- her mane and tail are falling out in chunks.



--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.doc


Lavinia Fiscaletti
 

Hi Victoria,

Sorry that Pippa is in trouble. Unfortunately, I can't open your case history document. Would you please check it and try uploading it again. Please let us know if you have any problems.

You'll be receiving a full welcome soon. Until then, a few things that can be tightened up are stopping the TC ration balancer and alfalfa pellets as both aren't safe for IR equines. Vit E should be doubled to 1000iu. Need 2-3 ounces of either ground flax or ground chia for her size. She needs to have at least 2% of her ideal weight in total feed per day - so that would be a total of 10lbs minimum. Too little food will only shift her body into a "starvation mode" where she will conserve calories instead of losing weight. It will also increase her appetite. Serve her total soaked hay in small mesh haynets, divided into a minimum of 3-4 times per day.

Has there been any change in her hay? That huge jump in her insulin levels could most certainly have induced laminitis. Any possibility she has eaten any odd weeds, leaves? Has Lyme disease been tested for?

Forget the Turmeric. The foundation for pain control and recovery is DIAGNOSIS.

Thyrozine does nothing for IR, although it may temporarily induce hyperthyroidism, which can help jump start weight loss. Hyperthyroidism can lead to hair loss, so that is one possibility.

If the Metformin piils are 500mg each, then the dose is correct for her.
High selenium ingestion can lead to the mane and tail falling out as well as major laminitc problems where the hoof capsules can slough entirely. Have you had your hay tested? If not, that would be a priority. In the meanwhile, you could transition her to entirely eating Ontario Dehy Timothy Balance Cubes, also available from Triple Crown as Triple Crown Naturals Timothy Balance Cubes. These are available thru any TC dealer. That would make sure her diet is safe and properly balanced.

How long has she been on the banamine?

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Eleanor Kellon, VMD
 

Please get hoof photos up ASAP.

The thyroxine may accelerate weight loss but doesn't change insulin resistance.

Soaking is no guarantee your hay is low enough. You need to analyze a sample that has been soaked then dried before shipping. Agree she should be getting 10 lbs/day.

Your Banamine dose is too high. Long term use has the same toxicity as phenylbutazone. It is only labeled for 5 days of use. It can also block the mobilization of abscess/fluid collections which only prolongs her pain. I would wean her off ASAP and replace with Jiaogulan.

Considering your location I would strongly suggest Lyme testing. It's odd her leptin would be normal so something else may be driving the insulin.  IME, laminitis with Lyme infection typically presents as sinking. There may also be exaggerated pain.

Mane and tail coming out in chunks sounds like reaction to tick bites or other insects. Fungal infection can also do this. Dermatophilus/"rain rot" can do this but not likely to only be mane and tail. Selenium causes mane and tail hair loss but not in chunks. Easy enough to check with a blood test. Hyperthyroidism causes hair loss mainly on the body.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

P.S.  Any history of Strangles, Strangles vaccine or Strangles exposure?  Any fever or diarrhea  (Potomac Horse Fever).
 
The thyroxine will also increase her appetite and can cause behavior changes.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


~NeanPiggy~
 

I have hoof pictures and a body shot from her trim yesterday, 4 Sept.  I just sent them to her to try and upload.  I don’t think I can do that for her??? Last trim (29July) was when there were subtle changes in her feet the hoof pain started the next day.  This trim her soles are even flatter and on the FR you can see the bulge of P3.  I did draw with a red sharpie on the hoof so you will see that in one of the pictures.  Relieved all wall pressure as best as possible on an uncomfortable pony.  I also beveled heels to plane of P3.  White lines all look tight with no pink or signs of inflammation.   She is not showing any laminitis growth rings yet.  Had pulses no heat.   Switched from RX boots to Soft Rides, increased hoof comfort.  Vet coming Mon to do Rads. For size scale her hoof is a 00 RX and an 8 soft ride.  Cresty neck, fat deposits on ribs and rump. Puffy orbital sockets.  
--

Jeannean Mercuri, Cricket, Monk & Rainbow Prince Willy Mercuri ~ PHCP Barefoot Trimmer/Mentor

Ridge, NY 2011

https://ecir.groups.io/g/CaseHistory/files/Jeannean%20and%20Prince%20Willy/ 

https://ecir.groups.io/g/CaseHistory/album?id=79126 


Maxine McArthur
 

Hi Victoria
To add to the responses you have already had from Dr Kellon and others, here is our welcome letter that we send all new members. It contains a lot of important information, so please read through it carefully, and ask any further questions you may have. 

Just a couple of quick housekeeping points first--this is not nit-picking, it is so we can quickly access your information and help you faster. At the moment your precious case history is floating around in the Files on the Case History group without a folder to live in. Could you please go here:
https://ecir.groups.io/g/CaseHistory/files
and click the blue 'New' tab with the little arrow, choose 'new folder'. In the folder name, write 'Victoria and Pippa'. Then click 'Add'. 
Now click on the blue 'uploaded' at the right-hand side of the list of folders. This puts the folders in order of uploading. You may have to click 'uploaded' twice to get the newest first. That will show you your 'Victoria and Pippa' folder. Open that folder, click the blue 'new' button again, and choose 'upload file'. Please upload your case history into the folder. 
So that we have the correct link in your signature, please copy the URL of the case history again (as you have done already, but this time it will be with the link to your folder) into your signature box in 'Subscription' on the main page and Save. 

One more thing--when you get the actual test results from your vet, could you please fill out the details in the 'test result' part of the case history with the range, time of day, whether the pony was fasted and if not what did she eat, etc. These details are important. 

Finally, on to the welcome message!

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 etiquettewhat 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.

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.

 

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
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Lavinia Fiscaletti
 

Thanks for the update, Jeannean.

Glad to hear she is working with you.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Victoria
 
Edited


Victoria
 

Thank you.
The Banamine was started on 9/1/2020 and I have been giving 500lb dose am/pm everyday since. Metformin is 500mg. The hay was tested in May, I know every batch can be different even if its from the same location but when I did test the NSC was about 10.6%. I will upload my test results.

So if I switch her to Stabul 1 and TC Timothy cubes, how much should I be giving her exactly? She'll be going from no grain to the stabul1 (which is a grain?). Will she still get 4lbs soaked hay am and pm?
I will up the Vitamin E to 1000 IU and 1/4 cup chia seeds. The turmeric was really just a flavor cover for the thyrozine and metformin.


--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218


Victoria
 

No strangles or vaccine. Poop Normal. I will check temp in the morning.
--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218


Lavinia Fiscaletti
 

Feed her a total of 10lbs per day, weighed dry. You can split that into 4 meals of 2.5lbs each. Add hot water to them and they will fluff up nicely in about 15min to a much larger mass so it will take longer to consume. Ideally, you want to feed every 6 hours, so she doesn't go more than 6 hours with nothing to put in her mouth.

You don't need to use Stabul 1 but if you want to use it as flavoring, a handful should be plenty at each meal. A handful is about 1/4 lb, so figure that into the daily totals. Just add the vit E, plain table salt and flax/chia  directly to the soaked cubes for a diet that is completely mineral balanced and known to be safe without having to test.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Kirsten Rasmussen
 

That hay test does have high iron and protein (which leads me to think it might be high in nitrates), so I think trying the cubes as suggested by Lavinia and seeing if there's a change might be helpful.

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


Victoria
 

I started with the triple crown timothy balanced hay cubes today. She has refused to eat all day, whether very wet or barely soaked. I put her meds and supplements (chia and vit e) in one of meals so I'm not sure if she got any of the thyrozine or metformin but I don't want to give another dose? Do I just leave her with the cubes and hope she gives in or should I also give one flake soaked hay? I'm afraid to make anything worse. Thanks.
--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218



Victoria
 

Hi guys, I'm really sorry, I'm starting to panic. I just emailed vet awaiting response.

It has been almost 24hrs to switching to hay cubes. She will not eat. I tried putting a small handful of her hay on top, I also mixed some in, I tried turmeric. I've gone through almost a whole bag trying different things to entice her. Yesterday she chose to eat the tree and shavings. She laid down most of the night and can get up so that is good but she seems weak this morning and won't leave her stall (normally food and water kept in paddock) I brought everything in/closer for her. I don't want her to become dehydrated. Much less poop obv because she isn't eating. Bracing on back legs and shaking. I will syringe her metformin in this morning so I know she gets that. I'm at a loss.
--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218



celestinefarm
 

Victoria, I would consider this an emergency and I would have the vet out asap. These are not normal side effects. I'm not going to venture a guess as to what it could be, but her symptoms say emergency. Keep us posted after she sees the vet. Is there anything poisonous she could have gotten into in her paddock? What kind of tree is she eating?
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Victoria
 

Hi, the vet just left. I uploaded the xrays in the album with link in signature (sorry poor quality until I get them emailed to me). Definitely nothing in her paddock besides a big oak tree. I rake a few leaves and any acorns a few times a day. We are adding gabapentin and bute in addition to the metformin and thyrozine. If we cannot get her more comfortable this week I do not want her to continue suffering. It has been a struggle just to get the meds into her without adding more problematic food.
--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218



Kirsten Rasmussen
 

Could the oak tree be the problem?  If she's eating it's bark, leaves and acorns? 

https://ecir.groups.io/g/main/topic/34106990#240357

I would block her access to it ASAP!  And make sure she can't get any leaves or acorns, raking them up is not enough unless you can be there 24/7 raking.

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


Kirsten Rasmussen
 

https://ecir.groups.io/g/main/message/243076

What to do for acorn induced laminitis.

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


Victoria
 

She only started gnawing it on it yesterday because she did not want to eat the hay cubes and I didn't give her any hay. She has always been in that paddock for years and my entire property is surrounded by oaks, her paddock unfortunately is the safest. But literally I do get almost every leaf and acorn. Do you think that could have caused the IR? I will chicken wire around the tree.

--
Victoria
Smithtown, NY
2020

https://ecir.groups.io/g/CaseHistory/files/Pippa/Pippa%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/album?id=253218



celestinefarm
 

Victoria, finally had a chance to look at your album and the hay analysis.  Agree that the analysis shows really high protein, is this grass hay? I would also be suspicious that it is high in nitrates.  The ESC and starch are well within acceptable range which is why the high protein is suspicious. You can call Equi Analytical tomorrow and ask them to do a nitrate test on that sample of hay. It's a $6 charge, they can do it relatively quick and at least you would have an answer. 
You do want to keep her away from the oak tree for reasons stated earlier. 
Something else you can try for her right now if she refuses to eat the Timothy Balance Cubes is Triple Crown's Safe Starch forage. It comes in a bale and you will want to weigh out the appropriate amount. She may be more willing to eat it. The Timothy balance cubes are cubed with beet pulp which for some equines is an acquired taste. It could be the reason she is refusing them. 
https://www.triplecrownfeed.com/products/safe-starch-forage/
If you can't find it asap, then another substitute is Green Meadows Equal Balance.

 Image result for green meadows equal balance
--These are temporary measures until you have a better handle on what is going on. What did your vet say? 
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .