General Advice


Carrie Bronner <carrie.espanasilk@...>
 

Good Morning all! This is my 1st post since I only just joined the group this morning. I have an 18 yr old mare that I suspect is IR. We purchased her 3 years ago, when we got her she was extremely obese but hadn't been ridden in probably 5 years and was just turned out to pasture. The boarding barn we were at had limited pasture so she was fed mostly grass hay and a minimal amount of Tribute Kalm N'Ez. She was ridden 3 to 4 times a week, became fit and was doing well. We moved to a friends barn the following spring and all the horses there are pasture kept 24/7. My 2 mares were on a 15 acre pasture and it soon became apparent that she could not handle the grass. She developed large fatty deposits and had off and on lameness issues. We moved again but this time to a barn with limited pasture again. She is getting a cup of Tribute Essential K (with a mineral supplement) 2x a day and is getting soaked grass hay. She is not getting the exercise she needs mainly because my daughter is 17 (enough said) and I had spinal surgery so was not able to ride her myself. I am just now back in the saddle so will start exercising her again. My question is even though she is on limited grass, eating soaked grass hay and on such a small quantity of feed we can't seem to get the fatty deposits to go away. I called the vet this morning so that we could get some blood tests done. From reading on the website (https://www.ecirhorse.org/ecir-group.php) it looks like we need to measure the level of endogenous adrenocorticotrophic hormone, do a Throid-Releasing (TRH) Stimulation Test, Cortisol Rhythm Test, obtain a non-fasting glucose, insulin and leptin. Is this correct? What else should we be looking for? Also is her feed ok or should I stop feeding the Essential K since the combined NSC and starch are 12.5%? Maybe use beet pulp to feed the supplement? Thanks in advance for all advice. I have never had a horse with this issue before and just want to make sure I am doing all I can for her.

Carrie
Indiana, United States
Joined Sept. 8, 2020


Kirsten Rasmussen
 

Hello Carrie,

Welcome to the group! 

Its great that you are being proactive and joined the group before a laminitis event!  Most people arrive here in crisis or at the tail end of it.  So well done!  Please do take the time to fill out a Case History so that we can find all your mare's information in one place, as well as any details missing in your post.

Yes, is sounds very much like she is IR, however, we really do recommend having the bloodwork to base the diagnosis on.  Until then, definitely treat her as IR.  At this time of year, the TFH Stimulation test is not done.  Instead, you can do a baseline ACTH, insulin, and glucose test from a single blood pull, although your vet will have to process the sample by centrifuge and separate various components for the different tests.  Leptin is optional, it can be a bit expensive and is not critical for diagnosis.  Non-fasting means the horse has had access to her usual forage (in your case you can test her while on the soaked grass hay as she will still likely have abnormal insulin given the signs you've described) before the blood pull, and for at least 4 hours in the morning if she ran out of forage overnight.  Make sure the blood is kept on ice or refrigerated until your vet can process it, and then frozen before shipping with ice packs.  We generally recommend Cornell for bloodwork, which has discounted shipping labels your vet can download from their website.  Do not test her after trailering or exercise or any other kind of "stress" as this can falsely elevate insulin and ACTH.

Because of all her body signs of IR, I would stop feeding everything  -  including the limited grass  -  but the soaked hay right now (as well as the other items in our emergency diet, see the "Diet" section below).  Yes you could feed her minerals on a small amount of rinsed-soaked-rinsed beet pulp but its high in calories so only feed the amount of beet pulp she needs to eat her minerals.  However, the Tribute Essential K is high in iron, and has a soy-alfalfa-wheat base as well as added molasses, all of which are problematic for IR horses so I personally would stop that as well and replace it with a custom mineral supplement that matches the deficiencies in your hay.  To do that, you will need a hay analysis with major and trace elements, as well as ESC and starch (done by wet chemistry methods).  If you cannot test your hay because you buy it from a dealer as you need it, there are other mineral mixes like California Trace that are free of iron and added sugars, and will help probably about as much as the Tribute Essential K without the added harm from the iron etc.

What follows is our standard welcome letter.  Take some time to read through it, clicking on the links that are relevant to you for more information as needed.  And let us know if you have any more questions.


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. 



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


Carrie Bronner <carrie.espanasilk@...>
 

Thank you so much for all the information! I printed out the emergency diet and will be implementing that immediately. I also have a call in to my vet for the bloodwork. I will fill out my case file as soon as I have all the required information! Thanks again! I believe this site will be indispensable! 
--
Carrie Bronner
Indiana, United States
September 2020