KSU iron panel


K Hanneson
 

Hello, I'm a new member and have uploaded the case history, photos and files for my Icelandic gelding Magni.

After the onset of this bout of laminitis several months ago, he is generally improving - he is moving around reasonably comfortably in a dry lot although I would say his feet have a ways to go.  But there seem to be some underlying conditions that are concerning that I would like to get a handle on and figure out how it is all related.  He's quite thin, which is unusual for an Icelandic, although he is eating well.  There is some indication in the blood chemistry that there is some concern about the liver (e.g. elevated GGTP), and I'm also wondering about iron.  One batch of hay that I had tested last winter was quite high in iron so we did a metal/mineral blood test which showed high iron.  Has anyone in Canada done the KSU iron panel - sending blood across the border?  Or is there somewhere in Canada that can do it?  What are the indications for doing this test? Anything else I should be looking into?

I would appreciate some help with the hoof photos, his next trim is scheduled for July 27.  Do I just ask here or is there a more formal process?

I'm sure I have a million more questions!  But for now, happy to have joined the group and appreciate everything I'm learning and reading about here.  I hope all my files and info are in the right places. Thanks!

--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


Cindy Q
 
Edited

Hello Kathy

Welcome to the group! Searching the forum, I see someone did do ferritin from Canada but that was several years back. Dr Kellon has said to another member that you can check with KSU if they still have import permits for Canada to get ferritin: https://ecir.groups.io/g/main/topic/41883626#242792 . I will flag your question out to Kirsten R in case she had any luck with that to chime in.

I noticed you are feeding Mad Barn Amino + and added copper zinc from them 3x a week (is this due to lack of access to do daily?). I'm not sure how you arrived at this but you may wish to check with one of the ECIR listed balancers on your diet, seeing that you seem to have a more recent change of hay. Your hay's ESC, starch and fat levels look ok for IR horses, but bear in mind if that this was by NIR analysis and not wet chemical, it can vary quite a bit off the accurate reading. From your IR calculator results, Magni is IR (and these figures still show risk for continuing laminitis). Are you rinsing soaking and rinsing your beet pulp pellets (as described in the emergency diet linked below)? If not well rinsed, there can be a lot of surface iron in beet pulp as well due to the processing. You answered "no" for is your beet pulp without molasses - not sure if this is by accident but do you mean you are feeding beet pulp with molasses. Either way, use beet pulp that is without molasses.

Is there a specific reason why you are feeding nettle? I saw you consulted a herbal practitioner. I think nettle can be high in sugar. If in doubt, best to revert to the Emergency Diet as that is safest especially with ongoing high insulin/laminitis.

For hoof input from Lavinia, asking here is fine and I will flag your question to her to have a look at your pictures. Good job with the ground level pictures where required and labelling.

I will set out our official welcome letter below. There are a lot of details there which set out our advised protocols.

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





 

Hi Kathy and welcome!

I took a look at Magni’s body shot and to me his weight looks good.  The amount of hay you are feeding should support a bit larger horse.  Are you weighing it out?  Is he eating it all?  The hay tests at less than ten but over nine percent ESC plus starch, which may still be too high for some IR horses.  If the test is near infra red (NIR), the values might be even higher.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


K Hanneson
 

Thanks Cindy!
Re Beet Pulp - No, I haven't been doing R-S-R.  Being at a boarding barn, I'm not sure how I would manage that.  And I did mean NO to molasses - I read that wrong on the form.
Re 3X/week for Copper/Zinc - I'm going by what the herbal practitioner suggested, not sure why, but I'll ask.  
Re sugar/starch levels - checking into NIR vs wet chemistry, will advise!

Thanks!

--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


K Hanneson
 

Hi Martha - yes, he's getting 18-20 lbs/day (weighing 3 bags between 6-7 lbs each) and eating it all.  I have been soaking it about 30 min/day but weaned him off the soaking when I got the test results at < 10% ESC + starch.  I'm checking in to the NIR vs wet chemistry question to get clarification from the lab (It's the Equine Complete package from SGS labs in Guelph, ON).  I'm glad you think he looks OK. 
Thanks,
--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


Kirsten Rasmussen
 

Hi Kathy,

I haven't done the KSU iron package so I cannot advise.  You could try calling the lab?  In the grand scheme of things, I just assume that my horse is iron overloaded due to his 25 or so years on the west coast where acid soils would increase iron in hay/pasture dramatically.  Knowing for sure if he is iron overloaded wouldn't change my management of him: feed as low of iron diet as possible, and balance trace minerals to the iron as per Dr. Kellon's recommendations.

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


Sherry Morse
 

Hi Kathy,

Just adding my opinion to Martha's, but Magni appears to be at a good weight.  Most ponies are fatter than they should be and fatter is not healthier.  Particularly with IR horses we want to see them at no more than a 5 on the Hennecke scale. Were he mine instead of feeding him so much hay I would cut him back to an amount that supports an ideal weight of 750 which is about where he is now.  That would be 15lbs a day TOTAL (hay and any carriers).  I would also continue to soak the hay as many IR horses can't handle ESC+starch so close to 10% and if he's showing continuing soreness it's best to err on the side of safety, although his trim could be contributing to that as well.

To get a trim evaluation it's best to post a message that says something like "Lavinia, trim advice needed" so Lavinia knows you need assistance.  Please do that at least a week prior to any scheduled farrier visit.

For help with hay balancing see the Balancing information in the files: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing and particularly https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf which is the list of people who can help with balancing tested hay




K Hanneson
 

Hi Sherry, no I don't want a fat pony!  I do think he's filled in a bit since 3-4 weeks ago when you could see every rib.  Thanks for the advice about the amount of hay and soaking.  I'm a boarder, and soaking is a bit of a logistical problem... OK for now.

Cindy offered to flag my message for Lavinia.

Thanks!

--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


Lavinia Fiscaletti
 

Hi Kathy,

I took a quick look at Magni's photos - thanks for uploading and labeling everything.

Quick question - were there any changes made to his trim between when the hoof photos were taken and when the body shots were taken?

Thanks.

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


K Hanneson
 

Hi Lavinia,
No, the last trim was July 6 and the hoof and body shots were all taken after that.
--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


Lavinia Fiscaletti
 

OK, thanks, Kathy.

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


Lavinia Fiscaletti
 

Hi Kathy,

Magni is adorable. I've added mark-ups to his album:

https://ecir.groups.io/g/CaseHistory/album?id=266135

Although the radiographs were done in March 2021, it appears that there hasn't been much change made in the trim since then, so they are still relevant. All toes are too long horizontally, putting the breakover ahead of where the bony column needs it to be. Heels are underrun to some degree. Soles were adequate but not excessive in the March rads. There is significant sinking present, which translates to hoof capsules that need to be taller than average to be able to encase the entire bony column properly. Goal of the trims should be to bring the toes back considerably so that the breakover gets set where the bony column needs it to be; remove the wall flares all around; correct any medio-lateral balance issues that are contributing to the flaring. Here are a few links to more in-depth info:

https://www.hoofrehab.com/Breakover.html

https://www.hoofrehab.com/HeelHeight.html

https://www.hoofrehab.com/HorsesSole.html

LF dorsal composite: On the rad side, green lines follow the ange of the new graoth toward the ground. Blue areas are the flared wall that needs to be removed. The lateral wall appears to be a bit longer than the medial one but the foot also appears to be attached somewhat crookedly as well. Need to check both collateral groove depths to assess whether both sides are as balanced as possible.
On the photos side, the green lines correspond to those on the rad and the blue areas are the flaring that needs to be removed.

LF lateral composite: On the rad, the pink line shows how the bony column aligns and ends at ground level where the breakover point needs to be. Green line follows the angle of the new growth toward the ground. This is NOT a trim line, just a visual for where the dorsal wall would be if it were well attached. Note that the green line runs parallel to the pink one. Blue line is where the toe should end, with the blue X the excess toe length.Orange line shows where the heels should line up. Lime line across the bottom is where the bottom of the foot needs to remain. Yellow line #1 runs thru the coronary band, #2 points to the extensor process. Theses should be overlapping - the distance between them denotes the amount of sinking.
On the photo, the green and orange lines correspond to the ones on the rad. the solid blue area corresponds to the blue X on the rad and is the excess toe length that needs to be removed.

LF sole: solid blue line is where the perimeter of the foot should be, with the blue hashed area being the flared walls and toe that need to be removed. Lime lines indicate a large flap of periople that can be trimmed off. Soles, bars and frog should be left alone. Rocker the heels but don't lower them.

RF dorsal composite: Same idea as the LF, with the blue areas being the flared wall that needs to be removed.

RF lateral composite: On the rad, the pink line again shows where the bony column should align. The purple line follows the actual alignment - note how it drops slightly back and down from the pink line. That's a broken back HPA (hoof-pastern axis), which is due to a combination of the sinking, long toe and underrun heels. Blue X is again the excess toe length that needs to come off.
On the photo, the solid blue area corresponds to the blue X on the rad, which is the excess toe length.

RF sole: Solid blue line is where the perimeter of the foot is when healthy, with well-attached walls. Blue hashed area is the flared wall/long toe that need to be removed. Lime hashes are on another piece of periople that can be trimmed away.
Purple lines are on the leading edge of the lateral bar that can be lightly cleaned up. Leave the soles, rest of bars and frog alone. Rocker the backs of the heels but don't lower them as that would negatively impact the HPA.

LH dorsal: Same discussion as the fronts - blue is the flared wall that needs to be removed.

LH lateral: Same idea as the fronts. Blue area is the extra toe length. Green line is the visual for where the dorsal wall would be. Orange line is where the heels should be. The yellow lines follow several of the horn tubules from top to bottom. These tubules should run parallel to the green and orange lines but they are at a much shallower angle, which is due to the heels being run under and the entire foot having squished forward.

LH sole: Back the toe to the solid blue line, bevel the walls and heel walls out of ground contact around the entire perimeter. Again, rocker the backs of the heel buttresses but don't lower the heels as there is no vertical height to work with.

RH dorsal: Blue are on the lateral wall is the flare that needs to be removed.

RH lateral: Same idea as the other three.

RH sole: Solid blue line should be the perimeter, blue hashed area is the flared walls and long toe that need to be removed.

Use padded boots any time he isn't comfortable/sound. If using boots, make sure to add a strong bevel to the treads at the toe and across the backs of the heels to compensate for the depth of the boot shifting the breakover forward.

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


K Hanneson
 

Thank you Lavinia!  I think we have made some improvements, I will post new photos ASAP.
(And yes, he's adorable! Thanks!)

A question about the boot bevel - I have been using Soft Ride boots but need to replace and was thinking about Easyboot Clouds.  Do they need additional bevel? (or Soft Rides, if I go with them again) If so, are there more specific instructions as to how to do this? 
Thanks!
--
Kathy H in ON 2021

https://ecir.groups.io/g/CaseHistory/files/Kathy%20and%20Magni

https://ecir.groups.io/g/CaseHistory/album?id=266135


Lavinia Fiscaletti
 

Hi Kathy,

All boots need to have the bevels added, or the ones they come with extended. Check these links for some pix and info:

https://ecir.groups.io/g/main/album?id=45323

https://www.hoofrehab.com/GloveMod.html

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