The best diet for horse with Cushing AND Lyme...


skyfirefarm@...
 

My horse coliced at a show on June 7th. He spent 24 hours at the emergency hospital. After he returned home he seemed better but then about 2 weeks later started acting strange again.  I am working with an equine nutritionist and we had gotten him switched over to an all forage diet with added supplements.  He gets free choice hay and was on alfalfa pellets, chia seeds, salt, dynamite supplement. Then he still just wasn't right so vet pulled blood and turns out he has Lyme and Cushings. So now at that point we've added Doxy, probiotics, and prascend. Getting this super picky horse to eat has been a struggle at the least! In the meantime he's all of a sudden (within the last 4 weeks) super lame in the rear end. Have had farrier twice and he reports there's nothing going on in the hooves. Still this horse stands camped under his belly and waddles at the trot. Since getting meds into him is such a challenge, he's now getting 2 cups Triple Crown senior, a handful of alfalfa pellets,  chia, salt, magnesium, dynamite supplement, Equine Omega Complete oil,  doxy, probiotics, Equioxx a.m., Prascend p.m. At this point its the only thing he'll eat and he was lame 3 weeks prior to starting the Triple Crown so I don't think thats adding to his rear end pain. I read that alfalfa can sometimes not work for all horses.  Once he's done with the doxy, I'd like to get him back to the best diet to manage his cushings. What is the preferred diet as far as feed besides the free choice hay? This horse also has lost weight, muscle, and is lethargic, and has very very poor stamina now which is a new thing. I feel like I'm not seeing improvement like I'd like to see by now (2 weeks on doxy and Prascend)  and I want to also do whats right for diet once we get past this course of doxy (the thing that is really hard to get into him). Thank you for any advice you can provide.
--
Lisa H in NH, 2021


 
Edited

Hi Lisa,

Welcome to the group! 

I’m sending along our formal group welcome which comes with your first post.  While your situation is a bit complicated, I’m sure you will find reading though it quite useful.  There are plenty of links included to even more valuable information.

Posting your case history with dates for each of the instances you describe would be very helpful.  What sort of testing was done when your vet pulled blood?  Was insulin and glucose tested along with the ACTH?   What were the actual results?  How old  is the horse and what is his breed?  What was the report that came from the colic hospitalization?

How long will he be given Doxy?  When I treated for Lyme, I pulverized the Doxy and syringed it in as a paste.  After a period of time, the horse seemed perfectly willing to eat it from his dish.

The ideal diet includes tested low sugar and starch hay (weighed to suit the horse’s needs), a mineral mix to balance the hay you feed, salt (other than a block), ground flax and vitamin E.  Flax is recommended because its omega 3 to 6 fatty acid ratio most closely resembles that of grass.  This would replace the chia seeds he gets now.  While this diet was designed especially to meet the needs of insulin resistant horses, it works well for any horse.  There are a few things he is being fed that are not on this list.

How long has he been on Equioxx or other NSAIDs?  We don’t recommend giving NSAIDs because they don’t help with laminitic pain and they can cause other problems.  The suggestion would be to slowly wean him off of any NSAIDs.  If he’s been on them awhile I might wonder if ulcers are a part of his problem.  Ulcers can cause a discriminatory outlook toward food.  Hay is great but nothing else is of interest.

It’s also possible that he hasn’t been on Prascend long enough to effect a change or that his dose is not high enough.  Insufficiently controlled PPID can also result in a fussy appetite.  Most of his complaints could be related to PPID but Lyme can cause similar issues.  His ACTH needs to be tested again at least three weeks after starting Prascend but the further we get into the fall rise, which naturally elevates ACTH, the more difficult it becomes to sort out the blood results.

How about Xrays?  Have any been taken in conjunction with his hind end lameness or do you feel the issue is not related to his feet?

You probably did not expect to receive a barrage of questions in response to yours but there’s a lot more we need to know to give you the best help we can.

The formal welcome follows.  I feel certain it will give you some aha moments.  Please fill out your case history as soon as possible.

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. 

--
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


 
 


Sherry Morse
 

Hi Lisa,

I just wanted to add to Martha's information on Doxy that it will cause anybody (horse or human) to feel crappy.  I always give Ulcerguard when I have horses on it to try to minimize the stomach upset.  NSAIDs (like Equioxx) can also cause stomach upset and many horses develop what we call the Prascend veil when first started on it so there are three reasons right there why your horse may be feeling unwell (beyond the issues with Lyme and PPID) and not wanting to eat.

Starting him on APF (which is mentioned in the Welcome letter) may help with the Prascend and the Doxy to some extent, but I would look at getting him on an appropriate diet sooner rather than later as that will help with the PPID (and IR if that's also a consideration). 




skyfirefarm@...
 

Hi Sherry,

Thank you! I have been treating with Ulcergard since the end of june and he was on an all forage diet up until just recently when I had to mix in some Triple Crown senior just to get meds into him. He's a challenge this one!!! I just started Magnesium pellets and now he won't eat his feed if those are in it! I'm exhausted trying to help him! He is on equioxx but I can take him off it and see if that helps at all.

Thank you so much for your info and ideas. Its just so odd that before he coliced he was living very healthy with absolutely no issues while being on a commercial grain etc but its just been since he coliced that he's having issues.
--
Lisa H in NH, 2021


Sherry Morse
 

Hi Lisa,

Frankly I can't waste medication trying to get a horse to eat it so I syringe it in using a 50cc dose syringe. My preferred version is this one:https://www.valleyvet.com/ct_detail.html?pgguid=FEB5ADC1-1209-4CF1-B16B-55721B659E12.  Without knowing why he's on Equioxx or how long he's been on it be aware that there are NSAID rebound effects from stopping them without tapering off.  Therefore we recommend tapering off slowly as outlined here: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/How%20to%20Taper%20Off%20NSAIDs.pdf.  If you need to keep him on a pain killer for some reason we recommend something like PhytoQuench.  This documents outlines how to switch from NSAIDs to PQ: https://ecir.groups.io/g/main/files/Pain%20Medication%20and%20Alternatives/Pain%20control,%20switching%20from%20Bute%20to%20Phyto-Quench.pdf.

Without a case history it's difficult to comment on before/after a colic episode. 




Lorna Cane
 

Hi Lisa,

He might prefer the magnesium pellets in powdered form?
Try putting them through a coffee grinder.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Kirsten Rasmussen
 

but its just been since he coliced that he's having issues.
Since he colicked, we've also moved into the seasonal rise when Cushings can start to cause issues in apparently normal horses, plus the Lyme infection could have occurred at any time but may now be rearing it's ugly head due to a generally suppressed immune system from the PPID and/or the colic event.  With PPID, a lot of seemingly unrelated things can happen at once because of its effect on suppressing the immune system.

A commercial grain diet is not necessarily bad for a horse in work (unless that is ALL he was getting, but I'm sure the bulk of his diet before was also forage and that you are talking about eliminating a few lbs of grains).  If the forage alone can't give them the calories they need, then sometimes a boost in the form of grains is justified.  It depends on the horse and their workload.

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


Kirsten Rasmussen
 

To follow up on my previous post...


https://drkhorsesense.wordpress.com/2016/07/12/do-any-horses-benefit-from-grain/

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


skyfirefarm@...
 

Thank you! That makes sense! No, he doesn't even get a couple of pounds of feed. He gets 2 measuring cups of Triple Crown Senior and 1/2 cup Alfalfa Pellets with oil and water in it. Just to get his meds and supplements into him.  I'm thinking I should switch to Teff pellets though instead of the Alfalfa pellets?
--
Lisa H in NH, 2021


Sherry Morse
 

Hi Lisa,

As noted in your welcome note alfalfa is a no go for many IR/PPID horses because it will make them footsore, in spite of the low ESC+starch numbers.  Triple Crown Senior is also over our recommended ESC+starch cutoff of 10%. If you need a carrier for supplements and meds it's much safer to use Triple Crown Timothy Balance Cubes or Stabul-1 as a carrier.