Just Diagnosed


jjlittle@...
 

Hello,

I am new here.  My Kentucky Mountain  mare was just diagnosed with PPID based on labs sent to Cornell after coming down with laminitis on Labor Day.  Kind of freaking out.  Didn't see this coming.  Took a lesson on her 2 days before symptoms became noticeable and she was great.  She is on stall rest.  Today is last day of Bute and we are starting Prescend.  Will try to get history uploaded today.
--
Marcy K. Austin TX 2021


Maxine McArthur
 

Hi Marcy
Welcome to the group! Don't freak out, you have come to the right place for information and support. Once we see the details of your mare's history, we will be able to suggest more for her individual situation, but in the meantime, the message below is our very long and detailed welcome message for all new members. Please take the time to read it carefully and follow up the highlighted links, as it will probably answer the majority of your questions. Many of us print out the message for easy reference later. If you have questions arising from the welcome message, please post them here. It would be useful if you could take hoof photos and upload them, ditto any xrays. Details on how to do that are in the Wiki here: main@ECIR.groups.io | Wiki

If you have any difficulty uploading the case history or navigating the group, the Wiki is your friend. Click on the last button in the menu (on the left of the screen on a computer), and there's a list of useful topics. 

Regarding your first post, it's good that you have weaned her off the bute. Do you have a small yard with no grass that you can let her wander around at will? Forced movement is not recommended for recovering laminitics but gentle movement within their tolerance is good. 
With the Prascend, make sure that you titrate the dose up to the recommended level (please add what the vet prescribed plus her blood test results in the case history) rather than starting on the full dose. This helps to avoid the transient inappetance that some horses experience. There is information on how to do this in the welcome message below. 

Looking forward to reading more details in your case history. When you get it uploaded, please either post a new message a topic like "new member needing case history review" or add to this thread. 

Hello 

Welcome to the group! 

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.

--
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

 


jjlittle@...
 

I just uploaded the case history. I think I did it right. There is a small dirt run off her stall that she has free access to.  Will try to remember to measure it when I go out there tomorrow. She was previously(prior to laminitis) living  in a  large paddock with 2 other horses and a round bale with about 6 hours daily in a grassy pasture. So she had 24 hour access to forage.  She loved it but it will never work for her again.
--
Marcy and Mocha 2021
https://ecir.groups.io/g/CaseHistory/files/Marcy%20and%20Mocha


Maxine McArthur
 

Thank you, Marcy, case history uploaded! A great start :).

One small housekeeping point--could you please go to your 'Subscription' box, where you quite correctly entered the URL of the case history, and add a space (or hit 'enter') at the end of the case history link. Then scroll down the page and click 'Save'. This will make the link 'live' so that we can click on it and go directly to the case history. 

I had a couple of comments about the information you've uploaded, and no doubt others will have input as well. 

Firstly, you give Mocha's ideal weight as 900lb, which sounds about right for 14.3hh. However, her current BCS is estimated at 7-8 and her current weight at 1064lb. So there is definitely room for some diet improvement. As your welcome message says, we recommend feeding 2% of ideal bodyweight or 1.5% of current weight if a horse needs to lose a bit of weight--whichever of these values is higher. So for Mocha, 2% of 900lb is 18lbs, which is what she is eating now. Do you actually weigh her hay? You may need to soak it in order to reduce calories while still giving her enough fibre. It doesn't look like you have a hay analysis, so until you can get one, it would be safer to soak it anyway (one hour in cold water, fully submerged, or half hour in hot water--there are a couple of documents in the Files about soaking), as it's impossible to know if a hay is safe in terms of sugar and starch without testing. Also, once you test you can start supplementing her with the minerals that are missing in your hay. 

What is in the one cup of Standlee? Is there an analysis for this feed? You would be safer with beet pulp (rinsed, soaked, rinsed) or soyhull pellets as a carrier. We also add Vitamin E to make up for the loss in hay. Many people use human Vit E capsules, just make sure they are in oil, not glycerin. 

Soaking her hay should help to reduce her high insulin also. Some of that high insulin may be driven by the high ACTH, but Rockies are often IR at baseline so I think you are right in assuming free choice forage is not for her. I'd retest both ACTH and insulin/glucose in 3-4 weeks after she has been on the 1 prascend. This will give you an idea of whether her PPID is coming under control and what effect this is having on the insulin levels. 

If you could upload body/hoof photos to an album, that will give us an idea of her BCS and our hoof gurus can comment on her trim if you would like. 

--
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

 


Sherry Morse
 

Hi Marcy,

Looking at your CH Mocha is IR as well as PPID (although the elevated ACTH may be driving the insulin up to some extent).  That means tight diet control is going to be key as she's quite overweight. Given that you have her current weight listed as 1064 and her ideal as 900 we recommend that you feed 1.5% of current weight or 2% of ideal weight whichever is greater.  The 18lbs you list is the ideal for her but is that hay being soaked? If not, I would start soaking it until you are able to get it tested.  Is that an actual weight or just an estimate? If it's an estimate you'll need to get a scale so you can actually weigh the hay before feeding.




jjlittle@...
 

Hello Sherry,

We have been weighing and soaking the hay since the day she was x-rayed and labs drawn.  The weight is from measuring with a tape measure, not a scale.  The ideal  weight is just a guesstimate.  My vet said 1.7% current weight or 2% of ideal..  Th  e vet will be back to see her on Thurs and will recheck the x-rays.She mentioned Metaboral but people on here don't seem to like it so I haven't ordered it.  Is it possible we will be able to stop soaking the hay after testing?
--
Marcy and Mocha 2021
https://ecir.groups.io/g/CaseHistory/files/Marcy%20and%20Mocha


Lavinia Fiscaletti
 

Hi Marcy,

We don't recommend Metabarol because there is no evidence it works and at around $160 per month, it's a pretty pricey experiment. Here is a link to some more info on Resveratrol, the main ingredient:

https://ecir.groups.io/g/main/files/8%20Commercial%20Items%20Targeting%20IR%20and%20PPID/Resveratrol.pdf

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


jjlittle@...
 

I uploaded x-rays from diagnosis of laminitis  9-9 and a side view of Mocha taken in August when we were working with a saddle fitter. (if I didn't do it right let me know)  She has now been on the diet for 11 days and has lost some weight.  I didn't think she was obese but vet felt she needed to lose 100lbs.

Thanks for the advice.
--
Marcy and Mocha 2021

https://ecir.groups.io/g/CaseHistory/files/Marcy%20and%20Mocha

https://ecir.groups.io/g/CaseHistory/album?id=268259


Sherry Morse
 

Hi Marcy,

As we typically see her toes are too long and she doesn't have a whole lot of sole although it's better than many.  Based on your weight calculations vs. ideal weight she did have quite a bit of weight to lose so if she's losing on the measured amount of hay keep that up.  Depending on your hay results you may be ok with not soaking, but some of that depends on the horse as well.