New Case History - looking for advice


Patty
 

I've submitted a case history, photos, hay analysis and labs for my horse INKY.  I've followed this group for some time but it has taken awhile to organize my data.  Inky had one laminitis episode in 2017.  He is not in acute distress, however, his most recent set of labs in August revealed his Cushings could be better managed, and the question arose about insulin resistance.  
Before I institute any changes, I'd like to know overall what should be addressed. I must rely heavily on the barn to carry out his feed, turnout, meds, etc., as I am an hour away and work full time.  The philosophy of management at the barn is traditional/old-fashioned in that things like soaking hay or multiple supplements - anything besides basic hay, grain, turnout and exercise - are superfluous.  Therefore, I need to 'pick my battles'.  I want to understand what Inky needs on a priority basis, and what changes are necessary, and what changes are recommended.  
Please review and request clarification where necessary.  Thank you

--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY/INKY%20CASE%20HISTORY.pdf .
https://ecir.groups.io/g/CaseHistory/album?p=Name%2C%2C%2C20%2C2%2C0%2C0&jump=1&id=268362 .
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


 

Hi Patty,
It looks to me like he is still in the early phase of PPID.  He could definitely benefit from more pergolide during the fall but appears to be well controlled during the rest of the year.  It may just be that the lack of PPID control most recently is responsible for the insulin rise.  I would suggest testing again in December to see if his levels have dropped again.  Keep in mind that TRH stim testing is only useful outside of the rise and with the horse not already on pergolide.  For any of the testing results, they should land about the mid point of the range.  The upper level of the range, while frequently considered to be normal, is actually elevated.

You state that the he is overweight so you might begin to monitor his intake better.  He appears to get lots of exercise so that may well be helping to control his insulin.  Keep him moving!  Did he perhaps get less exercise in the period before his latest testing?

I’m sure you will hear more from others but those were my first thoughts.
--
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 Patty,

Is the 11lbs of hay an actual weight or a guesstimate? Is that a total for the day or a meal?  Is it being soaked?  Alfalfa is not recommended for IR horses as so many of them are sensitive to it.  Likewise Strategy and Buckeye are not recommended for an IR horse due to their levels of ESC+starch being over our 10% recommendation.

Ideally Inky should be eating either 1.5% of his current weight or 2% of his ideal weight (whichever is greater) to encourage weight loss.  That includes all hay as well as concentrates. Exactly how much work is actually getting in a week?  You mentioned turnout.  As an IR horse Inky should be in a dry lot or turned out with a muzzle on (preferably closed if there is grass in the turnout area). 

This is a case where 'picking your battles' may include finding a situation better suited to the management of an IR horse.  Our goal here is NO laminitis and that includes managing these horses in such a way that they stay as healthy as possible.




Kirsten Rasmussen
 

Hi Patty,

I would be inclined to increase his pergolide more during the rise.  If ACTH is better controlled it's possible the elevated insulin will come down and dietary restrictions will not be as crucial.  The 2 recent elevated fall insulins could be explained by insufficient ACTH control, as could the very pronounced fat pads.  However, your Jan insulin this year was also elevated when ACTH was not (but the Jan insulin the year prior was essentially normal).  So I'm wondering if the Jan 2021 insulin was a true elevation, or if perhaps blood was pulled at the wrong time of day?   If Inky runs out of hay overnight, after he gets his morning meal he needs at least 4 hours before blood can be pulled, otherwise insulin will be artificially elevated from the first meal of the day.  Or maybe blood was pulled after his grain meal?  Or Inky wasn't being exercised regularly in January, which can also cause insulin to creep up?  I would retest in Dec/Jan again, following our testing conditions of non-fasting no grain and at least 4 hours after the first meal of the day, to see if insulin is still high when ACTH is low.

His hooves don't show any signs of laminitis in the last few months, and his insulin is not in the 'danger' zone for acute laminitis (>80 uIU/ml) but if it continues to climb any higher you will need to start making big changes to diet.  The last 3 insulins are high enough that the lamellar connections in his hooves are likely compromised already, which we would consider to be sub-clinical laminitis.  Making easy changes now, such as switching his supplements as Sherry suggested, and being more proactive with increasing pergolide prior to the seasonal rise as Martha suggested, are a good start (keep in mind that PPID is progressive and each year you might need to increase more).  And monitoring bloodwork to see if that is effecting enough change to keep insulin and ACTH low.  If that doesn't have a strong enough effect, then you'll have to escalate the hay and turnout changes Sherry advised.

Also, if Inky's exercise program gets interrupted for any reason, his insulin could increase into the 'danger' zone within a few weeks of no work.  So that is when I would caution you to be very careful with diet and/or monitoring his insulin.

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


Patty
 

Martha and Logo, thank you for your quick response - good to be heard!  Inky did have his TRH stim done in January 2018 and did not start pergolide until after those results.
He has had regular, consistent exercise since August 2019, and it was maintained before his latest testing.  I agree perhaps the insulin rise is secondary to his PPID, and I will plan on testing him again Dec/Jan.  I appreciate your help. 
--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


Patty
 

Hello Sherry, thank you for your review and suggestions. The 11 lbs of hay was a weight with me holding the 3 flakes and standing on a scale. It is primarily grass hay with some alfalfa mixed.  He gets 3 flakes in the stall from 3pm -6am the next day,  In the winter they have hay in the field.  Otherwise he is turned out and has free range, but, the grass is sparse.  I tried a greenguard muzzle but was very unsure about fitting it properly - (not sure if greenguard is considered closed or open?  greenguard-grazing-muzzle 

I agree his diet needs improving.  The buckeye NSC is listed as 13%, and I know Strategy is not recommended. I use ~ 1oz as a 'top-dressing' to encourage him to eat the buckeye, as that is the substrate for his pergolide.  Since increasing (by 0.12mg every 7 days x 4wks) to go from 1mg to 1.50 mg pergolide, he has been leaving much of the buckeye uneaten.
He is in training and is worked a minimum of 4x/week. 
 
I noted you referred to him as an IR horse, which was one of my questions.  Is he considered an IR horse at this point?  And when a horse is kept in a dry lot, he is separated from the herd - he can see them, but is penned in a small area.  Is this to be considered a long-term or a short-term measure? 

Inky has been at this barn for more than 10 years.  The barn owners kept him after he was abandoned by his previous owners and I bought him 9 yrs ago. The laminitis episode occurred after he competed in an eventing show but was not properly prepared prior to it.  At the show he mistakenly got fed twice his usual grain, and got alot of apples, carrots and nature valley trail bars. Obviously his lab data shows he has PPID which I know progresses with age. 

Is it your impression that his current situation is dire?  I'd like to try to improve his management where he is if at all possible.  I believe your recommendations include increasing the amount of hay (not alfalfa) that he is fed, discontinuing the ration balancer he is currently using, and keeping him in a dry lot or use closed muzzle. 

Again, thank you 



--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


Patty
 

Hi Kirsten,
Thank you for giving me guidance about how to interpret what's happening with Ink and what to do if and when certain scenarios progress.  You know, I'm not sure about the details of his blood draw from Jan. 2021, though I was careful about it for the recent August blood draw.  I did change vets between those two times, and the lab in Jan was not Cornell.  I will retest in Dec./Jan. 
The 1.5 mg pergolide he is currently on is an increase from 1 mg instituted after the Aug. blood tests, which I titrated up by 0.12 weekly for 4 weeks.  He has been leaving a lot of his Buckeye unfinished since the increase.  
I appreciate your advice to keep a close eye on his exercise and to institute the changes Sherry suggested without delay if necessary, or even if not necessary. 



--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362d 
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


Sherry Morse
 

Hi Patty,

The grass may be sparse but given the extra weight that Inky is carrying in spite of being exercised he's obviously needs a tightening up of his diet.  The Greenguard is not a closed muzzle.  When we refer to a closed muzzle we mean one that allows no intake of grass while a horse turned out.  I would not increase his hay intake without making sure there is a corresponding decrease in unknown grass intake.

We look at ESC+starch not NSC whenever possible. For the Gro n Win that number is: 5.89% starch, 9.1% sugar (per their nutritionist in 2008 and there's no reason to think it's improved since then.)  Strategy is 28% NSC and as per the manufacturer 10% Starch and 6.5% Sugar (although they say that's the maximum amount of both).

As a rule we do not recommend putting Prascend in grain and hoping it will be eaten as this often results in it not being eaten (as you're now seeing with Inky). It does take a bit more effort but putting it in a syringe and dosing it or feeding it in a high value treat is much more effective in making sure that it actually gets into the horse.  Doing that would also eliminate the need to feed him grains that are not suitable.  If you need to use a grain carrier we recommend Stabul-1 which is available though Chewy.com and is guaranteed to be below 10% ESC+Starch.

Given his elevated insulin numbers, fat pads and inability to lose weight while in regular work I would treat him as IR at this point and that does mean no grass turnout unless he's muzzled.  You can try a Best Friends or Tough 1 muzzle and see if he loses weight with that bit of restriction but if he does not or his insulin remains elevated that's a good indication he needs to be out with a closed muzzle (which means limited turnout as he won't be able to eat with it on) or being in a dry lot.  This isn't punishment but a lifestyle change to keep him healthy and happy.




Patty
 

When you put Prascend in a syringe do you dilute it? Or if you use a high value treat, what would that be?  What does a recommended dry lot look like, or is there something I can read about this?  I'd like to know about size, how long he'd be in it, footing, feed and socialization.  Not sure if what we have at the barn is appropriate.  He was in it for some months after laminitis, but it was temporary.  Thank you Sherry.
--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


Maxine McArthur
 

On Mon, Oct 11, 2021 at 02:23 PM, Patty wrote:
When you put Prascend in a syringe do you dilute it?
Hi Patty
I take a 10cc syringe, remove the plunger, place the Prascend tablet (or part thereof) into the syringe, replace the plunger, suck up about 5cc of plain water, and shake vigorously. It dissolves in seconds. Also shake a couple of times before inserting syringe in corner of horse's mouth and squirting. I give a small treat after, so they look forward to the treat and don't object to the syringe. The amount is so small that it's more or less impossible to spit out. 
The downside to this method is that the Prascend should be dissolved shortly before giving it to the horse. I dissolve it at home before going to the barn, so they get it within an hour. However, the upside is that it's quick to prepare, easy to administer, and you can be sure they are getting the full dose. 

A high-value treat is something the horse finds very palatable. The trouble with our IR horses, of course, is that most palatable items are high in sugar, starch or fat! If you must use something like carrot, use the smallest amount possible. The problem with concealing medication in treats is that often horses will eat a certain treat for a while then "go off" it. And you're back to square one. 

HTH


 
--
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

 


Kirsten Rasmussen
 

Hi Patty,
I noted you referred to him as an IR horse, which was one of my questions.  Is he considered an IR horse at this point?
Yes, he is IR.  IR can be induced by PPID, or it can be present at baseline (before the PPID) as Equine Metabolic Syndrome.  If you get the PPID under control with medication and keep it controlled, the IR could go away.  However, if he is IR at baseline then even with the PPID controlled, he will need dietary/management changes to keep the IR minimized as it is an inherent genetic trait that never goes away (and appears to worsen with aging).  His previous bloodwork is a bit contradictory, but if keeping weight off him is a problem then he is more likely to be IR at baseline, too, since these horses usually have no "stop" signals when it comes to eating.

A dry lot is whatever you make it.  Ideally large enough for exercise and more than 1 horse, with optional shelter from the elements.  You can feed hay in it but there should be no grass or weeds.  If there are any other horses at your barn that show signs of IR, maybe collaboration with their owners might lead to turnout companions for Inky and some help from management to build a better dry lot.

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


Patty
 

Very helpful, thank you


--
Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY
https://ecir.groups.io/g/CaseHistory/album?id=268362
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019


Frances C
 

I will be boarding an PPID horse this winter, He is not IR. The owner had been using a 60 cc syringe to administer Prascend. Is the 10 cc syringe easier to use? What other sizes would be appropriate? His diet will be appropriate for an IR horse while he is my care but he is thin so just boost him up with beet pulp?
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Sherry Morse
 

I use a 3cc syringe for 1.5 tabs of Prascend.