New-ish Member questions


Mialisa@...
 

Hi all,
I have uploaded my Case Histories for my Shetland ponies. But lacked the knowledge on how to send an email. :)needed help from the tech savvy younger generation.  I have learned so much just from receiving emails and reading responses. My two ponies were tested late 2020 IR pos. and tested for Cushings early 2021 neg. Our journey has led us here late in life, but there is still hope. Diet in place (Oct 2020) and will retest Insulin again this spring (ACTH?) I am wondering about the 'Metformin' I recently read about for lowering the insulin levels? My vet will be here on 4-1-22.
I hope to get trim advice from this group as well. TMO since 2019 following Pete Ramey's articles.
--
Rene` in WI 2021
CaseHistory@ECIR.groups.io | Files
CaseHistory@ECIR.groups.io | Files


Sherry Morse
 

Hi Rene,

You'll be getting a full welcome soon but it looks like Isaac tested positive for PPID last year and yet he's not on Prascend, is that correct?  While they're both IR and had high insulin results you haven't retested them since changing their diet, correct?  If that's the case you wouldn't be looking at using Metformin to control insulin until you knew for sure it could not be controlled through a tightening up of their diet alone.

Are they both still about 400lbs?  If so, and that's their ideal weight they shouldn't be eating more than 8lbs a day of hay plus any concentrates.  We do not recommend alfalfa for any IR equine because it will make many horses foot sore so if you're still feeding an alfalfa mixed hay you probably want to look at something that's only grass this year.  

Are they still eating Oats, the Buckeye feed and/or the Timothy pellets? All of those could cause a problem as well which again, is why we don't recommend them; particularly for ponies which are bred to be thrifty.




On Sunday, March 13, 2022, 02:17:41 PM EDT, Mialisa@... <mialisa@...> wrote:


Hi all,
I have uploaded my Case Histories for my Shetland ponies. But lacked the knowledge on how to send an email. :)needed help from the tech savvy younger generation.  I have learned so much just from receiving emails and reading responses. My two ponies were tested late 2020 IR pos. and tested for Cushings early 2021 neg. Our journey has led us here late in life, but there is still hope. Diet in place (Oct 2020) and will retest Insulin again this spring (ACTH?) I am wondering about the 'Metformin' I recently read about for lowering the insulin levels? My vet will be here on 4-1-22.
I hope to get trim advice from this group as well. TMO since 2019 following Pete Ramey's articles.
--
Rene` in WI 2021
CaseHistory@ECIR.groups.io | Files
CaseHistory@ECIR.groups.io | Files


Cindy Q
 

Hello Rene

Welcome to the group! 

Sherry has given you some good comments on the diet. Try to source for pure grass hay. If you have stopped feeding something which is listed in your case history, you can add a second row below it and state the item with the word STOPPED and the date/estimated date. You would do better with Timothy Balanced Cubes or a small amount of rinse soaked rinsed beet pulp (without any molasses) as a carrier.

MSM can affect mineral uptake like Copper and Selenium and can cause problems for IR equines.

You can read about the medication for PPID below under our Treatment header of the welcome letter. This is under the Diagnosis section (Diagnosis, Diet, Trim + Exercise only when stable/comfortable). We recommend keeping ACTH in the middle to low end of the normal range.

Under the Trim section of our letter, you will find instructions how to make a photo album and how to take good hoof photos to get trim advice.

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





Mialisa@...
 

Thank you Sherry for your response. You are correct, Isaac is not on Prascend as the vet said NOT Cushings because even tho' the numbers were over the reference interval they were not high enough for concern. She did recommend retesting every year. I did this in the Fall of 2021 during the seasonal rise. Correct timing? Also, I have not yet retested the insulin, our first test was Fall of 2020. Should I retest the ACTH at the same time I test Insulin this spring?

Both ponies are still ~400 lbs, but I think they are looking better overall. My Hay was tested and then balance by Kathleen Gustafson, so following her recommendations to feed both ponies 8 lbs of hay per day. I do give them slightly over by 0.5 lbs on occasion. The ponies have wintered well on this hay even tho' there was alfalfa. It was a first seeding so there was not much alfalfa. I am trying to find the best grass hay that they can eat. Finding this hay for the winter was a challenge because the 1st cutting I bought they did not do so well and even with soaking, they did not do well. We will try harder to find grass only this year.

Oat, Buckeye and other feeds are in the past and I will update the Case Histories. I went and reread the case history instructions and did not see that I should enter an end date previously.
--
Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Mialisa@...
 

Thank you Cindy. I have read most of this information in the last year, but I need to keep re-reading as there is just so much information. I will be updating the ponies Case Histories. I appreciate the guidance. It is so needed and helpful.
--
Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Sherry Morse
 

Hi Rene,

Good that Kathleen is balancing your hay.  Yes, you should retest ACTH this spring along with the insulin as that will provide a more accurate reading than doing the test in the fall. If he does need Prascend you want to start before the rise, not try to catch up during it.  Please note that you have the date for your ACTH testing as April 6th of last year, not in the fall - is that date not correct?




Mialisa@...
 

hmmm...I will double check on that date. I will be updating the case histories and will check on that too. Thanks! 
--
Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Mialisa@...
 

Hi Sherry
I did double check on the date, my case history is correct.
I have updated my Case Histories for both ponies. If you notice anything else missing let me know.
Thanks for your help!
--
Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Isaac
https://ecir.groups.io/g/CaseHistory/files/Rene%60%20and%20Joshua


Sherry Morse
 

Hi Rene,

You definitely want to check both this Spring then.  If he's still elevated you would then need to decide if you want to treat now or start treating him prior to the rise as you do not want to have a laminitic episode that could have been prevented.  He may only need medicating during the rise for now but how long that would continue is variable for each horse.